Journal of Global Health最新文献

Background: Preserved ratio impaired spirometry (PRISm) is closely related to chronic obstructive pulmonary disease (COPD). However, there is a lack of relevant research on the treatment of patients with PRISm. Therefore, this study aimed to investigate the risk factors of future exacerbations and treatment responses among different inhalation therapies of patients with PRISm.

Methods: This is a retrospective cohort study. Patients with PRISm were registered in the real-world study on the status of diagnosis and treatment of COPD (RealDTC) study between January 2017 and August 2024. Data on demographics, pulmonary function, symptom scores, number of exacerbations and hospitalisations in the past year, inhalation therapy regimens including long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS, and comorbidities were collected. The number of exacerbations, frequent exacerbations, hospitalisations, and all-cause of mortality were collected during one year of follow-up.

Results: A total of 575 patients were included for the final analysis. During one year of follow-up, 144 (25.0%) patients experienced exacerbations. The patients experienced exacerbations had higher age, symptom score, number of exacerbations and hospitalisations in the past year, as well as higher proportion of biofuel exposure and without inhalation therapy. Logistic regression analysis showed that age, number of hospitalisations in the past year, and without inhalation therapy were the independent risk factors for patients experienced exacerbations. Furthermore, after propensity score matching, the patients without inhalation therapy had higher number of exacerbations, frequent exacerbations, and hospitalisations during one year of follow-up. However, there were no significant differences in future exacerbations, frequent exacerbations, hospitalisations, and all-cause of mortality among LAMA, LABA + LAMA, LABA + ICS, and LABA + LAMA + ICS.

Conclusions: Patients with PRISm had high risk of future exacerbations. Inhalation therapy could reduce the risk of future exacerbations and clinicians should recommend mono-LAMA to patients with this condition.

Background: Overweight and obesity are well-established risk factors for numerous chronic diseases, but few studies have focused on obesity-related eating behaviours (OEB). Studies suggest that living near green spaces is associated with higher physical activity levels, highlighting the need to examine how these environments specifically influence behaviours related to obesity. Therefore, we aimed to investigate the impact of urban green spaces on OEB among university students across 31 Chinese cities.

Methods: A total of 11 659 students across 31 cities participated in the study. Each respondent completed a standardised questionnaire focused on health behaviour and health in China. We obtained the data on regional characteristics from the National Bureau of Statistics. We used multilevel logistic regression models to examine the associations between urban green space and OEB. Furthermore, we conducted a quantitative analysis to demonstrate the dose-response relationship between the city-level green space and the prevalence of OEB.

Results: Approximately 5.4% of students experienced OEB. According to a multilevel logistic regression analysis, greater availability of green land was significantly associated with a lower likelihood of OEB (odds ratio = 0.44; 95% confidence interval = 0.24, 0.67). There was also a significant inverse dose-response relationship between city-level green land area and the probability of OEB (β = -0.2784; P < 0.01).

Conclusions: These results reinforce existing literature demonstrating the beneficial role of green spaces in reducing stress and improving mental well-being. Future research should examine variations in student engagement with green spaces in urban environments and explore how natural environment elements can be incorporated into public health strategies across Chinese universities.

Background: Folate has been examined extensively in relation to carcinogenesis due to its role in one-carbon metabolism impacting the synthesis of DNA and RNA, methylation processes, and genomic integrity. Current evidence on the relationship between folate status and the risk of cancer is equivocal: low or deficient folate status may contribute to an increased risk of cancers, while high-dose folic acid supplementation may have adverse effects on carcinogenesis.

Methods: We searched MEDLINE, Embase, CINAHL, the Cochrane Library, and the Database of Abstracts of Reviews of Effects up to February 2024 for systematic reviews and meta-analyses investigating the associations of folate (measured as dietary intake, supplementation, or blood concentrations) with any specific cancer outcome. Screening, data extraction, and risk of bias assessment were performed in duplicate. We assessed the credibility of the evidence using predefined criteria.

Results: We found 67 syntheses, of which 57 provided meta-analyses. Over half of the syntheses had a high risk of bias. We identified 168 unique associations (unique exposure - unique outcome - unique setting) across 10 cancer types, 3 system cancers, and total cancer. Of these, we assessed 15 directional associations (colorectal, oesophageal, and total cancers) to be at a highly suggestive level of credibility, and 17 directional and 10 null associations to be at a suggestive level of credibility.

Conclusions: The available evidence for each category of unique association was generally limited. Highly suggestive associations were found for oesophageal, colorectal, childhood brain and spinal tumours and total cancers. More robust primary studies are warranted to follow-up the signal of a positive relationship reported for prostate cancer warranting further research. Evidence was weak for all but colorectal and oesophageal cancers, or the central nervous system cancers in children.

Registration: PROSPERO: CRD42021265041.

Background: The Government of South Africa has prioritised disease prevention and improved healthcare delivery, but the country remains challenged by disease burdens and inequity of resources across the country, including the availability of clinician-specialists to meet public sector and other needs.

Methods: To address the need for more physician specialists in the country, Discovery Health of South Africa collaborated with Mass General Hospital in the USA to create a clinical and research fellowship for South African clinician-scientists. We engaged fellows in semi-structured interviews to chronicle their experience in the programme and its impact and challenges.

Results: Six fellows were awarded the one-year fellowship between 2014 and 2022. Their specialties were in endocrinology, rheumatology, gastroenterology, anaesthesia, and obstetrics and gynecology. All fellows divided their time between research and clinical observership, with programmes individualised for the fellows and mentors in terms of time dedicated to each. The strengths of the programme included formal educational benefits; advanced research techniques, scholarship, and educational opportunities; clinical exposure; strong mentorship; expanded networks; immersive experiences; and accelerated career paths. Weaknesses comprised a relatively short period of study; challenges to reintegration in South Africa; tight budgets to live in the USA; inability to conduct clinical or hands-on practice in the USA; and desire for formal recognition of their time of study in the programme. The fellows all noted the impact of the programme on their own careers- including increased professional opportunities and expanded networks, as well as deepened commitment to and impact in strengthening the capacity of and breadth of service in South Africa's health system.

Conclusions: Despite challenges to the programme, the fellowship showed the impact of and need for more similar scientific and clinical academic training programmes to build capacity in low- and middle-income countries. With persistent global shortages of health workers, creative solutions that build expertise should be further scaled.

Background: Myopia is one of the most prevalent eye diseases worldwide, and its incidence is increasing. However, effective pharmaceutical treatments remain limited. We aimed to identify blood proteins causally associated with myopia as potential drug targets.

Methods: We performed a genome-wide association study (GWAS) meta-analysis involving 43 862 myopia cases and 84 820 controls. Then, we conducted a Mendelian randomisation (MR) analysis of blood proteins by utilising the deCODE and UK Biobank Pharma Proteomics Project datasets, and validated the correlations between these characteristics through a cross-sectional study of 50 586 individuals, including 3108 with myopia. Subsequently, through protein-protein interaction (PPI) analyses, we explored potential connections between proteins and existing myopia treatments.

Results: The GWAS meta-analysis found 26 genetic risk loci for myopia, including nine novel loci. The cross-sectional study showed correlations between height, smoking, and myopia. Proteome-wide MR analysis identified 164 plasma proteins potentially causally linked to myopia, with 20 proteins validated in both datasets. Genetic colocalisation analysis, PPI, and drug target analyses identified promising therapeutic targets for myopia.

Conclusions: We identified genetic loci associated with myopia and proteins with potential causal roles in its development. These results indicate new genetic architectures underlying myopia, offering potential treatment targets and a foundation for personalised therapeutic strategies.

Capacity-building programmes for health professionals in low- and middle-income countries often transfer technical knowledge without sufficient attention to community ownership. This suggests knowledge translation alone is insufficient; it must be integrated with critical evaluation to systematically support community participation. Here, we proposes an integrated framework to align knowledge translation with community ownership and balanced power. The framework reframes capacity building programmes as the governance of knowledge, power, and ownership, and provides actionable guidance for more sustainable and locally led systems.

Background: Gender disparities in early childcare practices impede gender equality and create long-lasting barriers to girls' health, well-being, and future opportunities. Through this systematic review and meta-analysis, we aimed to quantitatively synthesise evidence on gender disparities in low- and middle-income countries (LMICs) across the World Health Organization's five components of nurturing care: breastfeeding, immunisation, prenatal check-ups, postnatal check-ups, and healthcare expenditure for children under five.

Methods: We searched sixteen scientific databases, journals, and repositories in November 2021 and again in January-February 2024, for studies examining gender differences in early childcare practices in LMICs, covering breastfeeding, immunisation, prenatal, and postnatal check-ups, and healthcare expenditure for children under five. We set no restrictions on publication type or date, but with limitations to English-language studies with sample sizes over 30. We standardised effect estimates from individual studies into Hedges' g effect sizes and meta-analysed them using robust variance estimation. We assessed the quality of the included studies using the Joanna Briggs Institute quality appraisal tool.

Results: We identified 78 eligible studies covering 55 LMICs, with 52 studies and 231 effect sizes included in the meta-analysis. The pooled analysis showed gender discrimination against girls across outcomes (52 studies; Hedges' g = -0.082; 95% confidence interval (CI) = -0.133, 0.030), particularly pronounced in breastfeeding (17 studies; Hedges' g = -0.051; 95% CI = -0.089, -0.012) and immunisation (32 studies; Hedges' g = -0.073; 95% CI = -0.13, -0.016). While we also observed significant differences in favour of boys in pre- and post-natal check-ups (four studies; Hedges' g = -0.029; 95% CI = -0.058, -0.000), the results were less robust due to a limited number of studies. We found no gender differences in healthcare spending patterns (seven studies; Hedges' g = -0.278; 95% CI = -0.641, 0.083). Our meta-regression highlighted significant associations between a country's ranking on the Gender Inequality Index and effect sizes, indicating stronger health-related penalties for girls. Effect sizes did not significantly vary by regions and the quality of included studies.

Conclusion: s Our findings emphasise significant gender disparities in early childcare practices and point to the need for more evidence on inequalities in healthcare access and expenditures. We simultaneously observed signs of a narrowing gender gap in recent years, suggesting gradual progress toward more equitable child health outcomes.

Registration: PROSPERO: CRD42021286151.

Palliative care significantly improves the quality of life for individuals with advanced chronic diseases. However, access in Malaysia remains limited, particularly for patients with non-malignant conditions such as chronic obstructive pulmonary disease (COPD). Here, we discuss the barriers and solutions identified through a nine hour in-person stakeholder workshop to co-develop practical initiatives for integrating palliative care into the management of severe COPD. Key challenges in the assessment of severe COPD included limited training in holistic care, resource constraints, and fragmented care pathways. In management, issues included low awareness and availability of pulmonary rehabilitation, uncertainty in initiating palliative care and difficulty accessing opioids, limited provider training, and patient-level barriers such as stigma and low health literacy. Proposed solutions included cascade training, decentralised care models, strengthened communication skills, and integrated care pathways. This workshop highlighted the need for multidisciplinary training, system-level integration, and culturally responsive care models to improve palliative access for patients with severe COPD. It also underscored the importance of policy engagement to address structural barriers such as opioid regulation and fragmented care. This approach offers a promising model for capacity building in other resource-limited settings.

Background: Tuberculosis (TB) remains a major global health threat, particularly in resource-constrained settings where delayed diagnosis of smear-negative pulmonary TB (SNPTB) is common due to limited access to rapid molecular diagnostics. We aimed to develop a clinical algorithm-based scoring system to aid the diagnosis of SNPTB among symptomatic patients in Sabah, Malaysia.

Methods: We conducted a modified Delphi process between January and June 2024 involving three rounds of expert consultation via email to identify key clinical parameters for diagnosing SNPTB, followed by a consensus meeting to finalise the parameters and assign weightings. We then applied the algorithm to a data set of 60 symptomatic smear-negative individuals, of whom 29 were confirmed to be TB and 31 not TB based on culture. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the algorithm to obtain a cut-off score for 'likely TB' vs. 'unlikely TB'.

Results: Of 27 invited experts, 23 (85.2%) consented to participate in the Delphi process and contributed to the final consensus. Fifty-four parameters were identified in round 1, reduced to 26 in round 2 and 23 in round 3. Following the consensus meeting, we incorporated 21 weighted parameters (scores 1-10) into the final algorithm. The clinical algorithm achieved an area under the receiver operating characteristic curve of 0.88. A cut-off score of 19.5 differentiated 'likely TB' from 'unlikely TB', yielding a sensitivity of 86.2%, specificity of 77.4%, PPV of 78.1%, and NPV of 85.7%.

Conclusions: This diagnostic clinical algorithm could help doctors practicing in resource-constrained settings to diagnose SNPTB. A next step for research would be the prospective validation of the algorithm.