Pub Date : 2025-12-17DOI: 10.1016/j.puhe.2025.106095
Ben Wijnen , Margreet Ten Have , Linda Bolier , Frederick Thielen , Marlous Tuithof , Annemarie I. Luik , Filip Smit , Laura Shields-Zeeman
Objectives
Understanding economic benefits associated with improved mental well-being in the general population is important for informing population-level strategies. We aimed to estimate the economic impact associated with changes in mental well-being in the Dutch adult population.
Study design
This study was based on a longitudinal cohort (the Netherlands Mental Health Survey and Incidence Study-2)
Methods
5303 adults aged 18–64 years. Were included. Three measurements, each separated by a time interval of three years, were used to evaluate how a change in well-being predicts a change in costs. Well-being was measured using the Mental Health Continuum-Short Form. Societal costs encompassed three cost categories: 1) healthcare costs; 2) productivity losses; and 3) patient and family costs. Main analysis was based on a model where a change in costs Y(t2-t1) was regressed on a synchronically occurring change in well-being X(t2-t1). Additionally, this model was compared with a diachronic model where a subsequent change in costs was regressed on a preceding change in well-being, i.e. Y(t3-t2) on X(t2-t1).
Results
Each %-point increase in mental well-being reduced societal costs by –€50.74 (95 %CI: €78.72; –€22.76) per person, which was statistically significant (SE = 14.27, t = −3.56, p < 0.001). The majority of these savings (89 %) were attributable to increased productivity. In the diachronic model, no significant difference between wellbeing and subsequent costs was found.
Conclusion
This study demonstrated that improvements in mental well-being are potentially associated with simultaneously occurring cost reductions, primarily through increased productivity. Hence, there may be potential for mental well-being interventions to reduce societal costs and enhance productivity at a population level.
{"title":"Economic benefits of mental well-being over time: Results from the Netherlands mental health survey and incidence study-2","authors":"Ben Wijnen , Margreet Ten Have , Linda Bolier , Frederick Thielen , Marlous Tuithof , Annemarie I. Luik , Filip Smit , Laura Shields-Zeeman","doi":"10.1016/j.puhe.2025.106095","DOIUrl":"10.1016/j.puhe.2025.106095","url":null,"abstract":"<div><h3>Objectives</h3><div>Understanding economic benefits associated with improved mental well-being in the general population is important for informing population-level strategies. We aimed to estimate the economic impact associated with changes in mental well-being in the Dutch adult population.</div></div><div><h3>Study design</h3><div>This study was based on a longitudinal cohort (the Netherlands Mental Health Survey and Incidence Study-2)</div></div><div><h3>Methods</h3><div>5303 adults aged 18–64 years. Were included. Three measurements, each separated by a time interval of three years, were used to evaluate how a change in well-being predicts a change in costs. Well-being was measured using the Mental Health Continuum-Short Form. Societal costs encompassed three cost categories: 1) healthcare costs; 2) productivity losses; and 3) patient and family costs. Main analysis was based on a model where a change in costs Y<sub>(t2-t1)</sub> was regressed on a synchronically occurring change in well-being X<sub>(t2-t1).</sub> Additionally, this model was compared with a diachronic model where a subsequent change in costs was regressed on a preceding change in well-being, i.e. Y<sub>(t3-t2)</sub> on X<sub>(t2-t1).</sub></div></div><div><h3>Results</h3><div>Each %-point increase in mental well-being reduced societal costs by –€50.74 (95 %CI: €78.72; –€22.76) per person, which was statistically significant (SE = 14.27, t = −3.56, p < 0.001). The majority of these savings (89 %) were attributable to increased productivity. In the diachronic model, no significant difference between wellbeing and subsequent costs was found.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that improvements in mental well-being are potentially associated with simultaneously occurring cost reductions, primarily through increased productivity. Hence, there may be potential for mental well-being interventions to reduce societal costs and enhance productivity at a population level.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106095"},"PeriodicalIF":3.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783482","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 : 2025-12-17DOI: 10.1016/j.puhe.2025.106101
Chuan Li , Rong Song , Xin Yu , Yanhong Fang , Jiayuan Yang , Zhiyuan Tang , Shaoqi Wang , Xunrong Cheng , Jian Song , Weizhuo Yi , Rubing Pan , Hong Su
Objectives
This study aimed to investigate the association between low-level air pollution and adverse pregnancy outcomes, assess the potential mediating role of healthy lifestyle, and identify key modifiable behaviors.
Study design
Case-control study.
Methods
This study included a total of 231,331 female participants from the UK Biobank. A healthy lifestyle score was established based on non-smoking, moderate drinking, healthy diet, regular physical activity, and ideal BMI. Multivariable logistic regression model was used to explore the associations between low-level air pollution, healthy lifestyle and adverse pregnancy outcomes. The eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) were employed to elucidate the relative importance of these modifiable behaviors.
Results
Each 1 μg/m3 increase in PM2.5, PM10, NO2, and NOx was associated with an increased risk of low offspring birthweight. The odds ratios (95 % CI) were 1.046 (1.025–1.068) for PM2.5, 1.015 (1.004–1.027) for PM10, 1.007 (1.004–1.009) for NO2, 1.003 (1.002–1.005) for NOx. No significant associations were found between low-level air pollution and other adverse pregnancy outcomes. Participants with unfavorable lifestyle and higher low-level air pollution had the highest risk of low offspring birthweight. In the modeling study, a healthy diet, and ideal BMI were identified as main modifiable behaviors.
Conclusions
Low-level air pollution was still associated with reduced offspring birth weight. Adopting a healthy lifestyle, especially healthy diet, and ideal BMI, could help mitigate the risks of air pollution. These findings provide evidence to support integrated interventions that combine environmental regulation with lifestyle modification programs to reduce adverse pregnancy outcomes effectively.
{"title":"Healthy lifestyle mitigates the impact of low-level air pollution on adverse pregnancy outcomes: Evidence from a population-based study","authors":"Chuan Li , Rong Song , Xin Yu , Yanhong Fang , Jiayuan Yang , Zhiyuan Tang , Shaoqi Wang , Xunrong Cheng , Jian Song , Weizhuo Yi , Rubing Pan , Hong Su","doi":"10.1016/j.puhe.2025.106101","DOIUrl":"10.1016/j.puhe.2025.106101","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate the association between low-level air pollution and adverse pregnancy outcomes, assess the potential mediating role of healthy lifestyle, and identify key modifiable behaviors.</div></div><div><h3>Study design</h3><div>Case-control study.</div></div><div><h3>Methods</h3><div>This study included a total of 231,331 female participants from the UK Biobank. A healthy lifestyle score was established based on non-smoking, moderate drinking, healthy diet, regular physical activity, and ideal BMI. Multivariable logistic regression model was used to explore the associations between low-level air pollution, healthy lifestyle and adverse pregnancy outcomes. The eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) were employed to elucidate the relative importance of these modifiable behaviors.</div></div><div><h3>Results</h3><div>Each 1 μg/m<sup>3</sup> increase in PM<sub>2.5</sub>, PM<sub>10</sub>, NO<sub>2</sub>, and NO<sub>x</sub> was associated with an increased risk of low offspring birthweight. The odds ratios (95 % <em>CI</em>) were 1.046 (1.025–1.068) for PM<sub>2.5</sub>, 1.015 (1.004–1.027) for PM<sub>10</sub>, 1.007 (1.004–1.009) for NO<sub>2</sub>, 1.003 (1.002–1.005) for NO<sub>x</sub>. No significant associations were found between low-level air pollution and other adverse pregnancy outcomes. Participants with unfavorable lifestyle and higher low-level air pollution had the highest risk of low offspring birthweight. In the modeling study, a healthy diet, and ideal BMI were identified as main modifiable behaviors.</div></div><div><h3>Conclusions</h3><div>Low-level air pollution was still associated with reduced offspring birth weight. Adopting a healthy lifestyle, especially healthy diet, and ideal BMI, could help mitigate the risks of air pollution. These findings provide evidence to support integrated interventions that combine environmental regulation with lifestyle modification programs to reduce adverse pregnancy outcomes effectively.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106101"},"PeriodicalIF":3.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783459","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 : 2025-12-17DOI: 10.1016/j.puhe.2025.106099
Aditi Roy , Gavin Pereira , Jennifer Dunne , Sylvester Dodzi Nyadanu , Gizachew A. Tessema
Objectives
In a country such as India where caste systems deeply influence social dynamics, caste systems could modify the association between experiencing intimate partner violence (IPV) and maternal and child health and wellbeing. This study aimed to investigate the association between IPV and child mortality across various caste groups.
Study design
The study has a cross-sectional design drawn from the two latest available nationally representative National Family Health Surveys data (2015–2021) in India.
Methods
This study included 58,685 mother-child pairs. In the study, the main exposure variable was IPV, measured by women's experiences of emotional, physical, and sexual violence perpetrated by a partner, with caste considered as an effect modifier in the analysis. The outcomes of the study included under five mortality. By accounting for women's and child demographics, logistic regression analysis was used to estimate adjusted odds ratios (aOR) for the association between IPV and infant, neonatal, and under-five mortality stratified by caste.
Results
Women who had experienced IPV had 16 % greater odds of neonatal mortality (1.16, 95 % CI: 1.10–1.23), 17 % greater odds of infant mortality (1.17, 95 % CI: 1.03, 1.33), and 12 % greater odds of under-five mortality (1.12; 95 % CI: 0.98, 1.18). When stratified by caste, IPV exposure among women from upper castes had a 68 % greater in the odds of neonatal mortality (aOR: 1.68, 95 % CI: 1.22, 2.29), 24 % greater odds of infant mortality (1.24, 95 % CI: 1.02, 1.80), and 40 % greater odds of under-five mortality (aOR: 1.40, 95 % CI: 1.09, 1.81). Notably, among lower-caste groups, we observed greater odds of under-five mortality among women who experienced IPV in STs group compared to SCs and OBCs.
Conclusion
IPV is associated positively with neonatal, infant, and under-five mortalities with greater effect in upper than lower caste women. Our findings suggest that addressing IPV in caste-specific situations may be crucial for reducing under-five mortality in India.
{"title":"Maternal intimate partner violence and under five mortality in India: The effect modifying role of caste","authors":"Aditi Roy , Gavin Pereira , Jennifer Dunne , Sylvester Dodzi Nyadanu , Gizachew A. Tessema","doi":"10.1016/j.puhe.2025.106099","DOIUrl":"10.1016/j.puhe.2025.106099","url":null,"abstract":"<div><h3>Objectives</h3><div>In a country such as India where caste systems deeply influence social dynamics, caste systems could modify the association between experiencing intimate partner violence (IPV) and maternal and child health and wellbeing. This study aimed to investigate the association between IPV and child mortality across various caste groups.</div></div><div><h3>Study design</h3><div>The study has a cross-sectional design drawn from the two latest available nationally representative National Family Health Surveys data (2015–2021) in India.</div></div><div><h3>Methods</h3><div>This study included 58,685 mother-child pairs. In the study, the main exposure variable was IPV, measured by women's experiences of emotional, physical, and sexual violence perpetrated by a partner, with caste considered as an effect modifier in the analysis. The outcomes of the study included under five mortality. By accounting for women's and child demographics, logistic regression analysis was used to estimate adjusted odds ratios (aOR) for the association between IPV and infant, neonatal, and under-five mortality stratified by caste.</div></div><div><h3>Results</h3><div>Women who had experienced IPV had 16 % greater odds of neonatal mortality (1.16, 95 % CI: 1.10–1.23), 17 % greater odds of infant mortality (1.17, 95 % CI: 1.03, 1.33), and 12 % greater odds of under-five mortality (1.12; 95 % CI: 0.98, 1.18). When stratified by caste, IPV exposure among women from upper castes had a 68 % greater in the odds of neonatal mortality (aOR: 1.68, 95 % CI: 1.22, 2.29), 24 % greater odds of infant mortality (1.24, 95 % CI: 1.02, 1.80), and 40 % greater odds of under-five mortality (aOR: 1.40, 95 % CI: 1.09, 1.81). Notably, among lower-caste groups, we observed greater odds of under-five mortality among women who experienced IPV in STs group compared to SCs and OBCs.</div></div><div><h3>Conclusion</h3><div>IPV is associated positively with neonatal, infant, and under-five mortalities with greater effect in upper than lower caste women. Our findings suggest that addressing IPV in caste-specific situations may be crucial for reducing under-five mortality in India.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106099"},"PeriodicalIF":3.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783529","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 : 2025-12-17DOI: 10.1016/j.puhe.2025.106094
Jasper W.A. van Egeraat , Julie A.E. van Oortmerssen , Jeanine E. Roeters van Lennep , Maryam Kavousi , Robert T.A. Willemsen , Tobias N. Bonten , Annelieke H.J. Petrus , the IMPRESS consortium
Objectives
Acute coronary syndrome (ACS) incidence and mortality rates have risen among women <60 years. This study sought to examine sex differences in healthcare pathways for first-time ACS in young patients, focusing on pre-ACS care, diagnosis and in-hospital management, and post-discharge outcomes.
Study design
Observational cohort study.
Methods
This study uses linked data from primary care, hospital records and national mortality datasets to assess ACS care pathways among Dutch patients aged 30–60 years between 2013 and 2022. Continuous variables were compared with Wilcoxon rank-sum tests and categorical variables with Chi-square tests. Multiple testing is addressed by controlling the false discovery rate.
Results
Women more often had at least one comorbidity (57.6 % vs 51.3 %, p = 0.024) and more primary care consultations in the month preceding ACS (1.37 vs 1.00, p < 0.001). Men were more frequently diagnosed with ST-elevation myocardial infarction (STEMI), while women were more often diagnosed with non–ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA), p < 0.001. In-hospital interventions were similar between sexes for STEMI but were different and less frequently performed in women with NSTEMI (p = 0.001) or UA (p = 0.005) compared with men. Post-discharge, women were less likely to receive antithrombotic (87.7 % vs 91.5 %, p = 0.024) and lipid-lowering therapies (82.6 % vs 88.5 %, p = 0.002). Mortality rates before hospitalization, at 30 days, and at 1 year were comparable between sexes.
Conclusions
Sex differences exist in healthcare pathways for individuals aged 30–60 years with first-time ACS regarding prevalence of comorbidities, ACS subtype, in-hospital interventions, and post-discharge medication use. However, 30-day and 1-year survival rates after discharge were comparable between women and men.
{"title":"Sex differences in care for acute coronary syndrome in patients under 60 years: Primary care presentation, referral patterns, hospitalizations and clinical outcomes","authors":"Jasper W.A. van Egeraat , Julie A.E. van Oortmerssen , Jeanine E. Roeters van Lennep , Maryam Kavousi , Robert T.A. Willemsen , Tobias N. Bonten , Annelieke H.J. Petrus , the IMPRESS consortium","doi":"10.1016/j.puhe.2025.106094","DOIUrl":"10.1016/j.puhe.2025.106094","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute coronary syndrome (ACS) incidence and mortality rates have risen among women <60 years. This study sought to examine sex differences in healthcare pathways for first-time ACS in young patients, focusing on pre-ACS care, diagnosis and in-hospital management, and post-discharge outcomes.</div></div><div><h3>Study design</h3><div>Observational cohort study.</div></div><div><h3>Methods</h3><div>This study uses linked data from primary care, hospital records and national mortality datasets to assess ACS care pathways among Dutch patients aged 30–60 years between 2013 and 2022. Continuous variables were compared with Wilcoxon rank-sum tests and categorical variables with Chi-square tests. Multiple testing is addressed by controlling the false discovery rate.</div></div><div><h3>Results</h3><div>Women more often had at least one comorbidity (57.6 % vs 51.3 %, p = 0.024) and more primary care consultations in the month preceding ACS (1.37 vs 1.00, p < 0.001). Men were more frequently diagnosed with ST-elevation myocardial infarction (STEMI), while women were more often diagnosed with non–ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA), p < 0.001. In-hospital interventions were similar between sexes for STEMI but were different and less frequently performed in women with NSTEMI (p = 0.001) or UA (p = 0.005) compared with men. Post-discharge, women were less likely to receive antithrombotic (87.7 % vs 91.5 %, p = 0.024) and lipid-lowering therapies (82.6 % vs 88.5 %, p = 0.002). Mortality rates before hospitalization, at 30 days, and at 1 year were comparable between sexes.</div></div><div><h3>Conclusions</h3><div>Sex differences exist in healthcare pathways for individuals aged 30–60 years with first-time ACS regarding prevalence of comorbidities, ACS subtype, in-hospital interventions, and post-discharge medication use. However, 30-day and 1-year survival rates after discharge were comparable between women and men.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106094"},"PeriodicalIF":3.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783544","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 : 2025-12-16DOI: 10.1016/j.puhe.2025.106098
Andreas Lindegaard Jakobsen
Objectives
This study aimed to examine the association between living alone and adult loneliness, and the buffering role of neighbourhood social interaction and attachment on this association.
Study design
Cross-sectional study.
Methods
Survey data encompassing 15,044 adults aged 35 and older from the North Denmark Region Health Survey 2017 were linked to Danish population register data. Loneliness was assessed using the Three-Item Loneliness Scale (T-ILS). Neighbourhood social interaction, attachment and living arrangements were measured through survey-based indicators. Register data provided information on sociodemographic covariates including sex, age, own/parental country of birth, education, income, and employment status. Multilevel linear probability models, with individuals nested within small area neighbourhoods, were used to test the hypotheses.
Results
After adjusting for covariates, living alone was significantly associated with an 8.72 percentage point higher probability of loneliness. Individuals reporting frequent neighbourhood social interactions or high levels of neighbourhood attachment had an 8.18 and 5.06 percentage point lower probability of loneliness, respectively. Moderation analyses indicated that both neighbourhood social interaction and attachment significantly buffered the negative impact of living alone, as living alone was less strongly associated with loneliness among individuals who reported high levels of neighbourhood social interaction and attachment.
Conclusions
These findings suggest that neighbourhood social interaction and attachment may buffer the negative impact of living alone on loneliness. Strengthening neighbourhood attachment and fostering local social interactions could be valuable public health strategies to mitigate loneliness among individuals living alone.
{"title":"Living alone and adult loneliness: The buffering role of neighbourhood social interaction and attachment","authors":"Andreas Lindegaard Jakobsen","doi":"10.1016/j.puhe.2025.106098","DOIUrl":"10.1016/j.puhe.2025.106098","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the association between living alone and adult loneliness, and the buffering role of neighbourhood social interaction and attachment on this association.</div></div><div><h3>Study design</h3><div>Cross-sectional study.</div></div><div><h3>Methods</h3><div>Survey data encompassing 15,044 adults aged 35 and older from the North Denmark Region Health Survey 2017 were linked to Danish population register data. Loneliness was assessed using the Three-Item Loneliness Scale (T-ILS). Neighbourhood social interaction, attachment and living arrangements were measured through survey-based indicators. Register data provided information on sociodemographic covariates including sex, age, own/parental country of birth, education, income, and employment status. Multilevel linear probability models, with individuals nested within small area neighbourhoods, were used to test the hypotheses.</div></div><div><h3>Results</h3><div>After adjusting for covariates, living alone was significantly associated with an 8.72 percentage point higher probability of loneliness. Individuals reporting frequent neighbourhood social interactions or high levels of neighbourhood attachment had an 8.18 and 5.06 percentage point lower probability of loneliness, respectively. Moderation analyses indicated that both neighbourhood social interaction and attachment significantly buffered the negative impact of living alone, as living alone was less strongly associated with loneliness among individuals who reported high levels of neighbourhood social interaction and attachment.</div></div><div><h3>Conclusions</h3><div>These findings suggest that neighbourhood social interaction and attachment may buffer the negative impact of living alone on loneliness. Strengthening neighbourhood attachment and fostering local social interactions could be valuable public health strategies to mitigate loneliness among individuals living alone.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106098"},"PeriodicalIF":3.2,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776181","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 : 2025-12-15DOI: 10.1016/j.puhe.2025.106090
A. Clarke , L. Quinn , G.M. Peat
Objectives
To investigate inverse and positive care laws for the geographic distribution of different healthcare workforces in England between 2001 and 2021.
Study design
Repeated, cross-sectional, ecologic study at the level of Local Authorities (2001, 2011, 2021) and Integrated Care Boards (2021).
Methods
Using national Census survey data for England from 2001, 2011, and 2021 we correlated the prevalence of ill health in the resident population with the proportion of different health professional groups employed in the resident working-age population. To explore the previously described Positive Care Law for informal care, we correlated with the prevalence of ill health with the proportion of the resident population providing 50+ hours of unpaid care per week.
Results
Across 2001, 2011, and 2021, the distributions of medical professionals and ‘health associates and therapy professionals’ were consistently inversely distributed relative to population ill health. Nursing professionals and informal caregiving were consistently positively correlated. Data available in 2021 on detailed professional groups revealed wide variation in the distribution of different professional groups relative to population ill health: speech and language therapists (r=−0.456), complementary health associate professionals (r=−0.478), and psychotherapists/cognitive behaviour therapists (r=−0.558) showed the strongest inverse correlation with population ill health. Pharmaceutical technicians (0.774), nursing auxiliaries/assistants (0.764), and care workers/home carers (0.746) were among the most positively correlated.
Conclusions
Inverse and positive care laws for healthcare workforce distribution in England appear largely unchanged over the past 20 years. Marked variation between different health professions suggests the need for targeted actions to improve equitable distribution.
{"title":"The distribution of healthcare workforces relative to population ill health in England: Repeated cross-sectional analysis of Census data 2001–2021","authors":"A. Clarke , L. Quinn , G.M. Peat","doi":"10.1016/j.puhe.2025.106090","DOIUrl":"10.1016/j.puhe.2025.106090","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate inverse and positive care laws for the geographic distribution of different healthcare workforces in England between 2001 and 2021.</div></div><div><h3>Study design</h3><div>Repeated, cross-sectional, ecologic study at the level of Local Authorities (2001, 2011, 2021) and Integrated Care Boards (2021).</div></div><div><h3>Methods</h3><div>Using national Census survey data for England from 2001, 2011, and 2021 we correlated the prevalence of ill health in the resident population with the proportion of different health professional groups employed in the resident working-age population. To explore the previously described Positive Care Law for informal care, we correlated with the prevalence of ill health with the proportion of the resident population providing 50+ hours of unpaid care per week.</div></div><div><h3>Results</h3><div>Across 2001, 2011, and 2021, the distributions of medical professionals and ‘health associates and therapy professionals’ were consistently inversely distributed relative to population ill health. Nursing professionals and informal caregiving were consistently positively correlated. Data available in 2021 on detailed professional groups revealed wide variation in the distribution of different professional groups relative to population ill health: speech and language therapists (r=−0.456), complementary health associate professionals (r=−0.478), and psychotherapists/cognitive behaviour therapists (r=−0.558) showed the strongest inverse correlation with population ill health. Pharmaceutical technicians (0.774), nursing auxiliaries/assistants (0.764), and care workers/home carers (0.746) were among the most positively correlated.</div></div><div><h3>Conclusions</h3><div>Inverse and positive care laws for healthcare workforce distribution in England appear largely unchanged over the past 20 years. Marked variation between different health professions suggests the need for targeted actions to improve equitable distribution.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106090"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769716","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 : 2025-12-13DOI: 10.1016/j.puhe.2025.106097
Victoria Hernando , Catarina Filipe Santos , Natalia Cuenca , Julia del Amo , Asuncion Diaz , Enrique Acín , Carmen Martinez-Aznar
Objectives
Our aims were to describe the public health interventions for the prevention and control of HIV and HCV infections in penitentiary institutions in Spain from 1989 until 2023 and to describe the epidemiological trends of HIV and HCV among inmates from 1993 until 2023.
Study design
Ecological and retrospective observational study.
Methods
All prevention programs and control measures for HIV and HCV infections implemented in Spanish prisons were reviewed. Aggregate data were extracted from central registries, reports, official documents (grey literature) and epidemiological bulletins issued by the Public Health division of the General Subdirectorate of Prison Health.
Results
Various control measures, such as harm reduction programs, including syringe exchange and methadone maintenance programs, have been implemented in Spanish prisons since 1989. These measures have been modified and adapted in response to changes in the prison population. The prevalence of HIV and HCV infection among inmates in Spanish prisons has decreased markedly over the study period: from 23.5 % in 1993 to 3.2 % in 2023 for HIV, and from 48.6 % in 1998 to 9.6 % in 2023 for HCV. In the past three years, fewer than 1 % of inmates had a detectable HCV viral load. No HIV or HCV seroconversions have been reported in Spanish prisons since 2015 and 2020, respectively.
Conclusions
This ecological study found a correlation between interventions designed and implemented in Spanish prisons for the prevention, diagnosis and treatment of HIV and HCV, and a reduction in the prevalence of these infections among the prison population.
{"title":"Epidemiology and control of human immunodeficiency and hepatitis C virus in Spanish prisons over the last 30 years: Towards the achievement of sustainable development goals","authors":"Victoria Hernando , Catarina Filipe Santos , Natalia Cuenca , Julia del Amo , Asuncion Diaz , Enrique Acín , Carmen Martinez-Aznar","doi":"10.1016/j.puhe.2025.106097","DOIUrl":"10.1016/j.puhe.2025.106097","url":null,"abstract":"<div><h3>Objectives</h3><div>Our aims were to describe the public health interventions for the prevention and control of HIV and HCV infections in penitentiary institutions in Spain from 1989 until 2023 and to describe the epidemiological trends of HIV and HCV among inmates from 1993 until 2023.</div></div><div><h3>Study design</h3><div>Ecological and retrospective observational study.</div></div><div><h3>Methods</h3><div>All prevention programs and control measures for HIV and HCV infections implemented in Spanish prisons were reviewed. Aggregate data were extracted from central registries, reports, official documents (grey literature) and epidemiological bulletins issued by the Public Health division of the General Subdirectorate of Prison Health.</div></div><div><h3>Results</h3><div>Various control measures, such as harm reduction programs, including syringe exchange and methadone maintenance programs, have been implemented in Spanish prisons since 1989. These measures have been modified and adapted in response to changes in the prison population. The prevalence of HIV and HCV infection among inmates in Spanish prisons has decreased markedly over the study period: from 23.5 % in 1993 to 3.2 % in 2023 for HIV, and from 48.6 % in 1998 to 9.6 % in 2023 for HCV. In the past three years, fewer than 1 % of inmates had a detectable HCV viral load. No HIV or HCV seroconversions have been reported in Spanish prisons since 2015 and 2020, respectively.</div></div><div><h3>Conclusions</h3><div>This ecological study found a correlation between interventions designed and implemented in Spanish prisons for the prevention, diagnosis and treatment of HIV and HCV, and a reduction in the prevalence of these infections among the prison population.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106097"},"PeriodicalIF":3.2,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758193","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 : 2025-12-13DOI: 10.1016/j.puhe.2025.106105
Jingyu Sun, Ke Yao, Hang Chu, Jiajia Chen, Changhong Du, Bin Li, Zhijie Yu, Ziqi Zhang, Tao Chen
Objectives
This study aims to examine the impact of a 16-week Tai Chi program on the physical and mental health of college students (ages 18–20 years) with post-COVID-19 fatigue symptoms.
Study design
A randomized controlled trial.
Methods
Seventy students were randomly assigned to either a Tai Chi group (n = 35), participating in a 16-week Tai Chi exercise program (3 × 90 min/week), or a control group (n = 35), maintaining their usual routines. Physical and mental health were assessed before and after using various scales, including the Fatigue Scale 14, Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, the 10-item Kessler Psychological Distress Scale, Perceived Stress Scale, Self-Rating Depression Scale, the 36-Item Short Form Health Survey questionnaire (SF-36), International Physical Activity Questionnaire, and physical fitness data.
Results
The Tai Chi group showed significant improvements in fatigue, physical functioning (SF-36), balance (one foot with eyes closed), and squat performance compared to the control group (p < 0.05). Sleep quality, habitual sleep efficiency, physical and social functioning, total physical activity, high-intensity activity, flexibility, and core strength (e.g., sit-ups) also improved significantly (p < 0.05).
Conclusion
Tai Chi effectively reduces fatigue and enhances physical fitness, balance, and sleep in college students with post-COVID-19 fatigue symptoms.
{"title":"The effect of Tai Chi exercise on physical and psychological health of college students with persistent fatigue after COVID-19 infection: A randomized controlled trial","authors":"Jingyu Sun, Ke Yao, Hang Chu, Jiajia Chen, Changhong Du, Bin Li, Zhijie Yu, Ziqi Zhang, Tao Chen","doi":"10.1016/j.puhe.2025.106105","DOIUrl":"10.1016/j.puhe.2025.106105","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to examine the impact of a 16-week Tai Chi program on the physical and mental health of college students (ages 18–20 years) with post-COVID-19 fatigue symptoms.</div></div><div><h3>Study design</h3><div>A randomized controlled trial.</div></div><div><h3>Methods</h3><div>Seventy students were randomly assigned to either a Tai Chi group (<em>n</em> = 35), participating in a 16-week Tai Chi exercise program (3 × 90 min/week), or a control group (<em>n</em> = 35), maintaining their usual routines. Physical and mental health were assessed before and after using various scales, including the Fatigue Scale 14, Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, the 10-item Kessler Psychological Distress Scale, Perceived Stress Scale, Self-Rating Depression Scale, the 36-Item Short Form Health Survey questionnaire (SF-36), International Physical Activity Questionnaire, and physical fitness data.</div></div><div><h3>Results</h3><div>The Tai Chi group showed significant improvements in fatigue, physical functioning (SF-36), balance (one foot with eyes closed), and squat performance compared to the control group (<em>p</em> < 0.05). Sleep quality, habitual sleep efficiency, physical and social functioning, total physical activity, high-intensity activity, flexibility, and core strength (e.g., sit-ups) also improved significantly (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Tai Chi effectively reduces fatigue and enhances physical fitness, balance, and sleep in college students with post-COVID-19 fatigue symptoms.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106105"},"PeriodicalIF":3.2,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758203","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 : 2025-12-11DOI: 10.1016/j.puhe.2025.106080
Kasra Ghaharian , Mana Azizsoltani , Charles Cohen , Piyush Puranik , Bernardo Chagas
Objectives
In February 2025, the UK Gambling Commission mandated that online gambling operators must conduct financial risk checks for customers incurring a net loss of over £150 in any rolling 30-day period. This policy aims to mitigate gambling-related harm by identifying potentially vulnerable individuals. This study provides a pre-policy baseline profile of individuals who would have triggered these newly mandated thresholds, using large-scale open banking data.
Study design
Retrospective cross-sectional analysis.
Methods
We used a 12-month period of bank transaction data from 243,478 UK-based gamblers to characterize individuals who would have exceeded the threshold. We examined demographic and behavioural characteristics of this group and used cluster analysis to identify subgroups with distinct financial and gambling profiles.
Results
Nearly a quarter of gamblers triggered the threshold and accounted for the vast majority of total gambling expenditure (∼92%). These Exceeding Threshold Gamblers (ETGs) were disproportionately male, younger, and exhibited significantly greater gambling involvement. Cluster analysis revealed three ETG subgroups, with approximately half classified as diversified spenders whose gambling appeared proportionate to income and part of broader discretionary spending, while others exhibited patterns more consistent with potential financial vulnerability.
Conclusions
While the policy may effectively flag at-risk individuals, it also captures a heterogeneous population.
{"title":"Characterising online gamblers exceeding financial risk thresholds in the UK: A retrospective analysis using open banking data","authors":"Kasra Ghaharian , Mana Azizsoltani , Charles Cohen , Piyush Puranik , Bernardo Chagas","doi":"10.1016/j.puhe.2025.106080","DOIUrl":"10.1016/j.puhe.2025.106080","url":null,"abstract":"<div><h3>Objectives</h3><div>In February 2025, the UK Gambling Commission mandated that online gambling operators must conduct financial risk checks for customers incurring a net loss of over £150 in any rolling 30-day period. This policy aims to mitigate gambling-related harm by identifying potentially vulnerable individuals. This study provides a pre-policy baseline profile of individuals who would have triggered these newly mandated thresholds, using large-scale open banking data.</div></div><div><h3>Study design</h3><div>Retrospective cross-sectional analysis.</div></div><div><h3>Methods</h3><div>We used a 12-month period of bank transaction data from 243,478 UK-based gamblers to characterize individuals who would have exceeded the threshold. We examined demographic and behavioural characteristics of this group and used cluster analysis to identify subgroups with distinct financial and gambling profiles.</div></div><div><h3>Results</h3><div>Nearly a quarter of gamblers triggered the threshold and accounted for the vast majority of total gambling expenditure (∼92%). These Exceeding Threshold Gamblers (ETGs) were disproportionately male, younger, and exhibited significantly greater gambling involvement. Cluster analysis revealed three ETG subgroups, with approximately half classified as diversified spenders whose gambling appeared proportionate to income and part of broader discretionary spending, while others exhibited patterns more consistent with potential financial vulnerability.</div></div><div><h3>Conclusions</h3><div>While the policy may effectively flag at-risk individuals, it also captures a heterogeneous population.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106080"},"PeriodicalIF":3.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738423","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 : 2025-12-11DOI: 10.1016/j.puhe.2025.106089
Agnès Trouche , Nicolas Doudeau , François Vilain , Kahina Sadat , Yannick Morvan , Ariel Frajerman
Objectives
Sexual and gender-based violence (SGBV) affects an important part of the population, and medical trainees are no exception. A 2014 meta-analysis on medical students found that 59 % experienced at least one form of harassment or discrimination during their studies. This study aimed to gather data on SGBV among French medical students in 2024 and to compare its evolution since 2021.
Study design
Two national online surveys on mental health in medical school students and residents of all specialities were conducted in 2021 and 2024.
Methods
In both surveys, the questionnaire included a section on humiliation and sexual violence, using 5 questions from a nationwide survey on Students in France.
Results
We included 17,225 subjects: 9960 in 2021 and 7265 in 2024. The prevalence of violence during the medical studies was 27 % and 17 % for humiliation, 29 % and 22 % for sexual harassment, and 5 % and 6 % for sexual assault in 2021 and 2024, respectively. Women were five times more likely to experience sexual harassment than men. Among the victims, 76 % reported experiencing violence in the hospital, 28 % at student parties, and 10 % at the university. Since 2021, there has been a 26 % increase in reported incidents of violence compared to the previous year (19 %).
Conclusions
Despite policies implemented following previous surveys, the rate of sexual harassment remains high. The majority of these violent occurrences in hospital settings highlighting the importance of taking specific actions tailored to the structure of medical studies and the healthcare and caregiving system.
{"title":"Humiliation and sexual violence in medical students: Results from two nationwide studies","authors":"Agnès Trouche , Nicolas Doudeau , François Vilain , Kahina Sadat , Yannick Morvan , Ariel Frajerman","doi":"10.1016/j.puhe.2025.106089","DOIUrl":"10.1016/j.puhe.2025.106089","url":null,"abstract":"<div><h3>Objectives</h3><div>Sexual and gender-based violence (SGBV) affects an important part of the population, and medical trainees are no exception. A 2014 meta-analysis on medical students found that 59 % experienced at least one form of harassment or discrimination during their studies. This study aimed to gather data on SGBV among French medical students in 2024 and to compare its evolution since 2021.</div></div><div><h3>Study design</h3><div>Two national online surveys on mental health in medical school students and residents of all specialities were conducted in 2021 and 2024.</div></div><div><h3>Methods</h3><div>In both surveys, the questionnaire included a section on humiliation and sexual violence, using 5 questions from a nationwide survey on Students in France.</div></div><div><h3>Results</h3><div>We included 17,225 subjects: 9960 in 2021 and 7265 in 2024. The prevalence of violence during the medical studies was 27 % and 17 % for humiliation, 29 % and 22 % for sexual harassment, and 5 % and 6 % for sexual assault in 2021 and 2024, respectively. Women were five times more likely to experience sexual harassment than men. Among the victims, 76 % reported experiencing violence in the hospital, 28 % at student parties, and 10 % at the university. Since 2021, there has been a 26 % increase in reported incidents of violence compared to the previous year (19 %).</div></div><div><h3>Conclusions</h3><div>Despite policies implemented following previous surveys, the rate of sexual harassment remains high. The majority of these violent occurrences in hospital settings highlighting the importance of taking specific actions tailored to the structure of medical studies and the healthcare and caregiving system.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106089"},"PeriodicalIF":3.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738424","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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