This study examined trends in premature mortality from major noncommunicable diseases (NCDs) among individuals aged 30 to 69 years in Jakarta, Indonesia, from 2016 to 2021, and assessed excess mortality during the COVID-19 pandemic. A population-based ecological analysis was conducted using mortality data from the Jakarta Provincial Health Office. Causes of death were classified using International Classification of Diseases, Tenth Revision and grouped into major NCD categories. Incidence rate ratios and excess mortality were estimated to compare pre-pandemic and pandemic periods.A total of 46 562 deaths were analyzed. Mortality increased during 2016 to 2019 but declined in 2020 to 2021. No significant differences in cause-specific mortality were observed, while overall mortality was higher in the pre-pandemic period. Excess mortality was negative across all major NCDs.Although mortality declined, this pattern should be interpreted with caution, as it likely reflects disruptions in reporting and health care access rather than a true reduction in disease burden.
The health behaviours and health care experiences of Thai immigrants are relevant in the context of growing global migration, as they navigate health care systems across their origin and host countries. While numerous studies have examined these issues, existing evidence remains fragmented across countries, study designs, and population subgroups, limiting understanding of how Thai immigrants manage their health and engage with health care systems. This scoping review aimed to identify, categorise, and summarise existing knowledge on Thai immigrants' health behaviours and health care experiences. A comprehensive search of academic and grey literature was conducted in March 2025, yielding 54 studies. Five key themes were identified, namely preventive health behaviours, health-risk behaviours, health-seeking behaviours, cultural and emotional responses, and navigating health care systems. Across these themes, Thai immigrants face barriers related to cultural norms, language barriers, socioeconomic constraints, and psychosocial stressors. These barriers influence their participation in preventive care, responses to illness, and interactions with health care services. Difficulties in navigating complex health care systems and limited culturally appropriate support complicate access. However, existing evidence remains fragmented, particularly regarding older adults. This review provides an overview of current knowledge and highlights critical gaps to guide future research aimed at improving the understanding of Thai immigrants' health needs.
The global prevalence of mental health issues is increasing. While extensive research has demonstrated the positive effects of physical activity (PA) on mental health, its implementation within the Indonesian context necessitates consideration of the country's distinct cultural characteristics. This study aimed to systematically synthesize and analyze the existing evidence on the relationship between PA and mental health in Indonesia. A comprehensive search of Embase, PubMed, PsycINFO, Scopus, CINAHL, and Google Scholar was conducted from inception to September 2024. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklists, and findings were narratively synthesized. Of 640 identified records, 34 studies (19 observational and 15 experimental) met the inclusion criteria. Most studies (31 studies) reported a significant association between PA and mental health outcomes, suggesting mental health benefits of PA. Low PA levels among Indonesians highlight the need for culturally and contextually appropriate strategies to promote PA in Indonesia and similar low- and middle-income countries (LMICs). As more than half of the included studies were of moderate to low methodological quality and may have been subject to potential risk of bias, findings should be interpreted cautiously.
Despite Taiwan's universal National Health Insurance (NHI), homeless individuals may face a proposed "coverage paradox" in which legal entitlement to care may not guarantee actual health care engagement. This study applied the Health Belief Model (HBM) to investigate self-reported health care engagement propensity in this population. We conducted face-to-face interviews with 124 randomly sampled homeless individuals in Northern Taiwan. Hierarchical regression analysis was performed to compare the predictive power of sociodemographic variables against HBM constructs. While sociodemographic variables explained 19% of the variance in the initial model, the inclusion of HBM constructs significantly increased the total explanatory power to 41.0%. Perceived susceptibility (β = 0.38) and perceived severity (β = 0.34) emerged as the strongest predictors, surpassing self-efficacy (β = 0.20). Conversely, perceived barriers (β = -0.23) remained a significant negative predictor despite universal coverage. The primary bottleneck to care is not merely a lack of confidence but a low perception of health threat due to the normalization of poor health conditions. We recommend a 2-pronged strategy: implementing street-based health screenings to enhance risk awareness and deploying health navigators to overcome non-financial barriers.
This study explored depressive symptoms across pregnancy and the postpartum period among women with gestational diabetes mellitus (GDM) in Vietnam. One hundred ninety-five women were recruited from 2 health care facilities in the Thai Binh Province, Northern Vietnam. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 3 time points: before GDM diagnosis (24-28 weeks), at 36 weeks' gestation, and 12 weeks postpartum. Mixed-effects linear models guided by a directed acyclic graph were used to examine associations. The EPDS scores remained stable during pregnancy but were significantly lower postpartum than at prediagnosis (mean difference [MD] = -2.94; 95% CI, -3.59 to -2.29) and 36 weeks' gestation (MD = -3.16; 95% CI, -3.72 to -2.61). Differences in EPDS trajectories were observed across sociodemographic characteristics, with women who were not living with their showing the greatest reductions in EPDS scores. Maternal mental health in GDM follows a nonlinear trajectory. Integrated GDM care should include mental health screening and social support.
The aim of this study was to gain in-depth understanding of the experience of the contact tracing process by close contacts of invasive meningococcal disease (IMD) cases. Close contacts participated in semi-structured interviews. We interviewed 26 close contacts of IMD cases; most presented to a hospital emergency department for antibiotic chemoprophylaxis within 24 hours. They had prior knowledge about IMD but experienced anxiety about contracting it; many believed that the antibiotic prevented them from contracting IMD. Contacts were satisfied with information they received during the initial contact from the health department but were concerned about phone calls from an unidentified phone number being disingenuous. Most did not receive any information at the hospital about antibiotic side effects or its function. Findings from this study have implications for the public health response and management of close contacts recommended in jurisdictional IMD guidelines, for Australia and more broadly internationally.
Drug use among Korean adolescents is rapidly increasing and emerging as a critical social and public health issue. This study aimed to examine the prevalence of life time drug use among a nationally representative sample of Korean adolescents and to investigate the influence of mental health and risk behaviors on adolescent life time drug. This cross-sectional study analyzed data from the 2022-2024 Korea Youth Risk Behavior Survey (N = 159 383). Lifetime drug use was defined as any nonmedical use of sedatives, stimulants, analgesics, or narcotics. Sociodemographic, mental health, and risk behavior factors were examined using chi-square tests and multivariate logistic regression across 3 sequential models. Higher risks were observed among women, high school students, those living alone, and adolescents with significant anxiety (GAD ≥ 10), sadness or despair, or suicide attempts. Heavy drinking (aOR = 2.42, 95% CI = 2.03-2.91), lifetime smoking (aOR = 1.28, 95% CI = 1.03-1.58), heated tobacco use (aOR = 1.36, 95% CI = 1.10-1.68), sexual experience (aOR = 1.98, 95% CI = 1.67-2.34), and violence exposure (aOR = 2.99, 95% CI = 2.45-3.65) were also strongly associated with drug use. These findings indicate that adolescent life time drug use is influenced by overlapping sociodemographic vulnerabilities, psychological distress, and co-occurring risky behaviors. Adolescents experiencing anxiety, emotional distress, social disadvantage, or engagement in other high-risk behaviors are particularly susceptible to life time drug use. The results underscore the need for a multifaceted prevention framework that integrates mental health promotion, early screening for psychosocial risks, and concurrent prevention of high-risk behaviors.
Primary immunodeficiencies (PIDs) are rare disorders whose accurate surveillance, equitable care, and effective health policy depend on robust national data infrastructure. Malaysia lacks a national PID registry, creating a critical public health data gap that impedes disease burden estimation, resource planning, and patient outcomes. This systematic review searched 3 major electronic databases (Web of Science Core Collection, Scopus, and PubMed) for the period 2015-2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines with narrative thematic analysis identified system-level barriers to PID data management and developed an evidence-based registry framework to address them. Forty-one global studies from 15 countries (including 8 from Malaysia) revealed that underdiagnosis, diagnostic delays, fragmented data systems, and limited professional awareness compound the absence of national registry infrastructure. The proposed framework integrates a Minimum Data Set aligned with International Union of Immunological Societies classification, multidisciplinary governance, secure role-based technical infrastructure, automated validation, and audit mechanisms covering demographics, clinical, diagnostic, treatment, and outcome domains. A national PID registry in Malaysia is feasible through phased implementation, and would meaningfully strengthen disease surveillance, enable collaborative research, and inform health policy, thus translating a documented data gap into improved population-level outcomes.
The COVID-19 pandemic disrupted health care utilization worldwide, followed by uneven recovery patterns. South Korea also experienced this recovery disruption due to the nationwide medical strike in 2024. Especially, this medical strike raised concerns about the vulnerability and instability of the national health care system amid supply-side shocks during the post-crisis recovery. Its impacts and aftermaths need to be analyzed and evaluated for the latter response. In this article, we investigated changes in health care utilization and costs using National Health Insurance claims data across 6 phases: pre-COVID (2018-2019), early COVID (2020), mid-COVID (2021), late COVID (2022), recovery (2023), and the 2024 medical strike. In this work, we found that health care utilization declined during the COVID-19 pandemic, partially rebounded in 2023, and declined again during the 2024 strike. On the contrary, aggregate and per-patient health care expenditures increased during the recovery period and remained elevated during the strike despite reduced patient volumes. Per-patient expenditures rose most prominently in surgical and emergency-related specialties. We confirmed our results, suggesting that health care recovery may remain fragile and susceptible to subsequent supply-side disruptions. They also highlighted the need for specialty-sensitive monitoring and policy responses to support system resilience and patient financial protection.
Obesity is a risk factor for hypercholesterolemia; however, evidence of obesity among Orang Asli (OA) adults remains limited. Lifestyle changes, including unhealthy diets and sedentary behavior, may increase vulnerability to noncommunicable diseases. This study examined the sex-specific associations between body mass index (BMI) and hypercholesterolemia using data from the OA Health Survey 2022. A total of 8160 adults aged ≥18 years with complete questionnaires, anthropometric data, and blood data were analyzed. The prevalence of hypercholesterolemia among OA adults was 47.6%; of these, 41.5% were previously undiagnosed. Compared with normal BMI, overweight and obesity were associated with a higher odds of hypercholesterolemia in both sexes. Older age, Senoi tribe affiliation, and diabetes were associated with hypercholesterolemia in both sexes. These findings highlight the need for culturally tailored interventions to strengthen obesity prevention and cholesterol testing in primary care and outreach services to reduce cardiovascular risk in OA communities.
Long COVID has emerged as an important post-pandemic health challenge, yet physician awareness in low- and middle-income countries remains limited. This multicenter cross-sectional study assessed the knowledge, attitudes, and practices of physicians in Pakistan regarding COVID-19 and Long COVID using an online survey conducted in 2024. A total of 117 physicians participated. While knowledge of acute COVID-19 was generally adequate, with 74.4% achieving good scores, knowledge of Long COVID was considerably lower, with only 30.8% demonstrating adequate understanding. Although most participants recognized common Long COVID symptoms (94.9%), fewer correctly identified its formal definition (37.6%). Attitudes toward COVID-19 prevention and management were largely positive (86.3%), and most participants reported appropriate clinical practices (97.4%). Female physicians had higher odds of adequate Long COVID knowledge, whereas those with more than 10 years of experience had significantly lower knowledge levels. These findings highlight a substantial gap in physician awareness of Long COVID despite strong preparedness for acute COVID-19. Targeted educational interventions are needed to improve recognition and management of post-COVID conditions, particularly in resource-limited settings.
Despite its prevalence, the health care burden of co-occurring physical, psychological, and cognitive (PPC) disorders remains unclear. This study examines impact of different PPC-multimorbidity patterns on health care utilization and costs among 12 643 middle-aged and older Chinese adults using longitudinal data (China Health and Retirement Longitudinal Study 2011-2020). We measured outpatient/inpatient utilization (any visit/number of visits) and out-of-pocket (OOP) costs via self-reports. Binary, count, and censored outcomes were analyzed using mixed-effects logistic, negative binomial, and Tobit regressions, respectively. Results showed that PPC-multimorbidity significantly increased outpatient/inpatient utilization and OOP costs (ORoutpatient visit = 1.43, IRRoutpatient visit number = 1.41, ORinpatient visit = 1.73, IRRinpatient visit number = 1.53, IRRhospitalization days = 1.71, βoutpatient costs = 24.96, βinpatient costs = 353.02; P < .001). Increasing coexisting PPC types progressively amplified health care burden (dose-response P-trend < .001). Pattern-specific analyses demonstrated heterogeneous impacts, with nearly all PPC-multimorbidity combinations elevating health care demands. In conclusion, PPC-multimorbidity imposes a substantial health care burden. These findings advance multimorbidity conceptualization beyond simple disease counts, emphasizing the need to address distinct multimorbidity patterns and their complex interactions.
Deafblindness or difficulty seeing and hearing even with correction or hearing aids affects an estimated 7.4% (about 295 000) of New Zealanders, with prevalence rising sharply among older adults. Analysis of 2023 Census data using the Washington Group Short Set (WGSS) highlights not only the scale of this issue but also its inequitable distribution: gender-diverse people, Māori, Pacific peoples, and rural communities experience higher rates and earlier onset of sensory difficulties. However, the WGSS's Western, individualistic framing often undercounts deafblindness in Indigenous and collectivist cultures, risking invisibility for those most affected. Geographic disparities further compound inequity, with rural regions facing greater barriers to care. These findings reveal that current measurement tools and policies may not fully capture the lived realities of deafblind people, limiting access to services and perpetuating disadvantage. Addressing these gaps requires culturally responsive data collection, co-design with affected communities, and integrated, holistic support systems. Recognising deafblindness as a distinct disability and aligning policy with Te Tiriti o Waitangi and the United Nations Convention on the Rights of Persons with Disabilities are essential steps towards equity and inclusion.
Climate change is a major factor influencing cardiovascular health, yet its impact on diverse cardiac conditions in East Asia remains insufficiently explored. This study investigated associations between meteorological factors and cardiac morbidity in three South Korean cities, i.e. Seoul, Busan, and Daejeon using monthly administrative data from 2010 to 2023. Generalized additive models were employed to assess the effects of temperature, precipitation, and extreme weather indicators on acute pericarditis and heartbeat abnormalities. The results revealed distinct city-specific sensitivities: in Seoul, heatwave days were positively associated with increased pericarditis visits, while in Busan, more frequent precipitation days were linked to higher risks of heartbeat abnormalities. Furthermore, relative humidity emerged as a significant factor, with lower humidity levels correlating with increased pericarditis in Seoul and Daejeon, and higher humidity associated with elevated heartbeat abnormality risks in Seoul. Our results indicate that urban cardiovascular vulnerability involves a complex interplay of thermal and hygrometric stressors that varies by city. These findings highlight the importance of weather factors beyond temperature alone, suggesting the necessity of considering city-specific climate patterns in epidemiological monitoring.
