Journal of Global Health最新文献

Background: Diarrhoea among children under five years old (i.e. childhood diarrhoea) causes significant morbidity and mortality in low and middle-income countries (LMICs). We conducted this systematic review and meta-analysis to quantify the proportion of childhood diarrhoea attributable to Campylobacter spp., diarrhoeagenic Escherichia coli (E. coli), Salmonella spp., and Shigella spp. in LMIC settings.

Methods: We included epidemiological studies published between 2000 and 2025, and extracted data on study location, sample size, and pathogen-specific parameters. Two reviewers independently performed database searches, publication screening, data extraction, and quality assessment, with any conflicts resolved by a third reviewer. We reported the results of the meta-analysis as pooled proportions (positive samples divided by the total samples tested for each enteropathogen) and 95% confidence intervals. We assessed all potential sources of heterogeneity using univariable and multivariable meta-regression, quantified moderator contributions as pseudo-R² values based on reductions in τ², and tested for interaction effects. We also evaluated robustness through leave-one-out analyses, sequentially excluding individual studies to examine their influence on pooled estimates and heterogeneity.

Results: We included 71 records encompassing 84 studies. Pooled proportions were 8.6% for Campylobacter spp., 23.0% for diarrhoeagenic E. coli (DEC), 2.6% for Salmonella spp., and 8.8% for Shigella spp., with wide variation across studies. Subgroup analyses showed higher proportions of Campylobacter spp. and Shigella spp. in Asia and with polymerase chain reaction-based detection, and greater DEC proportions in America and Africa. Salmonella spp. remained low across regions and study designs. Year- and country-specific analyses showed no consistent temporal trends, though DEC peaked in 2014 (77.9%, two studies) and Shigella spp. was higher in 2020 (20.7%, ten studies), both driven by a limited number of studies.

Conclusions: Standardising diagnostic methods and study designs is essential for reducing heterogeneity and improving the reliability of pooled proportion estimates in epidemiological research on enteric pathogens. Improving water supply, sanitation, hygiene, and food safety remains crucial for reducing the burden of childhood diarrhoea in LMICs.

Background: Emergency medical services (EMS) personnel, including paramedics, emergency medical technicians (EMTs), and firefighters are subjected to substantial occupational stressors that diminish job satisfaction and increase turnover rate, ultimately affecting efficient delivery of pre-hospital emergency care. Therefore, we performed the first meta-analysis to determine the prevalence of job satisfaction and turnover intention among EMS personnel, including paramedics, emergency medical technicians (EMTs), and firefighters.

Methods: We comprehensively searched Web of Science, PubMed, Cochrane Library, Embase, and EBSCOhost until March 2025. The pooled prevalence of job satisfaction and turnover intention was analysed using the Freeman-Tukey double-arcsine transformation model in R software. Cochran's Q and statistics assessed heterogeneity and subgroup analysis explored moderator variables.

Results: A total of 25 studies with 59 562 EMS personnel were included. The pooled prevalence of job satisfaction was 63% (95% confidence interval (CI) = 53%, 72%), with estimates of 71% for EMTs, 62% for firefighters, and 54% for paramedics. Job satisfaction was 56% during the COVID-19 pandemic and 65% in the pre-pandemic period. The pooled prevalence of turnover intention was 29% (95% CI = 24%, 36%), with estimates of 28% for paramedics, 22% for EMTs, and 17% for firefighters. Turnover intention was 34% during COVID-19 pandemic and 27% in the pre-pandemic period.

Conclusions: Approximately, 63% of EMS personnel report job satisfaction, while 29% express intent to leave the profession. Mental health support, workload management, and professional development opportunities should be promoted among EMS personnel to further enhance job satisfaction and mitigate turnover intention.

Registration: PROSPERO: CRD420251027283.

Background: The kidney and eye share common metabolic and vascular risk factors, and chronic kidney disease (CKD) has been associated with the prevalence of visual impairment (VI). In this study, we examined the association of CKD with incident VI and major age-related eye diseases, including cataract, age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma, in a multi-ethnic Asian population.

Methods: We analysed data from 6486 Chinese, Malay, and Indian adults aged 40-80 years who participated in the Singapore Epidemiology of Eye Diseases study at baseline (2004-11) and six-year follow-up visit (2011-17) and were free of VI and the respective eye diseases at baseline. We defined CKD (n = 564; 8.7%) as an estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m², and categorised the severity of CKD into stages G1-G5. Eye examinations included refraction, slit-lamp examinations, and retinal imaging. We defined incident VI as best-corrected visual acuity <20/40 in the better eye. Eye diseases examined included cataract, AMD, retinopathy, including DR in those with diabetes and glaucoma. We examined associations between CKD, VI, and eye diseases using multivariable logistic regression models adjusted for age, gender, ethnicity, diabetes, and hypertension status, presenting the results as odds ratios (ORs) and 95% confidence intervals (CIs).

Results: CKD participants had a higher incidence of any VI (14.3% vs. 3.3%; P < 0.001), any AMD (8.0% vs. 5.4%; P < 0.001), and cataracts (65.1% vs. 40.8%; P < 0.001) than non-CKD participants. VI incidence increased with CKD severity in G1-G2 (3.3%), G3a (13.5%), and G3b-G5 (16.3%) (P < 0.001). In multivariable models, CKD was associated with incident VI (OR = 1.47; 95% CI = 1.03-2.10) and moderate/worse DR (OR = 2.62; 95% CI = 1.35-5.10).

Conclusions: Our results suggest that the presence of CKD increases the risk and severity of VI and eye diseases in Asian adults. Our findings highlight the importance of regular eye exams for CKD patients to reduce the risk of VI.

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report revised the combined chronic obstructive pulmonary disease (COPD) assessment. Patients were classified into groups A, B, and E, and the initial inhalation therapy recommendations were revised. This study aimed to investigate the application status of initial inhalation therapy recommendations in patients with COPD and determine whether adherence to the GOLD 2023 report could achieve a better prognosis.

Methods: This was a prospective cohort study. Demographic data, COPD assessment test (CAT) and modified Medical Research Council (mMRC) scores, pulmonary function, GOLD grades, GOLD groups, number of exacerbations, comorbidities, and inhalation therapy were collected. The patients were classified into adherent and non-adherent groups based on the provision of initial inhalation therapy recommendations that aligned with the GOLD A, B, and E groupings. All patients finished one year of follow-up to collect data on the number of exacerbations and mortality.

Results: A total of 1654 patients were enrolled, of whom 816 (49.3%) were in the adherent group. The patients in the adherent group had higher age, CAT and mMRC scores, and number of exacerbations and hospitalisations, higher proportion of combined with lung cancer and chronic heart disease, and worse pulmonary function. Patients in the adherent group had lower future exacerbations, frequent exacerbations, and hospitalisations. The patients in groups B and E who adhered to the GOLD 2023 report had lower future exacerbations, frequent exacerbations, and hospitalisations, while no significant difference was observed in group A (P < 0.05).

Conclusions: In the real world, many patients with COPD do not receive the initial inhalation therapy recommended by the GOLD 2023 report. However, adherence to the GOLD 2023 report may decrease the risk of future exacerbation. It implied that improved the dissemination and uptake of GOLD 2023 recommendations is needed in the clinical practice.

Background: Ovarian cancer (OC) has the worst prognosis and highest death rate of all gynaecological cancers in the USA. We examined the independent effects of individual-, neighbourhood-, and state-level factors on ovarian cancer incidence using a multilevel analytical framework.

Methods: In this retrospective cohort study, we analysed de-identified data from the All of Us research database, identifying women ≥18 years without prior ovarian cancer before January 2017. Participants were followed from 1 January 2017 through October 2023 (median follow-up: 6.6 years). Mixed-effects Cox regression models examined data on 85 388 individuals nested within ZIP-code areas and states, analysing individual-level risk factors and neighbourhood-level socioeconomic determinants, while accounting for geographic clustering. We fitted four progressive models: a null (random effects only), individual-level factors, neighbourhood-level factors, and full model with all covariates.

Results: Among 85 388 women followed for a total of 569 847 person-years, 419 (0.49%) developed OC. Age demonstrated the strongest associations, with significantly elevated risks of developing OC among women aged 50-59 years (adjusted hazard ratio (aHR) = 1.83; 95% confidence interval (CI) = 1.28-2.61), 60-69 years (aHR = 2.01; 95% CI = 1.39-2.90), and ≥70 years (aHR = 1.67; 95% CI = 1.07-2.59) compared to those <40 years. Retired women had increased risk of OC compared to employed women (aHR = 1.39; 95% CI = 1.04-1.86). Non-Hispanic Black women demonstrated lower risk of OC than non-Hispanic White women (aHR = 0.63; 95% CI = 0.45-0.88). Regional variations showed 53% lower risk in the South vs. Northeast (aHR = 0.47; 95% CI = 0.25-0.86). Hormone replacement therapy was associated with increased risk of OC (aHR = 2.46; 95% CI = 1.07-5.67). Significant geographic clustering of OC was observed at neighbourhood and state levels.

Conclusions: Individual-level factors, particularly age and employment status, are the primary determinants of OC risk, while apparent geographic disparities reflect population composition, rather than unmeasured environmental factors. The complete explanation of geographic clustering through measured covariates could provide important insights for targeted prevention strategies and future epidemiological research.

Background: The COVID-19 pandemic has significantly impacted global health, with low- and middle-income countries (LMICs) facing unique healthcare challenges. Polyester nasal swabs stored in dry tubes have emerged as a cost-effective and scalable method for routine testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to assess the prevalence of SARS-CoV-2 among deceased individuals in an urban slum in Karachi, Pakistan, using dry and wet polyester nasal swabs, and to validate their use for post-mortem detection of the virus.

Methods: We conducted a prospective observational study from July 2022 to August 2023 in a low-income setting. We collected nasal samples from 350 deceased individuals based on community death alerts using dry polyester and wet swabs with transport media. These were then processed for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR), with the positive samples sequenced on the Illumina platform to identify circulating variants. We also performed a comparative analysis between dry and wet swab methods for diagnostic performance.

Results: Of the 350 samples, 21 (6.0%) tested positive for SARS-CoV-2. Males accounted for 15/21 (71.4%) of positive cases, with the majority aged 60 and above (n/N = 12/21, 57.1%). The Omicron (22F) variant was the most prevalent, detected in 16/21 (76%) cases. The diagnostic performance of wet swabs showed a sensitivity of 76.19%, while dry swabs were more accurate, with a sensitivity of 90.48%, achieving a diagnostic odds ratio of 3120.5.

Conclusions: Our study demonstrated the feasibility and effectiveness of using dry polyester nasal swabs for post-mortem detection of SARS-CoV-2 in resource-constrained settings. These findings emphasise the method's potential for monitoring respiratory infectious diseases and guiding public health strategies in LMICs.

Background: Previous studies have reported associations between subjective cognitive decline (SCD) and both cardiometabolic multimorbidity (CMM, the co-occurrence of ≥2 cardiometabolic diseases (CMDs), including coronary heart disease, stroke, and diabetes) and lifestyle factors (LFs). While urban-rural disparities in health care access and risk factor distribution are well known, variations in these associations and the interaction between LFs and CMM among individuals with SCD in non-high-income countries remain unclear. This study aimed to investigate the association of CMM and LFs with SCD in older adults living in rural or urban areas in China.

Methods: This population-based study included 41 859 older adults (median age 72.0 years; 52.48% female; 38.95% rural) from 31 provincial regions in China. Subjective cognitive decline was assessed using the Eight-Item Informant Interview to Differentiate Aging and Dementia. High-risk LFs included tobacco smoking, alcohol drinking, unhealthy diet, low physical activity, and unhealthy body shape. Cardiometabolic diseases were assessed by self-reported physician diagnoses. Lifestyle factors were collected via interviewer-administered questionnaires. Logistic regression, relative excess risk due to interaction and attributable proportion were used to assess associations and additive interactions.

Results: Cardiometabolic multimorbidity (odds ratio (OR) = 2.36; 95% confidence intervals (CI) = 2.10, 2.66) and the number of CMDs (OR = 1.49; 95% CI = 1.43, 1.56) were significantly associated with an increased likelihood of SCD. Gradients in the associations between the number of high-risk LFs and SCD were observed (P < 0.05), except for five high-risk LFs. These associations were stronger in rural than in urban residents (P for interaction <0.05). Significant additive interaction was found between high-risk LFs and CMM (relative excess risk due to interaction = 1.63, 95% CI = 0.67, 2.59; attributable proportion = 0.54, 95% CI = 0.22, 0.86) for SCD.

Conclusions: The coexistence of CMM and high-risk LFs exhibited an additive association with SCD. These findings highlight the need for integrated management of modifiable CMDs and lifestyle risk factors, and may inform prioritisation of rural populations.

Background: The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) currently have no benchmarks or 'norms' for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Our objective was to understand which systematic reviews had addressed the following norms in the last five years: number of SSN beds per live births in a district or similar administrative unit (admission beds); space requirements for SSN units, including mother-infant dyads (space); health workforce ratios in SSN units (workforce); and travel time to health facilities with SSN units (travel time).

Methods: We searched for systematic reviews of admission beds, space, workforce and travel time norms for SSN under 28 days of age and their mothers in all health facilities and countries, regardless of infant gestational age and birth weight, that had been published in the previous five years (2018-23). For beds, space, and workforce norms, we searched for reviews of prevalence, incidence, mean and median estimates. For the travel time norm, we searched for reviews of estimates of effect, i.e. dichotomous (e.g. relative risks) or continuous measures (e.g. mean differences).

Results: We identified 9110 records and included eight systematic reviews published in the last five years: two related to space, five to workforce, and one to travel time norms. We found no reviews for admission bed norms. Two reviews included high income countries only, while three included tertiary neonatal intensive care units only. The reviews provided estimates of mean space requirements in SSN units, health workforce ratios of doctors and nurses, and optimal travel time to health facilities for SSN. Seven of the eight reviews had high risk of bias.

Conclusions: Despite the high burden of SSN in LMICs and the need to scale up hospital care, there have been few systematic reviews into this topic, and rigorous syntheses of evidence are lacking. The WHO and the UNICEF have now commissioned four systematic reviews. The next steps will be to analyse real-world country-level data and develop implementation guidance.

Registration: PROSPERO: CRD42023417847, CRD42023451302, CRD42023478512, CRD42023453644.

Background: In the face of pandemics from infectious diseases, enhancing community resilience is increasingly important. It is, therefore, essential to evaluate community resilience and identify factors that can strengthen it. This study aimed to evaluate community resilience by leveraging a data set comprising user information from Weibo and applying interpretable machine learning (ML) techniques to identify the contributions of various indicators underpinning community resilience.

Methods: This cross-sectional study analysed social media data from December 2022 to January 2023. COVID-19-related user interactions were examined as indicators of community resilience within the context of community response. This study introduced an evaluation framework comprising thirteen indicators. It also described the application of natural language processing (NLP) techniques, the K-means (KM) clustering, a random forest (RF) classifier and SHapley Additive exPlanations (SHAP) to achieve its objectives.

Results: A total of 177 000 Weibo posts were collected for this study. The NLP model demonstrated strong performance in accurately labelling posts, with the area under the curve (AUC) of 0.8862 (95% confidence interval (CI) = 0.8600-0.9102) and accuracy (ACC) of 0.8939 (95% CI = 0.8563-0.9277). This study identified four distinct community resilience levels: low (77.64%), medium-low (9.86%), medium-high (10.55%), and high (1.95%). Further analyses revealed clear regional disparities in community resilience, with higher levels observed in Eastern China. The top five indicators associated with community resilience, as determined by mean SHAP values, were 'Efficacy of performance altruistic response' (0.0101), 'Tangible aid engagement' (0.0051), 'Rapid performance of altruism' (0.0044), 'Sentiment response associated with recording positive posts' (0.0036), and 'Help-seeking response efficacy' (0.0035).

Conclusions: This study is the first to harness social media data to quantify community resilience in mainland China. Five indicators associated with enhanced community resilience are identified as potential predictors that can inform governmental strategies and strengthen decision-making support for improving health emergency responses.

Background: Intervertebral disc degeneration (IDD) is prevalent in orthopaedics, yet lacks effective treatments. This study seeks to discover potential therapeutic targets for IDD to inform clinical therapies and traditional medicine approaches.

Methods: In this study, IDD-related data sets were sourced from the Gene Expression Omnibus, and differential expression analysis was performed to identify differentially expressed genes. Subsequently, candidate genes associated with IDD were recognised using databases such as GeneCards, OMIM, DrugBank, and DisGeNET, with further validation of these genes' biological functions and involvement in signalling pathways through enrichment analyses. Additionally, machine learning algorithms were applied to select candidate targets. The diagnostic value of these targets for IDD was assessed by constructing a nomogram model, and their functional networks and biological processes were revealed using GeneMANIA and Gene Set Enrichment Analysis. Eventually, the research also encompassed immune infiltration analysis and the construction of competing endogenous RNA (ceRNA) networks, as well as predictions for potential drugs and traditional Chinese medicine (TCM) prescriptions.

Results: A total of 89 differentially expressed genes were identified through bioinformatics analysis, and further analysis led to the determination of 16 candidate genes associated with IDD. Seven candidate targets were found from the candidate genes using machine learning methods. Two of these targets, cytochrome P450 family 1 subfamily B member 1 (CYP1B1) and tumour necrosis factor alpha-induced protein 6 (TNFAIP6), were chosen as key targets because they demonstrated a significant difference in expression in IDD. Following, it was also found that CYP1B1 and TNFAIP6, as well as the nomogram, indicated good predictive performance for IDD. Furthermore, gamma-delta T cells were more prevalent in IDD. CYP1B1 and TNFAIP6 showed strong correlations with gamma delta T cells, indicating a tight link between these key targets and the pathology of IDD. Eventually, 11 natural small molecules corresponding to key targets were discovered. Three of these compounds (Quercetin, Genistein, Apigenin) were found in six TCM. This could offer new theoretical references for the clinical treatment of IDD.

Conclusions: This study identified CYP1B1 and TNFAIP6 as important targets for IDD, developed a predictive nomogram, and explored the application of TCM herbal formulae, providing new insights into the clinical treatment and prescription development of IDD.