This cohort study examines the association between circadian syndrome (CircS) and the risks of all-cause and cardiovascular disease (CVD) mortality, focusing on various age groups. The analysis included 8,972 participants from the National Health and Nutrition Examination Survey (NHANES). Kaplan-Meier survival curves were employed to assess survival probabilities and Cox proportional hazards models were utilized to evaluate the impact of CircS on mortality. The findings revealed a CircS prevalence of 37.7
Type 2 diabetes mellitus (T2DM) combined with cardiovascular disease (CVD) is a major cause of 30-day readmission in older adults (≥ 65 years), yet predictive models for this high-risk population remain scarce. Developing effective tools to enhance prognostic assessment and reduce readmission rates is critical for clinical practice. This study analyzed data from older adults with T2DM combined with CVD across seven Chinese medical centers (2012–2024). Using receiver operating characteristic (ROC) curves, 16 composite indicators for 30-day readmission risk were evaluated. Key predictors were identified via the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic analysis, forming the basis of a nomogram validated internally and externally. Nonlinear relationships and subgroup heterogeneity were further assessed. A total of 15,925 older adults with T2DM combined with CVD were ultimately included in this study (11,189 in the development cohort, comprising training and internal validation sets, and 4,736 in the external validation set). The ROC curve revealed that neutrophil percentage to albumin ratio (NPAR) was the best predictor of 30-day readmission risk [area under the curve (AUC) = 0.728]. Based on independent risk factors identified by LASSO-multivariate logistic regression, the 30-day readmission risk nomogram (including age, LOS, LMR, NPAR, AST/ALT, COPD, statins, and analgesic) was successfully constructed and validated with good predictive performance (AUC: 0.749, 0.731, and 0.725 in training, internal validation, and external validation sets, respectively). This study developed and validated a reliable metabolic-inflammatory nomogram for predicting 30-day readmission risk in older adults with T2DM combined with CVD. The model exhibited good predictive performance and provides a user-friendly, personalized tool for clinical risk assessment.
Circadian syndrome (CircS) is more predictive than metabolic syndrome (MetS). However, few studies have examined its risk factor. This study aims to investigate whether the static state or dynamic change of frailty is correlated with incident CircS in Chinese adults. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Baseline frailty was evaluated by frailty index (FI) and frailty status: frail (FI ≥ 0.25), pre-frail (0.10 < FI < 0.25), and robust (FI ≤ 0.10). Changes in frailty were assessed through changes in frailty status, total FI, delta FI and K-means clustering classifications. CircS was defined as the presence of at least 4 of 7 components (MetS components plus depression and short sleep duration). Restricted cubic splines (RCS) and logistic regression models were utilized to assess the association of baseline frailty or its alterations with CircS incidence after adjusting for potential confounders. A total of 5,042 and 3,527 participants were included in baseline and dynamic analyses, respectively. Compared with stable robust participants, those who transitioned from robust to pre-frail/frail status exhibited increased CircS risk (OR: 1.38, 95
Cesarean section is one of the most common surgeries in the world and a worrying challenge for women’s health in developed and developing countries. According to the World Health Report, natural childbirth is an important indicator in improving the health of mothers. Therefore, providing suitable and safe conditions for childbirth is one of the most important health obligations of the country. The purpose of this study is to develop a policy brief to promote vaginal delivery in Iran. This multi-methods study was conducted in three phases of rapid review including a systematic search in Medline, SCOPUS, ISI Web of Knowledge, and Google Scholar; qualitative study of semi-structured interviews with obstetricians, health managers, midwives, and pregnant women; and two-round Delphi technique including panel of 15 experts. A rapid review of 23 studies revealed that the strategies employed to promote vaginal delivery can be categorized into four major policy domains of population, financial, institutional and clinical quality improvement, and educational, cultural, and awareness-raising. The main challenges to vaginal delivery, based on the qualitative phase, relates to mothers, infrastructure, and provider. Finally, the results of the expert panel showed that there are five policy options of maternal education and empowerment; improving the natural birth process based on women’s preferences; community education and advocacy; empowerment and satisfaction of service providers; and monitoring, evaluation, and performance tracking. In this study, a comprehensive set of practical and strategic policy options was developed for improving vaginal delivery in Iran. If implemented, these policies could play a critical role in promoting natural childbirth, subsequently reducing cesarean rates and helping address fertility challenges exacerbated by unnecessary surgical births.
Acute kidney injury (AKI) is a common complication in critically ill patients receiving vasopressor therapy. Serum creatinine, the standard biomarker for AKI, rises relatively late and is influenced by several non-renal factors. The renal resistive index (RRI), measured by Doppler ultrasonography, may provide an earlier assessment of intrarenal hemodynamic changes. This study evaluated the association between serial RRI measurements and renal function in vasopressor-treated intensive care unit (ICU) patients. In this prospective single-center cohort study, 120 adult ICU patients requiring norepinephrine infusion were enrolled. RRI, serum creatinine, urine output, mean arterial pressure, and norepinephrine dose were recorded daily for seven days or until ICU discharge or death. Longitudinal changes were analyzed using linear mixed-effects models. Multivariable regression and receiver operating characteristic (ROC) analyses were used to assess the association and discriminatory performance of baseline RRI for AKI occurrence during the seven-day observation period. AKI developed in 38 patients (31.7
Women in low-income countries such as Ethiopia face multiple challenges in accessing maternal health services. This study aimed to explore factors influencing maternal health service use in the Sidama region, Ethiopia, from the perspectives of women and stakeholders, including healthcare providers, maternal health experts, and traditional birth attendants (TBAs). Eight focus group discussions (FGDs) were conducted with women using a maximum variation purposive sampling approach, ensuring broad representation across age groups, education levels, areas of residence, and histories of uptake of maternal health services. In-depth interviews were conducted with health extension workers (HEWs) and TBAs to gather and validate information from the women’s closest maternal health services providers through primary health services and traditional practices, respectively. A roundtable discussion was also held with midwives, clinicians, government officials, and researchers to capture broader stakeholder perspectives. An exploratory qualitative approach was employed to gain an in-depth understanding of the attributes of maternal health services from different perspectives. We adapted the Donabedian model of healthcare quality, which comprises the structure, process, and outcome domains, and incorporated demand-side barriers to organise the themes that emerged from our data. A total of 61 participants, including 48 reproductive-age women, 4 TBAs, 3 HEWs, and six maternal health experts, participated in this study. Factors constraining women’s utilisation of maternal health services included structural barriers, such as health system accessibility, infrastructure, and service costs; process-related barriers, such as healthcare providers’ attitudes and competence, and service efficiency; and outcome-related barriers, including prior treatment experiences, women’s perceptions of service quality, and referral systems. Moreover, demand-side barriers, such as socio-cultural and religious beliefs, family decision-making, and women’s domestic responsibilities, play a crucial role. This study highlights that multiple factors influence women’s utilisation of maternal health services in the Sidama region, Ethiopia. Addressing factors such as health service accessibility, efficiency, and the provision of compassionate, respectful, and affordable care can help design responsive interventions to improve maternal health service utilisation in resource-limited settings. It is recommended that policymakers prioritise interventions that address barriers to maternal health service use.
Older patients following percutaneous coronary intervention (PCI) face long-term health risks such as in-stent restenosis. Life-space serves as a valuable clinical indicator for assessing and predicting the overall health of patients. Monitoring changes in life-space can facilitate early detection of health status changes. This study aimed to identify the trajectories and associated factors of life-space among older patients following PCI, thereby prompting timely intervention and improving cardiac rehabilitation outcomes. A total of 236 patients were enrolled. During hospitalization, patients’ general information was assessed. At 1, 3, and 6 months after discharge, the patients’ life-space was assessed firstly, followed by semi-structured interviews with voluntary participants via outpatient or telephone. Purposive sampling selected 10 patients from the low-to-medium trajectory groups for qualitative analysis based on information sufficiency. Latent class growth model was used to analyze life-space trajectories, and multinomial logistic regression analysis was conducted to examine their associated factors. Conventional content analysis method was used to provide additional possible factors hindering patients from achieving high-level life-space trajectory. The life-space of older patients following PCI showed an upward trend within 6 months of discharge, with an initial rapid increase followed by a slower progression. Three trajectory subgroups of life-space were identified: low-level persistently restricted group (18.14
Economic dependency extends beyond limited decision-making power to encompass unemployment, restricted income generation, and residence in the poorest wealth strata. Women situated in these conditions may lack the financial capacity to afford screening, the resources to travel to health facilities, and the autonomy to prioritize preventive care over immediate household needs. Yet, empirical research in Nigeria has not adequately examined how this multidimensional economic dependency influences cancer screening behavior using nationally representative data. This study assesses the association between economic dependency and women’s cancer screening uptake in Nigeria. Data from the 2024 Nigerian Demographic and Health Survey were analyzed (n = 17,941). Economic dependency was measured using a composite index incorporating employment status, household wealth, and financial decision-making autonomy. Weighted frequencies, percentages, and 95
Access to combined safe Water, Sanitation, and Hygiene services remains a major public health concern across Sub-Saharan Africa, with coverage disparities influenced by a wide range of individual and community-level factors. Traditional statistical analyses may not fully capture the complexity and interactions of these determinants. Therefore, the objective of this study was to identify predictors of WaSH in Sub-Saharan Africa based on DHS data using machine-learning algorithms. This study used regionally representative Demographic and Health Survey data from 33 Sub-Saharan African countries and applied machine learning techniques to estimate household-level access to combined water, sanitation, and hygiene (WaSH) services. This study was based on weighted data from 233,391 households, spanning survey years from 2010 to 2020. Important categorical predictors were chosen, including the household wealth index, age group, marital status, sex, household head’s educational attainment, and community-level variables. These variables were identified based on evidence from the literature, their theoretical relevance to WaSH outcomes, and their demonstrated statistical significance in exploratory and model-building analyses. The Synthetic Minority Over-sampling Technique (SMOTE) was used to address class imbalance after the data had been preprocessed and encoded. With Hyperparameter tweaking through grid search, seven machine learning models- Logistic Regression, Random Forest, Gradient Boosting, Decision Tree, k-nearest Neighbors, Naive Bayes, and Neural Network—were trained and assessed over the course of seven iterations. Accuracy, precision, recall, specificity, F1-score, and AUC were used to evaluate the model’s performance. The most significant predictors were found by extracting feature importance from the top-performing models. Combined WaSH service coverage was 19
TyHGB is a novel indicator reflecting insulin resistance and has been validated in multiple metabolic disorders. However, the relationship between TyHGB and gestational diabetes mellitus (GDM) remains unclear. This study aimed to explore the cross-sectional association between TyHGB and GDM status among pregnant women undergoing routine gestational glucose screening. This retrospective cross-sectional study included 29,042 singleton pregnant women who completed 75 g oral glucose tolerance testing (OGTT) at 24–28 weeks of gestation. Multivariable logistic regression, restricted cubic splines (RCS), and stratified subgroup analyses were performed to evaluate the association and nonlinear dose-response pattern between TyHGB and GDM. Receiver operating characteristic (ROC) analysis was used to assess the concurrent discriminatory ability of TyHGB for GDM at the time of OGTT measurement. GDM was diagnosed in 5,823 of the 29,042 women (20.1
Obesity is a major risk factor for non-communicable diseases and mortality. This study aimed to examine the associations between ultra-processed food intake and the risks of obesity and weight gain, and to evaluate whether these associations differed by polygenic scores for obesity in Korean adults. This prospective cohort study included 77,344 Korean adults aged 40 years and older from the Health Examinees (HEXA), the Cardiovascular Disease Association Study (CAVAS), and the Korea Association Resource (KARE). Dietary intake was assessed using a food frequency questionnaire, and ultra-processed foods were classified based on the Nova system. Polygenic scores linked to obesity were computed from 27 single nucleotide polymorphisms. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95
Sustainable nutrition has gained increasing importance in recent years, with the aim of reducing environmental impacts and creating positive health outcomes. The EAT-Lancet diet index is a tool used to define healthy and environmentally sustainable diets. The aim of this study is to evaluate food sustainability knowledge and attitudes toward the EAT-Lancet dietary pattern among Turkish adults. The study included 3446 individuals aged 19 to 65 years, employed in various occupations. This cross-sectional study collected data using a demographic questionnaire and the Food Sustainability Knowledge and Attitudes Questionnaire. A Food Frequency Questionnaire was administered to calculate the EAT-Lancet index. The EAT-Lancet index is based on the frequency of food consumption across 14 components, with scores ranging from 0 (low adherence) to 3 (high adherence), and the total score (0 to 42) is divided into four quartiles (Q1 to Q4), representing increasing levels of adherence. Statistical analysis was performed using SPSS 24. No significant difference was observed in participants’ EAT-Lancet index scores based on their belief regarding whether a sustainable diet is equivalent to a healthy diet (p = 0.240). However, individuals who perceived animal-based foods such as meat, milk, and eggs as environmentally harmful had notably higher EAT-Lancet index scores (p < 0.05 for all comparisons). The mean EAT-Lancet index score among all participants was calculated as 23.41 ± 3.61. A very weak yet statistically significant positive correlation emerged between the willingness to pay more for sustainably sourced foods and EAT-Lancet index adherence, whereas no meaningful relationship was found between the index scores and participants’ sustainability-related knowledge or attitudes. Regression analysis revealed that marital status, alcohol use, presence of chronic conditions, and body mass index (BMI) were significantly linked to adherence levels to the EAT-Lancet dietary pattern. This study highlights that adherence to the EAT-Lancet diet among Turkish adults is shaped by a combination of knowledge, attitudes, and specific sociodemographic and lifestyle factors. While traditional demographic variables like age, sex, and education were not significant, factors such as marital status, BMI, chronic disease status, and environmental awareness showed meaningful associations. gov ID: NCT06941051-04/16/2025
Pertussis can seriously affect infants who are too young to be fully immunized (< 6 months of age) leading to increased risk of severe and potentially lethal complications. Pertussis control remains fragile in EMR, facing several challenges from the healthcare sector and providers, likewise low awareness, and a lack of clear recommendation of maternal immunization and maternal care services for infectious disease prevention and treatment, particularly against pertussis. The Eastern Mediterranean Public Health Network (EMPHNET) launched the initiative entitled “The Way Forward for Pertussis Control in EMR: Focus on Maternal Immunization” aims to emphasize that the primary goal is the control of pertussis, initially focusing on the protection of infants under 4 months through maternal vaccination strategies. This initiative aimed to leverage existing epidemiological data and disease burden, as well as the exchange of successful experiences both regionally and globally related to maternal vaccination strategies. The following document presents the key findings of the Expert Network Meeting on Pertussis Control implemented in Amman-Jordan in 4–8 August 2024. It proposes the way forward for Pertussis control strategies in the EMR, with recommendations on bolstering regional efforts towards strengthening maternal Tdap immunization.
Low- and middle-income countries bear a significant burden of the global maternal and neonatal mortality. Birth preparedness and complications readiness (BP/CR) reduces the risk of preventable deaths. To assess BP/CR and predictors among recently delivered women in urban Lagos, southwest Nigeria. This was a mixed-methods cross-sectional, community-based study involving urban women who delivered within two years prior to study. Recruitment was by multistage sampling method. Quantitative data were collected from 790 women using a validated questionnaire. Respondents’ level of BP/CR was measured using key components of BP/CR. Summary and inferential statistics were done. Predictors of BP/CR were determined by multivariable regression analysis. Focus group discussions (FGDs) were used to collect exploratory qualitative data using a semi-structured interview guide and were analyzed thematically. Mean age of 790 respondents was 31.1 years (SD 1.8). About 78
Young adults are frequently exposed to food advertising, and the messages conveyed in these advertisements (ads) often remain prominent in their minds. The primary objectives of this study were to explore the extent to which young adults’ exposure to food advertising via social media influencers (SMIs) affects their cognition and feelings and to investigate whether watching food ads influences individuals’ intentions and behaviours pertaining to food purchases. The participants in this research were students who were recruited from two public universities in Jeddah, Saudi Arabia. The participants were initially recruited through an invitation link that was distributed via WhatsApp. After the participants submitted consent forms online, they completed a brief questionnaire that aimed to collect demographic information and relevant background data. They also specified a suitable time when interviews could be scheduled. The stimulus‒organism‒response (S–O–R) framework guided this research. Seventeen face-to-face interviews were conducted, and thematic analysis was employed to analyse the data. Three primary themes (i.e., exposure, cognition and feelings, and outcomes) were identified, which included subthemes such as unhealthy food, recognition and recall, feelings of hunger, perceived trust, desire to eat, intention to buy and actual purchases. The findings of this research indicate that frequent exposure to food advertising by influencers could trigger cognitive involvement with the ads among participants, which might encourage young adults to remember or identify the advertised food; in turn, this impact may increase their intention to buy unhealthy food. The results also highlight the critical role played by repetitive exposure to influencer-driven food advertising in the process of eliciting affective and physiological feelings such as hunger and food cravings. A theoretical framework featuring ten propositions as well as relevant theoretical and managerial implications was developed. The results suggest that repetitive exposure to influencer-driven food advertising, alongside the use of advertising strategies and influencers’ perceived trust, may shape the ways in which young adults think, feel, and behave with respect to their eating decisions. The results shed light on the influence of food advertising and the overwhelming effect of influencers on young adults’ emotions, cognition and behaviours.
Tanya Obat (translating to “Ask about Medications”) is an Indonesian telepharmacy application offering online consultations, drug information, and digital medication purchases. Building on a prior early-stage evaluation that found below-average usability, this study reassesses the updated platform at the national level to quantify usability gains and identify remaining user-specific barriers. Evaluating usability is critical for ensuring equitable access and sustained adoption of digital health tools. A concurrent embedded mixed-methods study design was employed, combining the System Usability Scale (SUS) with open-ended questionnaires. Participants included pharmacists and general population users across Indonesia. Associations between demographic characteristics and perceived usability between participants with below-average (SUS < 68) and acceptable (SUS ≥ 68) scores were analyzed using the Chi-square test (p < 0.05), with Fisher’s Exact Test applied when expected cell counts were below the acceptable threshold. Qualitative responses were analyzed thematically. A total of 423 participants were included, consisting of 189 pharmacists and 234 individuals from the general population. The mean SUS score was 66.3 ± 11.3 and 68.6 ± 10.9 for pharmacists and the general population, respectively. These results suggest that usability among pharmacists remained below the usability benchmark, while general population rated the application within the acceptable range. This difference was statistically significant (p-value = 0.031, 95
Our objective was to evaluate the impact of canola oil (CO) and sunflower oil (SO) consumption on serum lipid profiles in adults, which included total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), low levels of high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and VLDL-C. Randomized controlled trials (RCTs) that assessed the impact of CO on lipid parameters in comparison to SO were identified through searches of PubMed, Scopus, Web of Science, and Google Scholar through March 2025. A random-effects model was employed to calculate the Standardized Mean Differences (SMD) and 95
Climate change threatens cardiovascular health, yet health-system responses remain underexamined. This scoping review maps pathways linking climate change to cardiovascular diseases (CVDs), identifies health-system challenges, and synthesises global, regional, and national policies addressing climate-related cardiovascular risks. Following Arksey and O’Malley and PRISMA-ScR guidance, we searched PubMed, Scopus, Web of Science, Embase, Cochrane Library, Google Scholar, and grey literature (2011–2024). Studies examining climate impacts on CVDs and evaluating management strategies, health-system responses, or policy frameworks were included. Twenty-one sources met inclusion criteria. Data underwent qualitative thematic analysis combining deductive and inductive approaches. Five themes emerged: climate-related cardiovascular impacts, health-system challenges, digital health solutions, policy/management strategies, and cross-cutting equity/governance considerations. Climate change exacerbates CVD risk through heat, air pollution, extreme weather, nutritional insecurity, and psychosocial stress. Health-system vulnerabilities include infrastructure fragility, disrupted chronic care, inadequate disaster preparedness, and supply-chain weaknesses disproportionately affecting vulnerable populations. International frameworks (WHO Operational Framework, Paris Agreement, Sendai Framework, SDGs) integrate health and climate priorities, yet non-communicable diseases remain underrepresented in adaptation plans. Emerging strategies include climate-resilient infrastructure, telemedicine, early warning systems, and provider education. Policy co-benefits linking air quality, sustainable nutrition, and walkable urban design offer dual advantages for climate and cardiovascular outcomes. The climate-CVD nexus requires integrated, equity-driven strategies embedding chronic disease management into climate policies. Given heterogeneous evidence, findings constitute broad mapping rather than causal conclusions. Urgent investment in health-system resilience, targeted research in under-studied regions, and sustained political commitment are essential to protect cardiovascular health while advancing climate objectives.
Metabolic dysfunction–associated steatohepatitis (MASH) is a rapidly escalating global health challenge driven by complex interactions among metabolic regulation, nutrition, immune signalling, gut microbiota, and environmental exposures. Current disease-centric frameworks prioritize late-stage pathology rather than early metabolic resilience. This article aims to redefine liver health as a dynamic, multidimensional state and to propose a prevention-oriented framework centered on nutrition and lifestyle as primary therapeutic pillars. This narrative review synthesizes current evidence on liver health and MASH. Relevant literature was identified through targeted searches, reference screening, and expert knowledge. The proposed framework positions liver health as an active state of metabolic flexibility supported by nutrition, physical activity, sleep quality, and circadian alignment. Advances in microbiome profiling, single-cell analyses, and multi-omics technologies reveal early disruptions that precede irreversible hepatic injury and may serve as actionable intervention targets. Nutrition emerges as a foundational driver that modulates systemic metabolism, inflammatory tone, and host–microbiome interactions. A multidimensional, nutrition-first strategy offers scalable opportunities for early screening, individualized prevention, and public health policy reform. Preventing MASH requires a paradigm shift from disease management to proactive cultivation of hepatic resilience. Integrating nutrition-centered, multidimensional interventions into clinical practice and policy can intercept disease trajectories before histological damage occurs.
Early pregnant women often experience changes in their dietary patterns. Interoceptive sensitivity (IS), the ability to detect internal bodily signals, influences appetite regulation and dietary choices, potentially impacting glucose metabolism. Whether IS is a protective factor against elevated FBG in early pregnancy, and poor dietary patterns are linked to impaired fasting glucose (IFG), the relationships between IS, dietary patterns, and IFG remain unclear. This cross-sectional study was conducted from December 2024 to June 2025. IS and FBG were recorded in early pregnancy; a three-day dietary diary was applied to record the number of consumed foods and was valued by Chinese Diet Balance Index for Pregnancy (DBI-P), which was used to assess dietary quality distance (DQD) and food variety which comprehensively reflect unbalanced diet and richness of food intake, respectively. Logistic regression analyzed association between IS and IFG. The mediation model test was employed to examine the mediating effect of dietary quality. A total of 215 patients were included in the study, and the prevalence of IFG was 17.2
