Pub Date : 2026-01-17DOI: 10.1016/j.puhe.2026.106157
Soyun An , Sunghyun Yi , Jihyung Hong
Objective
This study aimed to examine trends in income-related inequalities in cancer screening from 2013 to 2023 and decompose these inequalities into contributing factors.
Study design
This is a repeated cross-sectional study.
Methods
Data were drawn from the 2013, 2018, and 2023 waves of the nationally representative cross-sectional Korea National Health and Nutrition Examination Survey. Screening uptake was defined as having received any cancer screening within the past two years, reflecting Korea's biennial check-up schedule. Income-related inequality was assessed using the Erreygers concentration index (ECI) and the horizontal inequity index (HIwv). The ECI was decomposed to identify contributing factors.
Results
Screening rates increased across all income groups, with overall participation rising from 63.7 % in 2013 to 71.8 % in 2023. However, a widening pro-rich inequality was observed over this period. The ECI rose from 0.127 (standard error [SE]: 0.018) in 2013 to 0.149 (SE: 0.016) in 2023, and the HIwv increased from 0.108 (SE: 0.019) to 0.146 (SE: 0.016). Income and private health insurance (PHI) made the largest contributions. Income's share of inequality nearly doubled from 38.2 % to 71.4 %, while PHI's declined from 35.8 % to 24.9 %.
Conclusions
Despite near-universal financial coverage, persistent pro-rich inequalities in cancer screening suggest that eliminating direct screening costs alone is insufficient to achieve equity. Broader strategies addressing structural and social barriers — including post-diagnosis financial concerns, time constraints, and gaps in education and health literacy — are required to ensure equitable access to preventive care.
{"title":"Persistent income-related inequalities in cancer screening utilisation in South Korea: Evidence from repeated cross-sectional data, 2013–2023","authors":"Soyun An , Sunghyun Yi , Jihyung Hong","doi":"10.1016/j.puhe.2026.106157","DOIUrl":"10.1016/j.puhe.2026.106157","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to examine trends in income-related inequalities in cancer screening from 2013 to 2023 and decompose these inequalities into contributing factors.</div></div><div><h3>Study design</h3><div>This is a repeated cross-sectional study.</div></div><div><h3>Methods</h3><div>Data were drawn from the 2013, 2018, and 2023 waves of the nationally representative cross-sectional Korea National Health and Nutrition Examination Survey. Screening uptake was defined as having received any cancer screening within the past two years, reflecting Korea's biennial check-up schedule. Income-related inequality was assessed using the Erreygers concentration index (ECI) and the horizontal inequity index (HIwv). The ECI was decomposed to identify contributing factors.</div></div><div><h3>Results</h3><div>Screening rates increased across all income groups, with overall participation rising from 63.7 % in 2013 to 71.8 % in 2023. However, a widening pro-rich inequality was observed over this period. The ECI rose from 0.127 (standard error [SE]: 0.018) in 2013 to 0.149 (SE: 0.016) in 2023, and the HIwv increased from 0.108 (SE: 0.019) to 0.146 (SE: 0.016). Income and private health insurance (PHI) made the largest contributions. Income's share of inequality nearly doubled from 38.2 % to 71.4 %, while PHI's declined from 35.8 % to 24.9 %.</div></div><div><h3>Conclusions</h3><div>Despite near-universal financial coverage, persistent pro-rich inequalities in cancer screening suggest that eliminating direct screening costs alone is insufficient to achieve equity. Broader strategies addressing structural and social barriers — including post-diagnosis financial concerns, time constraints, and gaps in education and health literacy — are required to ensure equitable access to preventive care.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106157"},"PeriodicalIF":3.2,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.puhe.2026.106144
Seni Kouanda , Kadidiatou Kadio , Adama Sana , Mariam Congo , Nathalie Roos , Fiona Scorgie , Britt Nakstad , Sari Kovats , Jeremy J. Hess , Véronique Filippi
Objectives
Climate change has a wide range of adverse consequences for human health. The effects of extreme weather on maternal and newborn health, as well as the availability and quality of health services, remain under-researched in the sub-Saharan region. The aim of this study is to examine the effects of heat on pregnant women's use of health services, the health facility working environment and the impact of heat on the quality of care in Burkina Faso, a limited resource country.
Study design
We adopted a qualitative approach to address the research objectives.
Methods
This study was conducted in the primary health care centers of Wemtenga in Ouagadougou and Delga in Kaya, Burkina Faso, from September 30th to October 30th, 2020. The study included individual interviews and focus group discussions (FGD) with pregnant women, postpartum women, health providers and community leaders, women of reproductive age, as well as relatives and male spouses of women who recently had given birth. The interviews were transcribed into French and coded using NVivo11 software.
Results
Forty pregnant and postpartum women, aged 20–40 years, were interviewed, and 31 women of childbearing age, aged 21–39 years, participated in the FGDs; 29 spouses also participated in the FDGs. Interviews indicated that extreme heat was reported to reduce the attendance and use of health services by pregnant and postpartum women. The women's choice of delivery center depended on the quality of the health centers, notably whether they were equipped with cooling systems, as lack of cooling could adversely affect the care of women and newborns, and the number of managed patients. The conveniences offered by health centers, notably the presence of fans or air conditioners, were important factors influencing women's decisions on where to give birth. All stakeholders agreed that extreme heat affected the relationship between caregivers and patients, especially facilities with inadequate infrastructures, such as the lack of a cooling system and cramped spaces.
Conclusions
Extreme ambient heat negatively impacts the use of maternal and child health services, the performance and quality of care provided by health professionals, and the relationship between carer and patient. This is particularly concerning as worsening heat could undermine the progress made in maternal and child health in Burkina Faso and other similar settings. It is crucial for healthcare systems to adapt to the effects of climate change, particularly to extreme heat and heatwaves, which are becoming increasingly intense, frequent and long-lasting.
{"title":"Heat and its effects on maternal and neonatal health care: Evidence from Burkina Faso","authors":"Seni Kouanda , Kadidiatou Kadio , Adama Sana , Mariam Congo , Nathalie Roos , Fiona Scorgie , Britt Nakstad , Sari Kovats , Jeremy J. Hess , Véronique Filippi","doi":"10.1016/j.puhe.2026.106144","DOIUrl":"10.1016/j.puhe.2026.106144","url":null,"abstract":"<div><h3>Objectives</h3><div>Climate change has a wide range of adverse consequences for human health. The effects of extreme weather on maternal and newborn health, as well as the availability and quality of health services, remain under-researched in the sub-Saharan region. The aim of this study is to examine the effects of heat on pregnant women's use of health services, the health facility working environment and the impact of heat on the quality of care in Burkina Faso, a limited resource country.</div></div><div><h3>Study design</h3><div>We adopted a qualitative approach to address the research objectives.</div></div><div><h3>Methods</h3><div>This study was conducted in the primary health care centers of Wemtenga in Ouagadougou and Delga in Kaya, Burkina Faso, from September 30th to October 30th<sup>,</sup> 2020. The study included individual interviews and focus group discussions (FGD) with pregnant women, postpartum women, health providers and community leaders, women of reproductive age, as well as relatives and male spouses of women who recently had given birth. The interviews were transcribed into French and coded using NVivo11 software.</div></div><div><h3>Results</h3><div>Forty pregnant and postpartum women, aged 20–40 years, were interviewed, and 31 women of childbearing age, aged 21–39 years, participated in the FGDs; 29 spouses also participated in the FDGs. Interviews indicated that extreme heat was reported to reduce the attendance and use of health services by pregnant and postpartum women. The women's choice of delivery center depended on the quality of the health centers, notably whether they were equipped with cooling systems, as lack of cooling could adversely affect the care of women and newborns, and the number of managed patients. The conveniences offered by health centers, notably the presence of fans or air conditioners, were important factors influencing women's decisions on where to give birth. All stakeholders agreed that extreme heat affected the relationship between caregivers and patients, especially facilities with inadequate infrastructures, such as the lack of a cooling system and cramped spaces.</div></div><div><h3>Conclusions</h3><div>Extreme ambient heat negatively impacts the use of maternal and child health services, the performance and quality of care provided by health professionals, and the relationship between carer and patient. This is particularly concerning as worsening heat could undermine the progress made in maternal and child health in Burkina Faso and other similar settings. It is crucial for healthcare systems to adapt to the effects of climate change, particularly to extreme heat and heatwaves, which are becoming increasingly intense, frequent and long-lasting.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106144"},"PeriodicalIF":3.2,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.puhe.2026.106148
Lucie Richard , Rosane Nisenbaum , Allison Dyer , Daniela Mergarten , Michael Brown , Suzanne Stewart , Stephen W. Hwang
Objectives
People experiencing homelessness have high SARS-CoV-2 infection and re-infection burden, potentially leading to higher prevalence of post-COVID-19 condition (PCC). However, high baseline symptom rates may make identification of PCC difficult or impossible in this population. This study evaluates symptom patterns over time to assess their ability to identify potential PCC among individuals experiencing homelessness.
Study design
Prospective cohort study
Methods
We prospectively followed a large (n = 736), representative cohort of people experiencing homelessness recruited at random from 62 sites in Toronto, Canada between June and September 2021. Participants were interviewed up to five times over approximately 12 months. Longitudinal patterns of twelve self-reported symptoms were assessed through latent transition analysis, and generalized estimating equations with logit link were applied to determine their association with known risk of potential PCC.
Results
Among 736 participants, three latent statuses were identified: (1) ‘No/Few Symptoms’ (≥70 %), (2) ‘Non-Specific Symptoms’ (15–23 %), and (3) ‘Infection-Related Symptoms’ (≤5 %). Statuses 2 and 3 were associated with being at risk of PCC following symptomatic infection (aOR 3.41 [95 % CI 2.3–5.0] and 3.18 [95 % CI 1.6–6.4]) but not with being at risk of PCC overall. Transition probabilities suggested PCC would mostly occur among individuals with symptoms at baseline. However, the clustered area under the curve was modest (0.70 [95 % CI 0.65–0.75]), indicating symptom-based approaches are suboptimal for identification of potential PCC.
Conclusions
Self-reported symptoms do not reliably identify potential PCC among people experiencing homelessness, due to high rates of underlying symptoms and asymptomatic infections. Alternative, strengths-based approaches are recommended to more equitably identify post-COVID condition in this population.
无家可归者具有较高的SARS-CoV-2感染和再感染负担，可能导致更高的covid -19后病症（PCC）患病率。然而，在这一人群中，高基线症状率可能使PCC的识别变得困难或不可能。本研究评估了一段时间内的症状模式，以评估他们在无家可归者中识别潜在PCC的能力。研究设计前瞻性队列研究方法前瞻性随访了2021年6月至9月期间从加拿大多伦多的62个地点随机招募的大量（n = 736）有代表性的无家可归者队列。参与者在大约12个月的时间里接受了多达5次采访。通过潜在转移分析评估12种自我报告症状的纵向模式，并应用logit链接的广义估计方程来确定其与已知潜在PCC风险的关联。结果在736名参与者中，确定了三种潜在状态：(1)“无症状/很少症状”（≥70%），(2)“非特异性症状”（15 - 23%）和(3)“感染相关症状”（≤5%）。状态2和3与有症状感染后出现PCC的风险相关（aOR为3.41 [95% CI 2.3-5.0]和3.18 [95% CI 1.6-6.4]），但与总体出现PCC的风险无关。过渡概率提示PCC主要发生在基线时有症状的个体中。然而，曲线下的聚集面积适中（0.70 [95% CI 0.65-0.75]），表明基于症状的方法对于识别潜在的PCC不是最理想的。由于潜在症状和无症状感染率很高，自我报告的症状不能可靠地识别无家可归者中潜在的PCC。建议采用基于优势的替代方法，以更公平地确定这一人群的covid后状况。
{"title":"Identifying potential post-COVID-19 condition among people experiencing homelessness using longitudinal symptom patterns: A prospective cohort study","authors":"Lucie Richard , Rosane Nisenbaum , Allison Dyer , Daniela Mergarten , Michael Brown , Suzanne Stewart , Stephen W. Hwang","doi":"10.1016/j.puhe.2026.106148","DOIUrl":"10.1016/j.puhe.2026.106148","url":null,"abstract":"<div><h3>Objectives</h3><div>People experiencing homelessness have high SARS-CoV-2 infection and re-infection burden, potentially leading to higher prevalence of post-COVID-19 condition (PCC). However, high baseline symptom rates may make identification of PCC difficult or impossible in this population. This study evaluates symptom patterns over time to assess their ability to identify potential PCC among individuals experiencing homelessness.</div></div><div><h3>Study design</h3><div>Prospective cohort study</div></div><div><h3>Methods</h3><div>We prospectively followed a large (n = 736), representative cohort of people experiencing homelessness recruited at random from 62 sites in Toronto, Canada between June and September 2021. Participants were interviewed up to five times over approximately 12 months. Longitudinal patterns of twelve self-reported symptoms were assessed through latent transition analysis, and generalized estimating equations with logit link were applied to determine their association with known risk of potential PCC.</div></div><div><h3>Results</h3><div>Among 736 participants, three latent statuses were identified: (1) ‘No/Few Symptoms’ (≥70 %), (2) ‘Non-Specific Symptoms’ (15–23 %), and (3) ‘Infection-Related Symptoms’ (≤5 %). Statuses 2 and 3 were associated with being at risk of PCC following symptomatic infection (aOR 3.41 [95 % CI 2.3–5.0] and 3.18 [95 % CI 1.6–6.4]) but not with being at risk of PCC overall. Transition probabilities suggested PCC would mostly occur among individuals with symptoms at baseline. However, the clustered area under the curve was modest (0.70 [95 % CI 0.65–0.75]), indicating symptom-based approaches are suboptimal for identification of potential PCC.</div></div><div><h3>Conclusions</h3><div>Self-reported symptoms do not reliably identify potential PCC among people experiencing homelessness, due to high rates of underlying symptoms and asymptomatic infections. Alternative, strengths-based approaches are recommended to more equitably identify post-COVID condition in this population.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106148"},"PeriodicalIF":3.2,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To improve prediction and understanding of TB dynamics in Argentina, identifying key risk factors and high-incidence areas to inform surveillance and public health control strategies.
Study design
Retrospective observational study.
Methods
We applied (i) machine learning models (Histogram-Based Gradient Boosting, XGBoost, Random Forest, and Logistic Regression) to predict treatment outcomes, (ii) time series models (ARIMA, SARIMAX, and LSTM) to forecast weekly TB case counts, and (iii) spatial analysis tools (LISA, Moran's I) to identify high-incidence clusters.
Results
Weekly TB notifications increased after the onset of the COVID-19 pandemic (t = 4.75, p = 2.10 × 10−6), with LISA revealing two significant clusters (p < 0.05). HGB predicted treatment outcomes (ROC–AUC = 0.86; top predictors: HIV, treatment duration, age). LSTM outperformed SARIMAX (RMSE 3.50 → 2.88 in Salta–Jujuy; 3.82 → 0.89 in Autonomous City of Buenos Aires (CABA)–Buenos Aires; −18 %/−77 %). A sex-difference test indicated higher infection among men (p < 0.05).
Conclusions
Combining ML and spatial tools enhances TB monitoring by supporting early identification of high-risk areas, improving epidemiological surveillance, and enabling targeted, data-driven public health interventions in Argentina.
{"title":"Predictive modeling and spatiotemporal analysis of TB in Argentina: Advancing control efforts through machine learning","authors":"Iganacio Garcia , Leonardo Giovanini , Leonardo López","doi":"10.1016/j.puhe.2026.106151","DOIUrl":"10.1016/j.puhe.2026.106151","url":null,"abstract":"<div><h3>Objectives</h3><div>To improve prediction and understanding of TB dynamics in Argentina, identifying key risk factors and high-incidence areas to inform surveillance and public health control strategies.</div></div><div><h3>Study design</h3><div>Retrospective observational study.</div></div><div><h3>Methods</h3><div>We applied (i) machine learning models (Histogram-Based Gradient Boosting, XGBoost, Random Forest, and Logistic Regression) to predict treatment outcomes, (ii) time series models (ARIMA, SARIMAX, and LSTM) to forecast weekly TB case counts, and (iii) spatial analysis tools (LISA, Moran's I) to identify high-incidence clusters.</div></div><div><h3>Results</h3><div>Weekly TB notifications increased after the onset of the COVID-19 pandemic (t = 4.75, p = 2.10 × 10<sup>−6</sup>), with LISA revealing two significant clusters (p < 0.05). HGB predicted treatment outcomes (ROC–AUC = 0.86; top predictors: HIV, treatment duration, age). LSTM outperformed SARIMAX (RMSE 3.50 → 2.88 in Salta–Jujuy; 3.82 → 0.89 in Autonomous City of Buenos Aires (CABA)–Buenos Aires; −18 %/−77 %). A sex-difference test indicated higher infection among men (p < 0.05).</div></div><div><h3>Conclusions</h3><div>Combining ML and spatial tools enhances TB monitoring by supporting early identification of high-risk areas, improving epidemiological surveillance, and enabling targeted, data-driven public health interventions in Argentina.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106151"},"PeriodicalIF":3.2,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.puhe.2026.106141
Huihui Wang , Xiaotian Bai , Xiangrong Cheng , Xiaosheng Dong , Xiao Hou
Objectives
This systematic review and meta-analysis aimed to (1) assess the effects of school-based physical activity (PA) interventions on cardiorespiratory fitness (CRF) and body composition in children and adolescents, and (2) evaluate internal validity (i.e., Reach and Effectiveness) and external validity (i.e., Adoption, Implementation, and Maintenance) reported in the included studies using the RE-AIM framework.
Study design
Systematic review and meta-analysis.
Methods
Five databases (PubMed, Embase, Web of Science, EBSCO, and Cochrane Library) were searched for studies published from January 1, 2000, to July 10, 2024. Eligible studies were randomized or non-randomized controlled trials involving healthy children and adolescents aged 5–17 years. Only studies that reported CRF or body composition with PA or exercise as the sole intervention were included.
Results
43 studies with a total of 27,626 participants were included in the meta-analysis. School-based PA interventions had a significant positive effect on CRF (SMD = 0.28, 95 % CI = 0.19 to 0.38; I2 = 75 %). However, no significant effect of school-based PA interventions on percentage of body fat (%BF) was observed (SMD = −0.05, 95 % CI = −0.10 to 0.00; I2 = 28 %). The total proportion of RE-AIM framework reported was 48.1 %. Among the five dimensions, Effectiveness is the most frequently reported (72.7 %), followed by Reach (53.1 %), Adoption (52.3 %), Implementation (42.4 %), and Maintenance (4.7 %).
Conclusions
School-based PA interventions significantly improve CRF in youth but do not significantly reduce %BF. Moreover, internal validity indicators were reported more often than external validity components in the included studies.
目的：本系统回顾和荟萃分析旨在(1)评估以学校为基础的体育活动（PA）干预对儿童和青少年心肺健康（CRF）和身体成分的影响，以及(2)使用RE-AIM框架评估纳入研究的内部效度（即覆盖范围和有效性）和外部效度（即采用，实施和维持）。研究设计：系统评价和荟萃分析。方法：检索PubMed、Embase、Web of Science、EBSCO和Cochrane Library 5个数据库，检索2000年1月1日至2024年7月10日发表的研究。符合条件的研究是涉及5-17岁健康儿童和青少年的随机或非随机对照试验。仅纳入了报告CRF或体成分与PA或运动作为唯一干预的研究。结果：43项研究共27,626名参与者被纳入meta分析。以学校为基础的PA干预对CRF有显著的正向影响（SMD = 0.28, 95% CI = 0.19 ~ 0.38; I2 = 75%）。然而，没有观察到以学校为基础的PA干预对体脂率（%BF）的显著影响（SMD = -0.05, 95% CI = -0.10至0.00;I2 = 28%）。RE-AIM框架报告的总比例为48.1%。在五个维度中，有效性是最常被报告的（72.7%），其次是Reach（53.1%）、Adoption（52.3%）、Implementation（42.4%）和Maintenance（4.7%）。结论：以学校为基础的PA干预可显著改善青少年的CRF，但不能显著降低BF %。此外，在纳入的研究中，内部效度指标的报告频率高于外部效度成分。
{"title":"Effects of school-based physical activity interventions on cardiorespiratory fitness and body composition in children and adolescents: A systematic review and meta-analysis using the RE-AIM framework","authors":"Huihui Wang , Xiaotian Bai , Xiangrong Cheng , Xiaosheng Dong , Xiao Hou","doi":"10.1016/j.puhe.2026.106141","DOIUrl":"10.1016/j.puhe.2026.106141","url":null,"abstract":"<div><h3>Objectives</h3><div>This systematic review and meta-analysis aimed to (1) assess the effects of school-based physical activity (PA) interventions on cardiorespiratory fitness (CRF) and body composition in children and adolescents, and (2) evaluate internal validity (i.e., Reach and Effectiveness) and external validity (i.e., Adoption, Implementation, and Maintenance) reported in the included studies using the RE-AIM framework.</div></div><div><h3>Study design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>Five databases (PubMed, Embase, Web of Science, EBSCO, and Cochrane Library) were searched for studies published from January 1, 2000, to July 10, 2024. Eligible studies were randomized or non-randomized controlled trials involving healthy children and adolescents aged 5–17 years. Only studies that reported CRF or body composition with PA or exercise as the sole intervention were included.</div></div><div><h3>Results</h3><div>43 studies with a total of 27,626 participants were included in the meta-analysis. School-based PA interventions had a significant positive effect on CRF (SMD = 0.28, 95 % CI = 0.19 to 0.38; <em>I</em><sup><em>2</em></sup> = 75 %). However, no significant effect of school-based PA interventions on percentage of body fat (%BF) was observed (SMD = −0.05, 95 % CI = −0.10 to 0.00; <em>I</em><sup><em>2</em></sup> = 28 %). The total proportion of RE-AIM framework reported was 48.1 %. Among the five dimensions, Effectiveness is the most frequently reported (72.7 %), followed by Reach (53.1 %), Adoption (52.3 %), Implementation (42.4 %), and Maintenance (4.7 %).</div></div><div><h3>Conclusions</h3><div>School-based PA interventions significantly improve CRF in youth but do not significantly reduce %BF. Moreover, internal validity indicators were reported more often than external validity components in the included studies.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106141"},"PeriodicalIF":3.2,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.puhe.2026.106145
Ádám Pál-Jakab , Patrik Pesti , Zsuzsanna Horti-Maricza , Bettina Nagy , Boldizsár Kiss , Botond Biebel , György Pápai , Gábor Csató , Nora Boussoussou , Béla Merkely , András Gelencsér , Péter Sótonyi , Brigitta Szilágyi , Endre Zima
Objectives
Meteorological factors may influence cardiovascular emergency incidence, but comprehensive national evidence for out-of-hospital cardiac arrest (OHCA) associations remains limited. We investigated meteorological associations with OHCA occurrence using complete national population data.
We conducted a population-based time-series analysis using the Hungarian National Ambulance Service registry from November 2018 to December 2023. After excluding COVID-19 disruption period, 114830 OHCA cases across 1584 days were analysed. Meteorological parameters included temperature, wind speed, atmospheric pressure, humidity, and air quality. Associations were assessed using negative binomial regression models with temporal lag structures (0–3 days). We used a rolling 30-day z-score to detect outlier days with high OHCA cases and identified their unique weather conditions. Machine learning validation was performed with XGBoost and SHAP interpretation.
Results
Daily OHCA incidence averaged 60·9 ± 14·3 cases, peaking in winter (17·8 % higher than summer, p < 0·001). Each 1 °C temperature decrease was associated with a 1·4 % increase in daily OHCA incidence (IRR 0·986). Wind speed demonstrated inverse association (7·9 % decrease in OHCA incidence per-IQR effect; IRR 0·928). The highest-incidence days saw 31·9 % more cases, equivalent to 19 additional cases daily, linked to adverse weather.
Conclusion
Meteorological factors demonstrate strong, predictable associations with OHCA incidence, with extreme weather increasing rates by nearly one-third. The 3-day lag patterns enable weather-based early warnings, supporting the integration of meteorological data into emergency response to reduce preventable deaths.
{"title":"Meteorological associations with out-of-hospital cardiac arrest: A national population-based time-series analysis","authors":"Ádám Pál-Jakab , Patrik Pesti , Zsuzsanna Horti-Maricza , Bettina Nagy , Boldizsár Kiss , Botond Biebel , György Pápai , Gábor Csató , Nora Boussoussou , Béla Merkely , András Gelencsér , Péter Sótonyi , Brigitta Szilágyi , Endre Zima","doi":"10.1016/j.puhe.2026.106145","DOIUrl":"10.1016/j.puhe.2026.106145","url":null,"abstract":"<div><h3>Objectives</h3><div>Meteorological factors may influence cardiovascular emergency incidence, but comprehensive national evidence for out-of-hospital cardiac arrest (OHCA) associations remains limited. We investigated meteorological associations with OHCA occurrence using complete national population data.</div></div><div><h3>Study design</h3><div>Population-based time-series retrospective, non-interventional analysis.</div></div><div><h3>Methods</h3><div>We conducted a population-based time-series analysis using the Hungarian National Ambulance Service registry from November 2018 to December 2023. After excluding COVID-19 disruption period, 114830 OHCA cases across 1584 days were analysed. Meteorological parameters included temperature, wind speed, atmospheric pressure, humidity, and air quality. Associations were assessed using negative binomial regression models with temporal lag structures (0–3 days). We used a rolling 30-day z-score to detect outlier days with high OHCA cases and identified their unique weather conditions. Machine learning validation was performed with XGBoost and SHAP interpretation.</div></div><div><h3>Results</h3><div>Daily OHCA incidence averaged 60·9 ± 14·3 cases, peaking in winter (17·8 % higher than summer, p < 0·001). Each 1 °C temperature decrease was associated with a 1·4 % increase in daily OHCA incidence (IRR 0·986). Wind speed demonstrated inverse association (7·9 % decrease in OHCA incidence per-IQR effect; IRR 0·928). The highest-incidence days saw 31·9 % more cases, equivalent to 19 additional cases daily, linked to adverse weather.</div></div><div><h3>Conclusion</h3><div>Meteorological factors demonstrate strong, predictable associations with OHCA incidence, with extreme weather increasing rates by nearly one-third. The 3-day lag patterns enable weather-based early warnings, supporting the integration of meteorological data into emergency response to reduce preventable deaths.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106145"},"PeriodicalIF":3.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.puhe.2026.106156
Chun-Pin Esther Chang , Daniel Knox , Zhe David Yu , Kimberley Shoaf , Sharon L. Talboys , Mia Hashibe
Objectives
Individuals with substance use disorders may be more susceptible to COVID-19 outcomes due to damage in their immune, pulmonary and respiratory systems. The aim of our study is to investigate COVID-19 outcomes among individuals with a history of substance use disorders compared to individuals without substance use disorders.
Study design
This study was a population-based cohort study.
Methods
Using the Utah Population Database, individuals with substance use disorder history (2015–2020; n = 227,277) were individually matched by age and sex to individuals without substance use disorders (n = 227,277). COVID-19 outcomes from 2020 to 2023 were assessed with conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results
Individuals with substance use disorders had higher odds of hospitalization (OR: 2.90, 95% CI: 2.78–3.02), ICU admission (OR: 2.92, 95% CI: 2.72–3.13), all-cause death (OR: 2.94, 95 % CI: 2.81–3.08), and COVID-19-specific death (OR: 1.34, 95% CI: 1.14–1.57). The ORs for COVID-19 outcomes were similar for individuals with alcohol use disorders and opioid use disorders.
Conclusions
COVID-19 outcomes were strongly associated with substance use disorders, highlighting the need for targeted health strategies for individuals with substance use disorders.
{"title":"COVID-19 outcomes among individuals with substance use disorders","authors":"Chun-Pin Esther Chang , Daniel Knox , Zhe David Yu , Kimberley Shoaf , Sharon L. Talboys , Mia Hashibe","doi":"10.1016/j.puhe.2026.106156","DOIUrl":"10.1016/j.puhe.2026.106156","url":null,"abstract":"<div><h3>Objectives</h3><div>Individuals with substance use disorders may be more susceptible to COVID-19 outcomes due to damage in their immune, pulmonary and respiratory systems. The aim of our study is to investigate COVID-19 outcomes among individuals with a history of substance use disorders compared to individuals without substance use disorders.</div></div><div><h3>Study design</h3><div>This study was a population-based cohort study.</div></div><div><h3>Methods</h3><div>Using the Utah Population Database, individuals with substance use disorder history (2015–2020; n = 227,277) were individually matched by age and sex to individuals without substance use disorders (n = 227,277). COVID-19 outcomes from 2020 to 2023 were assessed with conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Individuals with substance use disorders had higher odds of hospitalization (OR: 2.90, 95% CI: 2.78–3.02), ICU admission (OR: 2.92, 95% CI: 2.72–3.13), all-cause death (OR: 2.94, 95 % CI: 2.81–3.08), and COVID-19-specific death (OR: 1.34, 95% CI: 1.14–1.57). The ORs for COVID-19 outcomes were similar for individuals with alcohol use disorders and opioid use disorders.</div></div><div><h3>Conclusions</h3><div>COVID-19 outcomes were strongly associated with substance use disorders, highlighting the need for targeted health strategies for individuals with substance use disorders.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106156"},"PeriodicalIF":3.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.puhe.2026.106136
Mengnan Tan , Jing Ma , Yaoyao Jiang , Mei Chen , Donghang Luo , Yanchao Qiu , Ce Jia , Jie Xu , Fan Lyu , Chu Zhou
Objectives
This study explored the factors influencing peer-recommended HIV testing in men who have sex with men (MSM), using the Theory of Planned Behavior (TPB), to inform strategies that promote peer engagement in HIV testing.
Study design
Qualitative study.
Methods
We recruited MSM participants through the Tongxing Community-based Organization (CBO) in Shijiazhuang City in September 2024. Semi-structured interviews were conducted using a TPB-based guide, and thematic analysis was performed.
Results
Twenty-four MSM were interviewed (median age = 34.5 years; Q1- Q3: 23–43.5). Most were college-educated, unmarried, and employed. Nineteen (79.2 %) expressed willingness to recommend HIV testing to peers. Three key themes emerged: (1) Attitudes – Participants with positive attitudes generally viewed testing recommendation as a beneficial health practice, whereas negative attitudes reflected concerns about creating discomfort or imposing a social burden on peers. (2) Subjective Norms – Influencing factors included supportive peer environments, limited social networks, and the normative role of CBOs. (3) Perceived Behavioral Control – Facilitators included risk awareness, trust in CBOs, prior experience of being recommended for testing, and access to tools such as HIV self-test kits and social media platforms. Barriers included inadequate HIV testing promotion, privacy concerns.
Conclusions
In summary, this study uses the TPB to conceptualize peer-recommended HIV testing among Chinese MSM as a social behavior that combines pathway navigation and transfer of trust in services. The findings suggest that HIV testing promotion programs should more deliberately integrate peer recommendation into existing services by strengthening norms that frame “recommending testing as caring for peers” and by providing simple scripts and clear pathway information to support potential referrers.
{"title":"Exploring the factors influencing peer-recommended HIV testing in men who have sex with men (MSM): A qualitative study based on the theory of planned behavior","authors":"Mengnan Tan , Jing Ma , Yaoyao Jiang , Mei Chen , Donghang Luo , Yanchao Qiu , Ce Jia , Jie Xu , Fan Lyu , Chu Zhou","doi":"10.1016/j.puhe.2026.106136","DOIUrl":"10.1016/j.puhe.2026.106136","url":null,"abstract":"<div><h3>Objectives</h3><div>This study explored the factors influencing peer-recommended HIV testing in men who have sex with men (MSM), using the Theory of Planned Behavior (TPB), to inform strategies that promote peer engagement in HIV testing.</div></div><div><h3>Study design</h3><div>Qualitative study.</div></div><div><h3>Methods</h3><div>We recruited MSM participants through the Tongxing Community-based Organization (CBO) in Shijiazhuang City in September 2024. Semi-structured interviews were conducted using a TPB-based guide, and thematic analysis was performed.</div></div><div><h3>Results</h3><div>Twenty-four MSM were interviewed (median age = 34.5 years; Q1- Q3: 23–43.5). Most were college-educated, unmarried, and employed. Nineteen (79.2 %) expressed willingness to recommend HIV testing to peers. Three key themes emerged: (1) Attitudes – Participants with positive attitudes generally viewed testing recommendation as a beneficial health practice, whereas negative attitudes reflected concerns about creating discomfort or imposing a social burden on peers. (2) Subjective Norms – Influencing factors included supportive peer environments, limited social networks, and the normative role of CBOs. (3) Perceived Behavioral Control – Facilitators included risk awareness, trust in CBOs, prior experience of being recommended for testing, and access to tools such as HIV self-test kits and social media platforms. Barriers included inadequate HIV testing promotion, privacy concerns.</div></div><div><h3>Conclusions</h3><div>In summary, this study uses the TPB to conceptualize peer-recommended HIV testing among Chinese MSM as a social behavior that combines pathway navigation and transfer of trust in services. The findings suggest that HIV testing promotion programs should more deliberately integrate peer recommendation into existing services by strengthening norms that frame “recommending testing as caring for peers” and by providing simple scripts and clear pathway information to support potential referrers.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106136"},"PeriodicalIF":3.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.puhe.2026.106140
Qianyu Liu , Shuyi Peng , Yuwei Yang , Yannan Guo , Guiyu Jiang , Lan Guo
Objectives
The rise in television and digital media use among adolescents has become a major concern, but the impacts of specific types of screen exposure on mental health remain underexplored. This study examined whether specific types of screen exposure are associated with emotional and behavioral problems (EBPs), and whether individual, family, and school factors moderate these associations.
Study design
Longitudinal study.
Methods
Participants (N = 10,770; mean age 15.89 years, 51.6 % male) completed standardized questionnaires at baseline and follow-up. EBPs were measured using the Strengths and Difficulties Questionnaire, and screen exposure and contextual factors were collected via self-report questionnaires. Generalized linear mixed-effects models, restricted cubic splines, interaction analyses, and sensitivity analyses were conducted.
Results
Specific screen types use, particularly educational apps and shopping/food delivery app exposures, were associated with increased total EBP difficulties. Each additional hour of social networking (OR, 1.04; 95 % CI, 1.01–1.07), short video viewing (OR, 1.05; 95 % CI, 1.01–1.09), or video gaming (OR, 1.06; 95 % CI, 1.01–1.10) was associated with an elevated risk of emotional symptoms. Short videos and video games were also associated with greater hyperactivity/inattention. Moderation analyses showed father's education, academic achievement, health status, and family function significantly modified these associations (e.g., family function × short video use: ORinteraction = 0.89, Pinteraction = 0.014).
Conclusions
These findings highlight the differential impacts of screen exposure types on adolescent mental health and underscore the importance of addressing specific screen behaviors while considering individual, family, and school characteristics that may modify these risks, although the study's observational design limits causal inference.
{"title":"Specific types of screen exposure and adolescent emotional and behavioral problems: Longitudinal associations and moderation by individual, family, and school characteristics","authors":"Qianyu Liu , Shuyi Peng , Yuwei Yang , Yannan Guo , Guiyu Jiang , Lan Guo","doi":"10.1016/j.puhe.2026.106140","DOIUrl":"10.1016/j.puhe.2026.106140","url":null,"abstract":"<div><h3>Objectives</h3><div>The rise in television and digital media use among adolescents has become a major concern, but the impacts of specific types of screen exposure on mental health remain underexplored. This study examined whether specific types of screen exposure are associated with emotional and behavioral problems (EBPs), and whether individual, family, and school factors moderate these associations.</div></div><div><h3>Study design</h3><div>Longitudinal study.</div></div><div><h3>Methods</h3><div>Participants (N = 10,770; mean age 15.89 years, 51.6 % male) completed standardized questionnaires at baseline and follow-up. EBPs were measured using the Strengths and Difficulties Questionnaire, and screen exposure and contextual factors were collected via self-report questionnaires. Generalized linear mixed-effects models, restricted cubic splines, interaction analyses, and sensitivity analyses were conducted.</div></div><div><h3>Results</h3><div>Specific screen types use, particularly educational apps and shopping/food delivery app exposures, were associated with increased total EBP difficulties. Each additional hour of social networking (OR, 1.04; 95 % CI, 1.01–1.07), short video viewing (OR, 1.05; 95 % CI, 1.01–1.09), or video gaming (OR, 1.06; 95 % CI, 1.01–1.10) was associated with an elevated risk of emotional symptoms. Short videos and video games were also associated with greater hyperactivity/inattention. Moderation analyses showed father's education, academic achievement, health status, and family function significantly modified these associations (e.g., family function × short video use: OR<sub>interaction</sub> = 0.89, <em>P</em><sub>interaction</sub> = 0.014).</div></div><div><h3>Conclusions</h3><div>These findings highlight the differential impacts of screen exposure types on adolescent mental health and underscore the importance of addressing specific screen behaviors while considering individual, family, and school characteristics that may modify these risks, although the study's observational design limits causal inference.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106140"},"PeriodicalIF":3.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.puhe.2026.106153
Maria Fernanda de Sá Camarço, Jefferson Felipe Calazans Batista, Sonia Oliveira Lima
Objectives
To analyze the spatial and spatiotemporal distribution of infant mortality in the state of Sergipe from 2019 to 2023.
Study design
Ecological study.
Methods
This ecological study used publicly available data on infant deaths in Sergipe between 2019 and 2023, obtained from the Mortality Information System. Variables related to the child, mother, and healthcare factors were considered. Bayesian mortality rates were calculated and mapped across municipalities. Moran's Index was applied to assess spatial correlation.
Results
Between 2019 and 2023, Sergipe recorded 2547 infant deaths. The leading causes were perinatal conditions (Chapter XVI) and abnormal findings in examinations (Chapter XVIII), predominantly in the northern region. Higher mortality was observed among Black female infants with very low or low birth weight, as well as clusters of deaths among adolescent mothers in the Itabaiana region, and adult or late-age mothers in Propriá, which also showed higher mortality among preterm infants. The municipalities of Propriá and Nossa Senhora do Socorro reported more deaths associated with cesarean deliveries. Aracaju, São Cristóvão, and Nossa Senhora do Socorro formed high-mortality clusters, with a risk 641.77 times greater; conversely, Nossa Senhora da Glória, Lagarto, and Estância exhibited a 66 % lower risk.
Conclusion
Infant mortality in Sergipe is unevenly distributed, concentrated in high-risk clusters, and reflects regional disparities as well as specific maternal and neonatal factors.
目的分析2019 - 2023年塞尔希佩州婴儿死亡率的时空分布特征。研究设计生态研究。方法本生态研究使用了2019年至2023年塞尔希佩州婴儿死亡的公开数据，这些数据来自死亡率信息系统。考虑了与儿童、母亲和保健因素相关的变量。对各个城市的贝叶斯死亡率进行了计算和绘制。采用Moran’s Index评价空间相关性。结果在2019年至2023年期间，Sergipe记录了2547例婴儿死亡。主要原因是围产期条件（第十六章）和检查结果异常（第十八章），主要发生在北部地区。出生体重过低或过低的黑人女婴死亡率较高，在Itabaiana地区的青少年母亲和propriae地区的成年或高龄母亲中也有大量死亡，这也表明早产儿死亡率较高。普罗德市和诺萨·森霍拉·多·索科罗市报告与剖宫产有关的死亡人数更多。Aracaju、s o Cristóvão和Nossa Senhora do Socorro形成了高死亡率集群，风险高出641.77倍；相反，Nossa Senhora da Glória、Lagarto和estncia的风险降低了66%。结论Sergipe地区婴儿死亡率分布不均匀，集中在高危聚集群中，反映了地区差异和特定的母婴因素。
{"title":"Spatial and spatio-temporal distribution of infant mortality in the state of Sergipe, Brazil: An ecological study, 2019–2023","authors":"Maria Fernanda de Sá Camarço, Jefferson Felipe Calazans Batista, Sonia Oliveira Lima","doi":"10.1016/j.puhe.2026.106153","DOIUrl":"10.1016/j.puhe.2026.106153","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the spatial and spatiotemporal distribution of infant mortality in the state of Sergipe from 2019 to 2023.</div></div><div><h3>Study design</h3><div>Ecological study.</div></div><div><h3>Methods</h3><div>This ecological study used publicly available data on infant deaths in Sergipe between 2019 and 2023, obtained from the Mortality Information System. Variables related to the child, mother, and healthcare factors were considered. Bayesian mortality rates were calculated and mapped across municipalities. Moran's Index was applied to assess spatial correlation.</div></div><div><h3>Results</h3><div>Between 2019 and 2023, Sergipe recorded 2547 infant deaths. The leading causes were perinatal conditions (Chapter XVI) and abnormal findings in examinations (Chapter XVIII), predominantly in the northern region. Higher mortality was observed among Black female infants with very low or low birth weight, as well as clusters of deaths among adolescent mothers in the Itabaiana region, and adult or late-age mothers in Propriá, which also showed higher mortality among preterm infants. The municipalities of Propriá and Nossa Senhora do Socorro reported more deaths associated with cesarean deliveries. Aracaju, São Cristóvão, and Nossa Senhora do Socorro formed high-mortality clusters, with a risk 641.77 times greater; conversely, Nossa Senhora da Glória, Lagarto, and Estância exhibited a 66 % lower risk.</div></div><div><h3>Conclusion</h3><div>Infant mortality in Sergipe is unevenly distributed, concentrated in high-risk clusters, and reflects regional disparities as well as specific maternal and neonatal factors.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106153"},"PeriodicalIF":3.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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