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Abstract Background Monitoring HIV infection estimates is critical to guide health interventions and assess their impact, especially in highly vulnerable groups to the infection such as African pregnant women. This study describes the trends of HIV infection over eleven years in women attending selected antenatal care (ANC) clinics from southern Mozambique. Methods We performed a secondary analysis of data registered at the ANC clinic of the Manhiça District Hospital and from the Ministry of Health's HIV National Program Registry between 2010 and 2021. HIV incidence was calculated using prevalence estimates. HIV incidence trends over time were obtained by fitting splines regression model. Results Data from 21,810 pregnant women were included in the analysis. Overall HIV prevalence was 29.3% (95% CI: 28.7–29.9), with a reduction from 28.2% (95% CI: 25.6–30.8) in 2010 to 21.7% (95% CI: 19.8–23.6) in 2021, except for a peak in prevalence (35.3%, 95% CI: 30.1–40.8) in 2016. Over the study period, by maternal age group, the largest reduction in HIV prevalence was in the 15–20 year-old group [62% reduction, from 14.3% (95% CI 10.8–18.4) to 5.3% (95% CI: 3.6–7.5)], followed by the 20–25 year old group [43% reduction, from 29.0% (95% CI: 24.2–34.5) to 16.6% (95% CI: 13.6–19.8)] and the 25–30 year old group [13% reduction, from 36.9% (95% CI: 31.0–43.1) to 32.0% (95% CI: 27.3–37.0)] (p

Abstract Background Miners exposed to silica dust are susceptible to silicotuberculosis (STB) outcome – the development of tuberculosis (TB) in miners with silicosis. STB is an important occupational and public health issue in the twenty-first century. This scoping review aimed to map the risk factors associated with STB. Methods A literature search was carried out to identify the available international literature on STB risk factors from four databases: MEDLINE, EMBASE, CINAHL, and COCHRANE LIBRARY. Various grey literature sources such as Google Scholar, Science.gov, and WHO Global Index Medicus were also searched. The main study outcome is STB; the selection criteria also included studies assessing TB and silicosis as comorbidities leading to STB. Results The final review included 22 studies. Findings identified various STB risk factors including demographic factors such as age and sex, lifestyle factors including smoking and alcohol intake, clinical factors such as history of TB, grades of silicosis, and human immunodeficiency virus (HIV), in addition to occupational factors encompassing silica exposure, duration of employment, and type of work setting. Conclusion The findings of this scoping review highlight the research gaps in the reviewed literature, including the dearth of longitudinal studies focusing on the directionality of the two comorbidities (TB and silicosis) that lead to STB, lack of gender considerations in research on this topic, and an absence of articles on vulnerable populations including children. The findings of this review may help guide future research and inform occupational health and safety policies addressing STB outcomes among miners.

Abstract Background Despite the substantial burden of obesity in the United States (US), data on the comprehensive range of comorbidities in different age groups is limited. This study assessed the prevalence of various comorbidities among people diagnosed with obesity (as per ICD-10 diagnosis code) across age cohorts and compared how they differ from people without obesity. Methods This cross-sectional study analyzed individuals from all four regions (Midwest, Northeast, South, and West) of the US who had continuous insurance coverage from 2018 to 2020, using a large health insurance claims database (Merative™ MarketScan®). Identification of disorders relied on ICD-10 diagnosis code in patient claims and their prevalence was calculated. Results Of 6,935,911 individuals, people with a diagnosis of obesity accounted for 22.0%, 33.6%, and 34.4% in the 18–39 years, 40–64 years, and ≥ 65 years age groups, respectively. Within age strata, the mean age of people with obesity was comparable with those without obesity. Comorbidity burden was significantly higher among people with obesity, but increased with age in both obesity and non-obesity groups. Comorbidities with highest prevalence in people with obesity included: (i) hypertension (18–39 years: 29.0%, 40–64 years: 66.2%, ≥ 65 years: 89.4%), (ii) dyslipidemia (18–39 years: 28.1%, 40–64 years: 65.4%, ≥ 65 years: 88.0%), (iii) depression or anxiety (18–39 years: 44.1%, 40–64 years: 39.0%, ≥ 65 years: 38.9%), and (iv) prediabetes (18–39 years: 17.1%, 40–64 years: 32.2%, ≥ 65 years: 35.3%). Notably, increased prevalence of cardiometabolic risk factors such as hypertension and dyslipidemia began at an earlier age in people with obesity as compared with those without obesity. Ratio of prevalence between obesity and non-obesity groups was highest for the 18–39 years age group, as compared to older groups. Disorders such as obstructive sleep apnea, osteoarthritis, type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, coronary heart diseases (CHD), and chronic kidney diseases also exhibited substantial burden among those with obesity. Conclusions In this claims study, hypertension and dyslipidemia were the leading comorbidities in people with obesity, with an increasing prevalence with age. The burden of cardiometabolic comorbidities among the younger age group suggested potential risk for early onset of CHD in later life. Understanding the range of obesity-related comorbidities seen in this claims data may encourage healthcare professionals and healthcare systems to systematically diagnose and better manage these disorders. Further research using additional data sources can offer a more accurate view of the prevalence of obesity and its impact.

Abstract Background Triglyceride-glucose (TyG) index was regarded as a cost-efficient and reliable clinical surrogate marker for insulin resistance (IR), which was significantly correlated with cardiovascular disease (CVD). However, the TyG index and incident CVD in non-diabetic hypertension patients remains uncertain. The aim of study was to explore the impact of TyG index level and variability on risk of CVD among non-diabetic hypertension patients. Methods A total of 9313 hypertensive patients without diabetes aged 30–70 years in Jiangsu Province who participated in the baseline survey from January 2010 to December 2010 and were followed up to May 2020 were included in this study. The TyG index was calculated as ln [fasting triglyceride (TG) (mg/dl) × fasting plasma glucose (FPG) (mg/dl)/2] and variation degree was calculated as the TyG index at first year follow-up (2011) minus that at baseline (2010). Cox proportional analysis regression and restricted cubic spline were used to investigate the association between TyG index level as well as variability and CVD risk. Results Of 9313 included participants, 5423(58.23%) were female. During a mean follow-up of 8.32 ± 1.43 years, 890(9.56%) CVD events was identified. Cox regression analysis showed that with the highest TyG index in Q4 group at baseline, the incidence of CVD risk increased by 33.6% after adjustment for multiple confounders compared to Q1 group. Compared with TyG index variation degree 0 ~

Abstract Background The improper disposal of unwanted or unused medications is a pressing issue that can lead to drug misuse and environmental contamination. Pharmacists play a crucial role in promoting safe drug disposal by the public. This study explores pharmacists’ perceptions of the causes of unwanted and unused medications, their practices, and the barriers to promoting safe medication disposal among the public in the United Arab Emirates. Methods This cross-sectional study included pharmacists working in the UAE’s community and hospital settings with direct patient contact. A convenience sampling approach was used, where pharmacists who were available during the data collection period were invited to participate. Printed copies or a survey link to the questionnaire were provided to pharmacists to complete independently during in-person visits. Participants were categorised into three levels: extensive, adequate, or minimal involvement, based on their engagement in activities such as reviewing patients’ medications, educating them on proper storage and disposal, and participating in drug take-back programmes. Chi-square test was used to assesses the association between categorical variables and pharmacists practice levels. The data was analysed using the Statistical Package for the Social Sciences (SPSS) software version 29. Results A total of 370 pharmacists participated in this survey, most of whom were between 18 and 34 years old (69.2%). The top three perceived causes of unwanted or unused medications include changes in prescriptions due to patients’ poor clinical outcomes (83.8%), inappropriate storage conditions (79.7%), and expiration of medications (78.6%). Moreover, factors such as pharmacist age, type of pharmacy, country of education, pharmacy location, employment status, and years of experience were significantly associated with pharmacists’ level of involvement in promoting safe medication disposal practices. The most cited barriers were a lack of public awareness about the risks of improper medication disposal (88.9%), lack of time due to workload (82.4%), and lack of training and education (78.1%). Most pharmacists believed in collaborating with public health agencies to promote medication disposal awareness (97.6%) and developing national guidelines (97.6%). Conclusion This study’s findings have significant implications for public health, highlighting the necessity of essential groundwork for developing targeted interventions and policies to enhance public awareness and identify specific areas where pharmacists can actively encourage safe medication disposal practices in the UAE.

Abstract Background Diarrheal infections continue to be a major public health concern in Bangladesh, especially in urban areas where population density and environmental variables increase dissemination risks. Identifying the intricate connections between weather variables and diarrhea epidemics is critical for developing effective public health remedies. Methods We deploy the novel approach of Wavelet-Autoregressive Integrated Moving Average with Exogenous Variable (WARIMAX) and the traditional Autoregressive Integrated Moving Average with Exogenous Variable (ARIMAX) technique to forecast the incidence of diarrhea by analyzing the influence of climate factors. Results Higher temperatures are associated with greater diarrheal occurrences, demonstrating the vulnerability of diarrheal epidemics to weather fluctuations. The Wavelet-ARIMAX method, which uses wavelet analysis within the ARIMAX structure, is better at forecasting performance and model fit than the standard ARIMAX model. Based on climatic variables, Wavelet-ARIMAX can accurately predict diarrheal occurrence, as indicated by the mean absolute error (MAE), root mean squared error (RMSE), and root mean squared logarithmic error (RMSLE). The outcomes highlight the necessity of employing advanced time-series modeling tools such as Wavelet-ARIMAX to better understand and anticipate climate-health interactions. Wavelet-ARIMAX uses wavelet analysis to identify time-varying patterns in climate-disease interactions, providing useful insights for public health initiatives. Conclusions The results of this research have implications for climate-adaptive health planning, emphasizing the need for focused actions to reduce the impact of climate change on diarrheal illness burdens in towns and cities.

Abstract Background Phthalate exposure has been hypothesized to influence cholesterol metabolism and gallstone pathogenesis, but previous studies are limited. We aimed to examine the associations between urinary phthalate metabolites and prevalence of gallstone disease in a nationally representative sample. Methods We analyzed data on 1,696 adults aged ≥ 30 years from the National Health and Nutrition Examination Survey (NHANES) 2017–2018. Gallstone disease was defined based on self-reported physician-diagnosis. Exposure was measured by urinary concentrations of 10 phthalate metabolites. Multivariable logistic regression model was to assess individual exposure-effect associations. Weighted quantile sum (WQS) regression, Quantile g-computation (Qgcomp) analysis and Bayesian kernel machine regression (BKMR) assessed metabolite mixtures in relation to gallstones. Results In the multivariable logistic regression model, compared to the lowest quartile (Q1) of urinary mono (2-ethyl-5-carboxypentyl) phthalate (MECPP), the highest quartile (Q4) was associated with an 82% increased risk of gallstone formation (OR: 1.82, 95% CI: 1.17, 2.85). Similarly, for mono(3-carboxypropyl) phthalate (MCPP), the risk increased by 78% in the Q4 group compared to Q1 (OR: 1.78, 95% CI: 1.02, 3.14). The WQS index exhibited a significant positive association with gallstone prevalence (OR: 1.37, 95%CI: 1.02, 1.84). In the Qgcomp model, four urinary phthalate metabolites, including MECPP, MCPP, mono benzyl phthalate (MBzP) and mono-carboxynonyl phthalate (MCNP), were positively associated with an increased risk of gallstones. BKMR identified exposure-response trends for MECPP, MCPP, and MBzP. Conclusion Higher urinary phthalate metabolite concentrations were associated with increased gallstone risk. These novel findings suggest phthalate exposure may contribute to lithogenic pathogenesis. Future prospective and mechanistic research is warranted.

Abstract Background The aim of this randomized control trial is to test the impact of providing additional training and support to volunteers who are paired with youth of color in the Big Brothers Big Sisters (BBBS) community-based mentoring program. The aim of the intervention activities is to enhance the capacity of mentors to have more culturally responsive and informed interactions with their mentees of color, thereby strengthening the youth’s ethnic/racial identity and abilities to both cope with experiences of racism and contribute to causes that advance social justice. Methods Recruitment started in June 2022, with a goal of enrolling 240 dyads (i.e., “matches”), each consisting of a volunteer mentor and a youth of color aged 9- to 17-years old with whom they were paired through BBBS. Each match is assigned randomly to receive either standard BBBS services or to services that incorporate the intervention activities (i.e., approximately 3 h of initial training that is then supplemented with booster emails and in the context of the contacts that case managers have with mentors routinely in the program). The BBBS staff who are responsible for delivering the enhancements receive preparatory training as well as ongoing support with implementation. The study has a mixed-methods design. Survey data, on outcomes (e.g., ethnic/racial identity, sense of mattering, efficacy) aligned with the theory of change, are collected at multiple time points within 12 months from mentors, youth and their parent/guardian, and BBBS staff. Multiple qualitative interviews are conducted with a subset of youth, mentors, parents and BBBS staff to examine how the intervention works and how it impacts relationship development and youth outcomes over time. Integration of quantitative and qualitative data will aim to better understand whether and how the intervention works with respect to its potential influence on mentor attitudes (e.g., cultural humility), mentor-youth interactions, and emergent identities and capacities that have well-documented importance for the resilience and well-being of youth of color. Discussion This culturally tailored training and support intervention for volunteer mentors may be one way to increase the effectiveness of mentoring programs for youth of color. Study findings will have implications for youth mentoring programs and for other settings (e.g., schools, after school programs) in which children and adolescents form relationships with adults. Trial registration www.clinicaltrials.gov —Clinical Trial #NCT05391711; original 05.21.2022; Amendment 07.01.2022: study status was updated and more details were provided on outcome measures; Amendment 11/13/2022: sample size was modified, a few mentor outcome measures were added in the 12-months survey, the timing of a mentor measure was updated.

Abstract Background Occupational noise has been associated with numerous adverse health outcomes. However, limited evidence exists regarding its association with obesity. We aim to investigate the effect of occupational noise exposure on the risk of overweight/obesity among workers, providing scientific evidence for the prevention and management of overweight/obesity in the occupational population. Methods This study included 3427 participants from two factories in Guangzhou, China. Individual occupational noise exposure levels were assessed using cumulative noise exposure (CNE). Body mass index (BMI) data were obtained from physical examinations. Linear and logistic regression models, restricted cubic spline, as well as subgroup analyses, were used to explore the association. Results In continuous models, each 1 dB-year increase in CNE was significantly associated with a 0.03 (95% confidence interval (CI): 0.00, 0.05) kg/m² increase in BMI. In categorical models, higher CNE levels were significantly associated with BMI (β = 0.54, 95% CI: 0.16, 0.92) and overweight/obesity (odd ratio (OR) = 1.57, 95%CI: 1.21, 2.04). Restricted cubic splines (RCS) analysis demonstrated a linear dose-response relationship between CNE and overweight/obesity (P for overall=0.013, P for non-linear=0.175). Additionally, shift and night work were identified as critical moderating factors, with a stronger association observed among workers engaged in shift and night work. Conclusion Occupational noise exposure is positively associated with overweight/obesity, particularly among those engaged in shift and night work. Thus, enhancing noise source management and promoting awareness among workers for prevention are imperative.

Abstract Objective To analyze the consumption frequency and factors associated with hookah usage. Methods This cross-sectional study involved adults, hookah users, residing in the city of Curitiba. Hookah groups were contacted on social networking sites via an invitation that contained a link to the questionnaire, which comprised 21 questions covering demographic and socioeconomic characteristics, user profiles, use of cigarettes and alcohol, symptoms, and perceptions of the risks of hookah use. The dependent variables were low and high consumption frequency. Multivariate analysis was performed using the backward method with p ≤ 0.20 in the chi-square test, and variables with p ≤ 0.05 were included in the final model. Results Two hundred and seven questionnaires were included, and most hookah users were aged 22 years or older, resident in the south region, male, higher education, single, with high income, and categorized as low-consumption users. They started using hookah at up to 17 years old, discovered it through friends, purchased hookah essence from a tobacconist, and used it in groups, with 3 sessions or more per day, and the session duration was 50 min or more. They did not smoke conventional cigarettes, either during the hookah session or otherwise, and consumed alcohol during the hookah session, felt dizzy while using the device, and most believed that hookahs could harm their health. Higher values for high consumption compared to low consumption were observed in individuals aged up to 22 years, those with high school education, and those who purchase hookah essence from a distributor. High consumption was associated with individual use and the absence of symptoms when using hookah. Smoking conventional cigarettes during hookah session, experiencing dizziness, and reporting that symptoms disappeared after cessation of use were higher in the low-consumption group. Among high-consumption users, the majority resided in the northern region (Prevalence Ratio 6.736), were under 22 years of age (1.445) and bought essence from the distributor (1.463). Those who experienced dizziness (0.671) consumed hookah less frequently. Conclusion High consumption was associated with region, age, and place of purchase of essence, indicating that effective public policies necessitate formulating. Categories: Behavioral, Epidemiologic, and Health Services Research.

Abstract Background Ever since the emergence of COVID-19 and its consequent spread across continents, engulfing both advanced and developing nations, COVID-19 vaccine was considered to be the main weapon to curb the spread of the virus. The COVID-19 vaccination program in India started after the first wave of infections (March – December 2020) had almost subsided. Objective In this work, the objective is to perform a state-wise analysis to assess the impact of vaccination in slowing down the spread of infections during the second COVID-19 wave (February – October 2021) in India. The prediction accuracy of the proposed model with the optimal lag length (in days) after including the impact of vaccination is evaluated and compared with a model without it. A total of 21 states are chosen for the analysis encompassing 97% of the Indian population. Methods We use the generalized Gompertz curve to study the COVID-19 outbreak. The generalized Gompertz model is then further modified to study the impact of vaccination to slow down the spread of COVID-19. The modified model considers the cumulative proportion of individuals having the first COVID-19 vaccine shot in each state as the explanatory variable. Results By incorporating the impact of vaccination in the Generalized Gompertz Curves, it is seen that the visible impact of the first dose of the vaccination is observed after a lag of 20 days with 16 out of the 21 states showing the impact of vaccines in curbing the spread of COVID-19. However, in states like Telangana, West Bengal, Tamil Nadu, Rajasthan, and Kerala, we do not conclusively observe the impact of vaccination during the study period. Conclusions Using only COVID-19 infection cases and the vaccination data in the proposed model, we conclude that overall, the vaccination program effectively curbed the spread of COVID-19 in India.

Abstract Background The utilization of dental care is affected by different factors. Despite the importance of dental care, there are significant disparities in its utilization among various population groups. The aim of this study was to identify the main factors of dental care utilization and the influences of the Health Transformation Plan (HTP) in Iran based on the Anderson model. Methods and materials This cross-sectional house-by-house study was conducted during Aug-Nov 2022 among 704 adult people in two cities under the coverage of the HTP and two cities out-side the plan using a multi-stage sampling method. Dental visit in the last year was considered as the utilization of the dental services. Independent Factors included the contextual, individual enabling, individual predisposing and individual need factors based on the Andersen model. Personal health behaviors were also assessed. Statistical analysis was conducted using Chi-square tests, simple and multivariable logistic regression models (α

Abstract Background In 2024, the Korean Ministry of Health and Welfare enforced a policy to increase the number of medical school students by 2,000 over the next 5 years, despite opposition from doctors. This study aims to predict the trend of excess or shortage of medical personnel in Korea due to the policy of increasing the number of medical school students by 2035. Methods Data from multiple sources, including the Ministry of Health and Welfare, National Health Insurance Corporation, and the Korean Medical Association, were used to estimate supply and demand. The inflow-outflow method was used for supply estimation, and assumptions were made regarding national medical examination pass rates, clinical physician consultation rates, mortality rates, and overseas emigration rates. Per capita medical use by gender and age group in 2022 was calculated for demand estimation of future medical use, and the results of future population projections were applied. The numbers of working days examined were 265, 275, 285, and 289.5 days. Results The Korean government’s prediction that there will be a shortage of 10,000 doctors in 2035 can be confirmed by the underestimation of the number of working days (265 days). However, if the actual number of working days, 289.5 days, is applied, not only will there be no shortage of doctors in 2035, but there could also be an oversupply of 3,000 doctors. If the number of medical school students has increased for five years and the public’s medical use behavior and the number of working days for doctors are maintained at the current level, there is a possibility that there will be an oversupply of as many as 11,000 doctors by 2035. Conclusions Medical experts expressed concerns that the rapid increase in medical school enrollment would exacerbate the phenomenon of concentration, increase the cost of medical care, and collapse the medical system. In order to establish a reasonable plan for the supply and demand of medical personnel in the mid- to long-term, it is necessary to consider the future medical environment through discussions with medical providers and related organizations.

Abstract Background There exists an intricate relationship between burnout and sleep disturbances, especially among firefighters. Network analysis offers novel perspectives for understanding the interactions of psychopathological variables. This study aims to elucidate the relationship between burnout and sleep disturbances among firefighters through network analysis. Methods A total of 1,486 Chinese firefighters were included in this study. The Maslach Burnout Inventory-General Survey (MBI-GS) (Chinese version) and the Pittsburgh Sleep Quality Index (PSQI) were used to assess burnout and sleep disturbances among firefighters, respectively. Two network construction methodologies, the regularized partial correlation network (RPCN) and the directed acyclic graph (DAG), were employed to perform network analysis. Results Within the RPCN, “Subjective sleep quality” emerged as the central domain of firefighters’ burnout and sleep disturbances, as well as “Emotional exhaustion” and “Daytime dysfunction” were influential bridge domains connecting the two. From the results pertaining to the DAG, “Subjective sleep quality” was the activation domain that triggered other burnout and sleep disturbance domains, with sleep disturbances serving as the potential cause of burnout. Conclusions Our findings offer some enlightenment into further understanding the relationship between burnout and sleep disturbances in firefighters. Furthermore, the aforementioned central, bridge, and activation domains may be potential targets for prevention and intervention.

Abstract Background Child malnutrition remains a critical public health problem, with socioeconomic factors playing a significant role. Socioeconomic factors include household income, parental education, and access to healthcare, which influence a child’s nutritional status. Despite overall progress in reducing under-five child malnutrition in Kenya, disparities persist. This paper analyzes changes, and determinants of child malnutrition, contributions of these determinants to health inequality, and their potential use in the screening for chronic malnutrition in children under five years. Methods We use data from the Kenyan Demographic and Health Survey (KDHS 2014 and 2022) and analyze malnutrition using three indicators: Stunting, underweight, and wasting. The determinants of malnutrition are analyzed using multivariate logistic regression. Trends in socioeconomic inequality are analyzed using concentration indices and visualized using concentration curves. Wagstaff decomposition is used to explore the contributions of determinants to inequality in child malnutrition. We investigate diagnostic utility using sensitivity, specificity, predictive values, and area under the ROC curve. Results Socioeconomic inequality in under-five child malnutrition increased between 2014 and 2022, with children from the poorest socioeconomic quintiles being disproportionately affected. A child’s age (in months) (Adjusted Odds Ratio [AOR] = 1.01; 95% Confidence Interval [CI]: 1.01 – 1.02), being born to a household in the poorest socioeconomic quintile (AOR = 2.67; 95%CI: 1.92 - 3.72), and sex (male) (AOR = 1.50; 95%CI: 1.35 – 1.67) were associated with an increased risk of stunting. The mother’s age, sex of the child (male), and household socioeconomic status (poorest) was associated with an increased risk of being underweight and wasted, whereas residence was associated with an increased risk of wasting alone after adjusting for potential confounders. A household’s socioeconomic status was the largest contributing factor to health inequality. Sensitivity, specificity, and AUC values were 67.4% (95% CI: 66.4% – 68.4%), 50.6% (95%CI: 50.0% - 51.1%), and 0.59 (95%CI: 0.58 – 0.60), respectively, when using socioeconomic status as a screening tool for stunting. Conclusion Socioeconomic disparities are a major barrier to reducing child malnutrition in Kenya, with children from lower socioeconomic quintiles at a greater risk of stunting, underweight, or wasting. This study identifies a child’s sex, age, and household socioeconomic status as key predictors of malnutrition, highlighting the need to include these factors in public health interventions. Addressing these disparities with targeted strategies considering immediate health risks and underlying socioeconomic challenges is essential for equitably improving child health outcomes.

Abstract Background Understanding the association between socioeconomic inequalities and health behaviors is imperative for elucidating and effectively addressing health inequities among children and adolescents. Despite the wealth of literature on social gradients in health behaviors, longitudinal analyses of socioeconomic inequalities in the health behaviors of children and adolescents are relatively limited, particularly in the Australian literature. Therefore, this study aimed to investigate the association between socioeconomic inequalities and health behaviors among Australian children and adolescents. Methods This study utilized the secondary data from the Longitudinal Study of Australian Children (Waves 2–8), which included participants aged 2 to 15 years. Relative index inequality (RII) methods were used to investigate the associations between socioeconomic inequalities and the health behaviors of children and adolescents. Results Compared with their counterparts, children and adolescents with high socioeconomic status (SES) are 84% more likely to consume fruits and vegetables (RII = 1.84, 95% CI = 1.63–2.09) and 19% less likely to consume sugary beverages (RII = 0.81, 95% CI = 0.77–0.86), but more likely to consume sweet and savory foods (RII = 1.09, 95% CI = 1.01–1.19). Children and adolescents with high SES were less likely to spend their free time on screens (RII = 0.86, 95% CI = 0.81–0.91) and more inclined toward outdoor activities (RII = 1.75, 95% CI = 1.53–1.98). Conclusion This study provides useful insight into socioeconomic inequalities and health behavior outcomes in children and adolescents. These findings stress the need for tailored interventions designed to improve the health behaviors of families from lower socioeconomic backgrounds. Additionally, addressing unhealthy dietary behaviors, such as the higher consumption of sweet and savory foods among children from higher SES backgrounds, is equally critical. Such comprehensive interventions have the potential to reduce socioeconomic disparities in health behaviors and improve the well-being of the broader population.

Abstract Background The coexistence of obesity and hypertension (HTN) is a global health concern due to its association with various health abnormalities. This study targeted the association between uncontrolled HTN—defined according to the JNC8 guidelines— and different obesity patterns (general and abdominal) among adult hypertensive individuals. Methods Data for the present investigation were obtained from the 2021 STEPwise Approach to NCD Risk Factor Surveillance (STEPS) national survey in Iran. Participants were classified based on general obesity (BMI) and different abdominal obesity patterns (waist circumference [WC], waist-to-hip ratio [WHR], and waist-to-height ratio [WHtR]). Data were weighted by sex, age, and residence (rural and urban). Multivariate logistic regression models were performed to determine the association between different obesity patterns and uncontrolled HTN, adjusting for confounders including demographic variables, lifestyle factors, and history of metabolic abnormalities. Results A total of 8,692 hypertensive adult subjects ≥ 18 years were recruited from all provinces in Iran. The overall mean age of participants was 55.8 ± 0.15, and 55.6% being women. The prevalence of general obesity among controlled and uncontrolled hypertensive patients was 30.3% and 69.8%, respectively. Regarding abdominal obesity, the prevalence among controlled and uncontrolled hypertensive patients was 29.8% and 70.2% based on WC, 28.4% and 71.6% based on WHR, and 28.8% and 71.2% based on WHtR, respectively. Compared to normal weight, underweight (adjusted odds ratio [AOR] = 0.94, 95% CI: 0.57–1.56), overweight (1.37 [1.16–1.61]), and general obesity (1.47 [1.24–1.75]) were associated to uncontrolled HTN compared to normal weight. Abdominal obesity according to WC (1.30 [1.13–1.51]), WHR (1.31 [1.10–1.53]), and WHtR (1.39 [1.11–1.74]) was also associated with uncontrolled HTN. Conclusion Both general and abdominal obesity are more prevalent and strongly associated with uncontrolled HTN in hypertensive patients. These findings underscore the need for healthcare providers to implement targeted interventions promoting healthy lifestyle changes to mitigate these risk factors and improve HTN management.

Abstract Background The emergence of mosquito-borne viruses (MBVs) in Europe emphasizes the need for preparedness and response plans. This requires knowledge integration and collaboration across the human, animal, vector, and environmental health domains, aligning with the One Health approach. Despite the importance of a One Health approach, engaging stakeholders from each domain remains challenging. This study aims to identify stakeholders in the field of preparedness and response to MBVs in the Netherlands and map collaborations, knowledge- and information-sharing between these stakeholders, their domains and governance levels. In addition, we aim to identify bottlenecks in these networks and uncover underlying reasons. Methods This study combined stakeholder- and social network analysis. Stakeholders were identified through document analysis and snowballing. Semi-structured interviews were conducted with eligible stakeholders. Stakeholders’ collaborations, dependencies, and their roles in MBV preparedness and response were discussed. Interviewees not currently active in MBV policy were given the opportunity to share their experiences regarding ‘zoonotic infectious diseases’ or ‘healthy living environments’. Interview transcripts were coded to identify collaborations and information- and knowledge sharing between stakeholders. Stakeholders were categorized into domains (animal, vector, human, environment, other) and governance levels (international, national, regional, local, other). Networks were visualized and analysed using Cytoscape and R. Results Stakeholder analysis identified 87 stakeholders who influence or are (likely to be) influenced by MBV preparedness and response, of whom 47 were identified as having an active role in the MBV interaction network. Network visualisation unveiled 153 connections among these 47 stakeholders, encompassing all domains and governance levels but showed underrepresentation of regional, local and environmental stakeholders. Transcript analysis revealed low urgency for MBVs among these stakeholders as an underlying reason for their underrepresentation in the MBV interaction network. Analysis and visualisation of the networks for the other two themes (“healthy living environment” and “(zoonotic) infectious diseases”) did show multiple connections with environmental and regional/local stakeholders. Conclusions The underrepresentation of the environment domain, regional and local stakeholders in the MBV preparedness and response network underlines the remaining challenge of including all relevant stakeholders. We recommend utilising existing collaborations, identified in this study, and central stakeholders to overcome these bottlenecks.

Abstract Purpose Chronic musculoskeletal pain (CMP) is a costly public health threat that is closely related to mental health. This cross-sectional study aimed to investigate the status and factors related to CMP in young males. Methods A total of 126 young males with CMP were randomly sampled between June 20 and October 19, 2023. Demographic information was collected using the Short-Form McGill Pain Questionnaire (SF-MPQ) and Hospital Anxiety and Depression Scale (HADS). Results Moderate-to-mild CMP was showed (15.51 ± 10.07). Older age, lower education level, shorter sleeping hours, and more severe CMP were associated with lower mental health. Specifically, hierarchical regression and path analysis revealed that sleeping hours partially mediated the relationship between chronic musculoskeletal pain and mental health (coefficient = 0.249, p

Abstract Background Malaria is one of the important diseases that threatens the global health system, especially in developing countries, including Yemen. Based on surveillance data, this analysis aimed to assess the trend of malaria in Yemen over the last sixteen years from 2006 to 2021. Methods A retrospective analysis was conducted on secondary malaria data from the database from the Ministry of Public Health and Population in Yemen. Results Of the 15,153,763 suspected cases, approximately 3,651,508 malaria cases were confirmed by both laboratory and clinical diagnoses. Plasmodium falciparum, P. vivax, mixed infections, P. malariae, and P. ovale were recorded at 1,118,117 (98.72%), 123,28 (1.10%), 1838 (0.16%), 155 (0.01%), and 30 (0.01%), respectively. Approximately 77.2% of all malaria cases were recorded in six governorates. Al Hudaydah recorded the highest number of malaria cases (1,231,294), followed by Hajjah (623,937), Taiz (450,051), Dhamar (167,399), Sa’adah (157,881), and Al-Mahweet (154,763). The overall incidence rate of malaria cases and P. falciparum, respectively, was 8.9 and 2.66 per 1,000 people. The highest mean incidence rate of malaria was recorded in Al Hudaydah, Hajjah, Al-Mahweet, Sa’adah, and Abyan, respectively, at 29.71, 19.49, 14.98, 10.62, and 10.14 per 1,000 people. Yemen reported 704 (0.02%) malaria death cases with an overall rate of case fatality of 0.03% and a mortality rate of 0.18 per 100,000 populations. The trend of case fatality decreased from 0.029% in 2006 to 0.015% in 2020, while the mortality rate per 100,000 individuals decreased from 0.3 in 2006 to 0.08 in 2021. Conclusion It currently suggests a continuous increase in the malaria burden without specifying trends or fluctuations and is becoming a public health threat and causing widespread concern. Therefore, the treatment and prevention of malaria infection are crucial for reducing mortality and complications by increasing the use of vector control tools and promoting early diagnosis and treatment.

Abstract Objective To analyze the equity and efficiency of public health resource allocation in China from 2018 to 2022, and to provide a scientific basis for promoting the development of public health resources in China. Methods Data on public health resources of 31 provincial-level administrative regions in mainland China were extracted from 2018 to 2022, and descriptive analysis, Theil index, and health resource agglomeration degree (HRAD) were used to analyze the equity, and data envelopment analysis (DEA) was used to analyze the efficiency. Results The Theil index of public health resource allocation by population in China ranges from 0.006 to 0.049, and the Theil index contribution rate of the number of beds, health technicians, licensed (assistant) physicians, and registered nurses within region is less than 28.76%. The Theil index of public health resource allocation by geography in China ranges from 0.274 to 0.624, and the Theil index contribution rate of the number of institutions, the number of beds, health technicians, licensed (assistant) physicians, and registered nurses within region is more than 77.05%. The HRAD of public health resources is more than 2.18 in the eastern and central regions, while the HRAD of public health resources is less than 1 in the northeastern and western regions. The overall HRAD/population agglomeration degree (PAD) is less than 1 in the northeastern and eastern regions, and greater than 1 in the central and western regions overall. The scale efficiency and overall efficiency of public health resource allocation in China are not 1, the returns to scale are decreasing, and the DEA is relatively ineffective from 2019 to 2022. Conclusion The equity by geography is slightly worse than the equity by population, and the inequity by population mainly comes from between regions, while the inequity by geography mainly comes from within regions. There is a contradiction in the equity by population and by geography allocation in the eastern and western regions, and a congruence in the equity by population and by geography allocation in the northeastern and central regions. The DEA of public health resource allocation in China is relatively ineffective in 2019–2022.

Abstract Background In recent years, public health emergencies, such as the COVID-19 pandemic and Ebola outbreaks, have occurred with increasing frequency worldwide, posing significant threats to global public health security. Policies serve as the foundation and institutional framework for effective emergency responses. Consequently, evaluating and optimizing the formulation and implementation of Public Health Emergency Response Policies (PHERPs) to enhance emergency response capacities has become an urgent and important research priority. Methods This study developed an evaluation system for PHERPs using content analysis of policy texts, expert consultations, and the PMC-Index model. It quantitatively analyzed 33 central-level PHERPs in China issued between 2003 and 2020. Results The analysis revealed an average PMC-Index score of 6.43 for the 33 PHERPs. The PMC-Surface analysis highlighted that the top three scoring indicators were policy openness, policy structure, and policy area. In contrast, the lowest-scoring indicators were policy timeliness, issuing agency, and incentive measures. Conclusions The study demonstrates was generally good. However, significant variability was observed in the scores of individual indicators across different policies. These findings provide valuable insights into the strengths and weaknesses of PHERPs and offer a reference for optimizing policy design and implementation.

Abstract Background Enabling community-led health initiatives will contribute to reducing the burdens on the healthcare system. Implementing such initiatives successfully in high and upper-middle income Asian countries is poorly understood and documented. We undertook a Rapid Review, systematically synthesising the evidence to develop implementation guidelines to address this gap. Methods Eligible studies focused on community movements or affiliated constructs in upper-middle and high-income Asian countries, conducted between 2014 and 2021. Studies were sought from either electronic databases – Cochrane and Campbell Collaboration, PubMed, Embase, CINAHL, SCOPUS, APA Psycinfo, Web of Science, Google Scholar – or recommendation from experts. Extraction was undertaken according to mid-level programme goals, termed Intermediate Results. These were conceptualized by a cross-disciplinary team and iteratively reworked as analysis progressed. Framework analysis was undertaken and structured according to the IRs. 28 studies (9 mixed methods, 9 quantitative, 7 qualitative and 3 case studies) were included and synthesised. Results The MovEMENTs checklist and related strategies were elicited through the review. The six Intermediate Results include to: (1) Move the community to be recruited and retained (2) Engage capacity and build capability; (3) Maintain emotional resonance; (4) Embed participatory approaches; (5) Nurture network building and partnerships; (6) Team up to improve commissioning and funding structures. Sixteen strategies and related implementation guidelines underpinning the Intermediate Results are extracted from the evidence-base of included studies. Conclusion The MovEMENTs for Health checklist is developed to serve as a guide for implementers and proposed to be adaptable to various contexts. The checklist should be tested, validated, and updated as a field tool. Trial registration PROSPERO ID: CRD42023471832.

Abstract Background Despite the relatively small number of items on the Perceived Social Support Scale (PSSS-12), there has been a trend toward simplification of the scale in order to minimize testing time. In this situation, some researchers based on the responses of military spouses in the U.S., has simplified the PSSS-12 to develop the PSSS-M6. This study aimed to develop a short version of the PSSS-12 suitable for the Chinese general population. Methods A multi-stage stratified cluster sampling method was employed to collect data from 10,914 residents in 120 cities across the country. After randomly dividing the data into two parts, exploratory analysis and confirmatory analysis were conducted separately. During the exploratory analysis of dataset 1, the scale was simplified using both Classical Test Theory (CTT) and the Ant Colony Optimization (ACO), resulting in one short form for each approach. Additionally, three short forms were obtained by introducing other short forms of the Multidimensional Scale of Perceived Social Support (MSPSS) scale derived from multidimensional item response theory in previous studies. The reliability and discriminant validity of the three short forms were tested. Subsequently, the reliability, validity, model fit and measurement invariance for the two short forms of the MSPSS scale were examined using dataset 2. Results The 6-item short form developed based on the ACO (PSSS-A6) exhibited the best psychometric properties among all the short forms. Moreover, the 3-item short form composed of items with the highest factor loadings in each dimension also demonstrated good psychometric properties. Conclusions In future research, if a short form of the MSPSS scale is needed for measurement purposes, the 3-item short form is suitable for clinical settings, large-scale cross-sectional studies, or longitudinal studies, while the PSSS-A6 is more appropriate for more precise measurements. Trial registration This study underwent ethical review (JNUKY-2021-018) by Jinan University.

Abstract Background To comprehend the current state of death anxiety among Chinese college students during the COVID-19 pandemic, analyze its influencing factors, and provide recommendations for mitigating death anxiety among these students. Methods From March to May 2023, utilizing a cluster sampling method, students from three universities in Changzhou, Jiangsu, were selected as research participants. The investigation employed a general information questionnaire, the PTSD Checklist for DSM-5 (PCL-5), the Chinese Version Templer-Death Anxiety Scale (CT-DAS), and the brief version of the Big Five Inventory (BFI-10). Multivariate linear regression analysis was performed to examine the factors influencing death anxiety among Chinese college students during the COVID-19 pandemic. Results The total average score of death anxiety among the college students in this study was 44.35 ± 8.21. There was a positive correlation between death anxiety scores and both PTSD symptoms scores and neuroticism (r = 0.134, 0.255, both P

Abstract Background Colostrum is the first form of milk produced immediately following the delivery of a newborn. It is highly nutritious and contains antibodies to protect the newborn against disease and crucial for the newborn’s health Despite its benefits, some mothers avoid giving colostrum to their newborns. Objective This study aims to assess the prevalence and factors associated with colostrum avoidance among postnatal mothers in Addis Ababa, Ethiopia. Methods A health facility-based mixed-methods of study design was conducted. Both quantitative and qualitative data were collected using pretested questionnaires and key informant interview question guides, respectively.Quantitative data were collected through structured interviews and analyzed using descriptive statistics such as frequencies, means, and standard deviations were performed. Binary logistic regression analysis was employed to assess the associated factors of colostrum avoidance among postnatal mothers at health facilities in study area.Qualitative data were gathered via in-depth interviews and analyzed thematically. Results The prevalence of colostrum avoidance was 8.94% (95% CI: 5.9–10.9). Multivariable analysis revealed significant predictors of colostrum avoidance: lack of counseling about colostrum benefits (AOR = 5.802, 95% CI: 2.467–13.647), cesarean delivery (AOR = 3.420, 95% CI: 1.411–8.288), poor maternal knowledge about colostrum (AOR = 13.111, 95% CI: 5.462–31.468), and late initiation of breastfeeding (AOR = 3.330, 95% CI: 1.242–8.926). Qualitative findings echoed these results, with cultural beliefs and misconceptions about colostrum contributing to its avoidance. Conclusion The study highlights a significant prevalence of colostrum avoidance among postnatal mothers in Addis Ababa. Key predictors include inadequate counseling, cesarean delivery, poor knowledge about colostrum, and delayed breastfeeding initiation. Interventions aimed at improving maternal education and breastfeeding practices are essential to reduce colostrum avoidance.

Abstract Background Despite the high global prevalence, burden, and direct and indicated costs, migraines are often under-diagnosed and undertreated. Understanding the prevalence of migraine and unmet needs is crucial for improving diagnosis and treatment across Europe (EU) countries; however, real-world studies are limited. Methods This retrospective cross-sectional survey utilized weighted patient-reported data from the 2020 National Health and Wellness Survey (NHWS) in five EU (5EU) countries (France, Germany, United Kingdom [UK], Italy, and Spain). The survey included adults aged ≥ 18 years who self-reported experiencing migraines in the past 12 months and had a physician’s diagnosis. The survey assessed migraine prevalence by age and sex. Other measures included migraine characteristics, disability assessment, migraine frequency (monthly migraine days [MMDs] and monthly headache days [MHDs], menstrually-related migraine, treatment patterns, and provider characteristics. Results The study included 7,311 respondents with diagnosed migraines, representing an estimated 30.5 million adults with a weighted prevalence of 11.5% in the 5EU. Spain had the highest prevalence (14.0%), followed by Italy, France, UK, and Germany. Migraine prevalence was highest in the age group of 30–39 years, and females had nearly twice the prevalence compared to males. About 56% of respondents reported disability due to migraines, with highest percentage reported in Germany (66.0%). About 46% of female respondents reported experiencing menstrually-related migraines. One-fourth of the study respondents reported > 4 MMDs and 56.2% reported > 4 MHD. Current treatment patterns revealed that 79.7% of respondents were receiving some form of migraine treatment, with non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, and triptans being the most commonly reported prescription medications. Primary care physicians (PCPs) were the most common providers diagnosing migraines, followed by neurologists. Conclusions In the 5EU, one-fourth of diagnosed respondents reported > 4 MMDs, and 56.2% reported > 4 MHDs. Nearly half of females experienced menstrually-related migraines. Although most patients reported taking medication for migraine, severe disability and medication overuse were observed. PCPs were the main treatment providers, highlighting the need for improved expertise and referrals to specialists. Further research is required for a better understanding of the disparities between migraine frequency and treatment approaches.

Abstract Background Young chronic obstructive pulmonary disease (COPD) refers to people with COPD between the ages of 20 and 50 years. Current epidemiological studies focus on local geography, and there is a lack of global-level analysis. This study provides in-depth analyses of the disease burden of young COPD at global, regional, and national levels. Methods This study used the Global Burden of Disease Study 2021 (GBD). The age-standardised prevalence rate (ASPR), age-standardised incidence rate (ASIR), age-standardised death rate (ASDR), and age-standardised disability-adjusted life years (DALYs) rate were used to describe the disease burden. The estimated annual percentage change (EAPC) during the study period was calculated. Joinpoint regression analysis examined the time trend from 1990 to 2021. Annual percentage change (APC) and average annual percentage change (AAPC) were calculated. Risk factors were reported by region and sex. Results In 2021, the global number of young COPD cases was 30,384,539, and the ASPR, ASIR, ASDR, and age-standardised DALYs rates fell slightly. Oceania reported the highest ASPR, ASDR, and age-standardised DALYs rate. High-income North America has the highest ASIR. In 2021, the prevalence, incidence, death, and DALYs rates exhibited similar trends, increasing with age. From 1990 to 2021, both the prevalence and death rates showed a consistent downward trend across all age groups. Joinpoint regression analysis indicated a slight increase in both the ASPR (APC: 0.13; 95% CI: 0.06 to 0.19) and the ASIR (APC: 0.17; 95% CI: 0.10 to 0.24) during the period from 1990 to 1994. The leading DALYs attributable to risk factors for young COPD are household air pollution from solid fuels (20.4%), ambient particulate matter pollution (17.9%), and smoking (13.5%). Conclusions The global burden of ASPR, ASIR, ASDR, and age-standardised DALYs rates in young COPD has decreased, however, the absolute number of patients has increased. The global burden shows noticeable regional differences, with particularly high burdens observed in Oceania. Improving air quality, promoting smoking cessation, and increasing access to lung function tests, raising awareness of young COPD are key strategies for alleviating the burden of young COPD.

Abstract Background Internal displacement and cross-country migration are an increasing global phenomenon drawing the attention of politicians and the public. Causes and effects on the migrants and receptor populations are varied and often shaped by immigration laws and how migrants and refugees are being dealt with by local conditions, policy frameworks and by the host population (receptors). The massive influx of Venezuelan migrants into Colombia for more than a decade has characteristics which warrant a systematic analysis to identify contextual and individual factors favouring and hindering the well-being of migrants and their new Colombian neighbours of the receptor population. Methods A household interview survey was conducted in two cities of the Colombo-Venezuelan border: Cucuta and Valledupar. The survey included 412 migrant families, comprising 1656 individuals, and 317 Colombian neighbour families, totalling 1077 individuals. Only migrants staying in the border area for more than 6 months and excluding “short term migrants” who cross the border only for getting treatment or schooling for their children. We used systematic sampling in neighbourhoods with the highest concentration of migrants. The sampling interval was set at every 7 and 6 migrant households. Ethical approval was obtained by the ethics committees of the three participating universities and the local health authority. Results Venezuelan migrants were younger than their Colombian neighbours (22.04 and 28.69 years respectively). The primary reason for migration among these individuals was economic (84.1%) and much less for political reasons (

Abstract Background Developing interventions along with the population of interest using systems thinking is a promising method to address the underlying system dynamics of overweight. The purpose of this study is twofold: to gain insight into the perspectives of adolescents regarding: (1) the system dynamics of energy balance-related behaviours (EBRBs) (physical activity, screen use, sleep behaviour and dietary behaviour); and (2) underlying mechanisms and overarching drivers of unhealthy EBRBs. Methods We conducted Participatory Action Research (PAR) to map the system dynamics of EBRBs together with adolescents aged 10–14 years old living in a lower socioeconomic, ethnically diverse neighbourhood in Amsterdam East, the Netherlands. For just over two years, we conducted weekly PAR sessions (45–120 min) with four dynamic groups - two in primary schools and two in secondary schools - each school year (n = 4–8 adolescents in each group (0-100% girls); n = 40–54 sessions in total per group). These adolescents acted as co-researchers and created Causal Loop Diagrams (CLDs) for each EBRB and explored important underlying mechanisms for unhealthy EBRBs. Based on the underlying mechanisms, three overarching drivers for unhealthy EBRBs were distinguished. Results The three overarching drivers for unhealthy EBRBs are: (1) the physical environment, (2) social norms, and (3) unhealthy behaviours reinforcing each other. The adolescents explained that their physical environment fosters unhealthy behaviour by providing easy access to unhealthy food products while restricting physical activity. They explained the importance of social norms around EBRBs that are formed by their peers, friends, and family. The influence of their peers often led to unhealthier EBRBs, especially after the transition to secondary school. The adolescents explained that unhealthy behaviours reinforced each other, while healthy behaviour led to more healthy behaviour. Conclusions Our novel approach combining PAR with systems thinking gained valuable insights into the system dynamics of EBRBs from the adolescent perspective. These insights can inform future interventions targeting systems change regarding EBRBs.

Abstract Background Older adults with cognitive impairment tend to experience deteriorating oral health and inadequate oral hygiene behaviors, but few studies have addressed interethnic variability. This study aimed to explore the associations between cognitive impairment and oral health or oral hygiene behaviors in multiethnic older adults in Western China. Methods We conducted a cross-sectional multicenter study from four provinces of Western China, recruiting multiethnic older adults aged 50 years and older between July and December 2018. Oral health and oral hygiene behaviors were evaluated through an oral examination and a self-made questionnaire, whereas cognitive condition was assessed via the Chinese version of the Short Portable Mental Status Questionnaire (SPMSQ). Three multiple regression models were used to examine the associations between cognitive impairment and oral health or oral hygiene behaviors, with adjustments for relevant variables. Results A total of 6529 participants with a median age (interquartile range) of 62.4 (55, 68) years were included. The prevalence of cognitive impairment was 15.4%, with the Yi group having the highest prevalence (28.9%), followed by the Tibetan (19.1%) and Qiang (15.4%) groups. Poorer self-rated oral health, fewer residual teeth, less frequent use of toothbrushes and toothpaste, and irregular dental care were associated with a risk of cognitive impairment (p

Abstract Objectives The COVID-19 pandemic led to public health crises beyond the direct casualties from the virus itself. This study assesses the impact of COVID-19 on suicide rates in South Korea, which implemented effective policy interventions against COVID-19 and has one of the highest suicide rates among member states of the Organisation for Economic Co-operation and Development (OECD). Study design A county fixed effects model. Methods We analyze county-level data covering the 2017-2022 period from the National Statistical Office of Korea and use a county fixed effects model. The primary outcome is the suicide rate per 100,000 population. Our main analysis compares pre-pandemic suicide rates (2019) with those during the pandemic (2020-2022) at bimonthly frequency, focusing on the population aged 20-59 years. Results We find that, in contrast to the initial global concerns about potential increases in suicide because of pandemic-related stress, suicide rates significantly decreased during the pandemic. However, this trend was not uniform: young women experienced fluctuating suicide rates, highlighting a demographic-specific impact. The study also finds that both people who died by suicide and people who died of other non-suicide causes were more likely to have a college diploma and were less likely to be married. Additionally, there are mixed results regarding the location of death. Overall, the pandemic appears to have had a complex effect on suicide behaviors in South Korea. Conclusions The findings underscore the need for targeted mental health interventions, especially for vulnerable groups such as young women. The findings also emphasize the importance of considering demographic-specific responses in public health strategies to better address the mental health consequences of large-scale crises.

Abstract Background Leukemia, a group of malignant tumors, has been a significant public health concern due to its high incidence and mortality rates. This study aimed to provide an in-depth analysis of the global leukemia burden from 1990 to 2021 using the Global Burden of Disease (GBD) database, focusing on trends in incidence, mortality, and Disability-Adjusted Life Years (DALYs) across different regions, genders, and age groups including forecasting future trends. Methods Data were sourced from the GBD study, utilizing the Global Health Data Exchange (GHDx) query tool. We employed descriptive, trend, cluster, and forecasting analyses using age-standardized rates (ASRs) and the Estimated Annual Percentage Change (EAPC) to quantify changes over time. Hierarchical clustering and forecasting models, including ARIMA and Exponential Smoothing (ES), were utilized to predict future trends. Notably, ARIMA and ES smoothing parameters were meticulously identified and estimated. Results The analysis of global leukemia burden from 1990 to 2021, as reflected by DALYs, indicates a downward trend, with the number of DALYs estimated to have decreased from 578,020 (401,241–797,570) in 1990 to 302,902 (206,475–421,952) in 2021, corresponding to an EAPC of -0.94 (-1.01—-0.88). Notably, it is important to highlight that there is variability in these estimates across different regions and demographic groups, which should be interpreted with caution due to potential data limitations. High-income regions generally showed a decreased leukemia burden, while some middle- and low-income countries exhibited an opposite trend. Males displayed higher leukemia incidence, mortality, and DALY rates compared to females. The oldest age groups, mainly those aged 95 and above, experienced the most significant changes, with the highest EAPC observed in this demographic. Geographical and Socio-demographic Index (SDI)–based analyses further highlighted the heterogeneity in leukemia burden. Additionally, forecasting models project a continued decrease in leukemia burden, emphasizing the importance of ongoing public health strategies. Conclusion The study indicates overall progress in reducing the leukemia burden at a global level due to medical advancements. However, specific regions and demographic groups, particularly males and the elderly, continue to face challenges. Socioeconomic status significantly impacts healthcare outcomes, with a need for resource distribution and healthcare system strengthening in low-income areas. The findings call for nuanced public health strategies tailored to socioeconomic contexts and sustained research and healthcare infrastructure efforts.

Abstract Background Evaluating access to psychosocial services can inform policy decision-making on ways to address shortages in the availability of mental health (MH)-specialized providers. The objective of the study was to assess how the mental health (MH)-specialized workforce met the demand for psychosocial services of Medicaid-insured children in Georgia, with direct relevance in establishing quantitative network adequacy. Methods We used the 2018 Medicaid (TAF) claims data, the 2018 National Plan and Provider Enumeration System database, and the 2019 Georgia school-based program data to estimate community-level demand and practice-level supply of psychosocial services. We evaluated the availability of services using mathematical models. The outcome measures were met demand and travel distance. We explored the impact of increasing in-home care delivery, expanding Medicaid participation, or increasing caseload for the Medicaid-participating providers on improving met demand for psychosocial services. Results Our findings showed that 34% of the demand from Medicaid-insured children in Georgia remained unmet, and 25% of the Georgia census tracts (rural 79%; urban 16%) had

Abstract Background Although mortality from myocardial infarction (MI) has declined worldwide due to advancements in emergency medical care and evidence-based pharmacological treatments, MI remains a significant contributor to global cardiovascular morbidity. This study aims to examine the risk factors associated with individuals who have experienced an MI in Türkiye. Methods Microdata obtained from the Türkiye Health Survey conducted by Turkish Statistical Institute in 2019 were used in this study. Binary logistic regression, Chi-Square, and CHAID analyses were conducted to identify the risk factors affecting MI. Results The analysis identified several factors associated with an increased likelihood of MI, including hyperlipidemia, hypertension, diabetes, chronic disease status, male gender, older age, single marital status, lower education level, and unemployment. Marginal effects revealed that elevated hyperlipidemia levels increased the probability of MI by 4.6%, while the presence of hypertension, diabetes, or depression further heightened this risk. Additionally, individuals with chronic diseases lasting longer than six months were found to have a higher risk of MI. In contrast, factors such as being female, having higher education, being married, being employed, engaging in moderate physical activity, and moderate alcohol consumption were associated with a reduced risk of MI. Conclusion To prevent MI, emphasis should be placed on enhancing general education and health literacy. There should be a focus on increasing preventive public health education and practices to improve variables related to healthy lifestyle behaviours, such as diabetes, hypertension, and hyperlipidemia.

Abstract Background Bullying, encompassing physical, psychological, social, or educational harm, affects approximately 1 in 20 United States teens aged 12-18. The prevalence and impact of bullying, including online bullying, necessitate a deeper understanding of risk and protective factors to enhance prevention efforts. This study investigated the key risk and protective factors most highly associated with adolescent bullying victimization. Methods Data from the Student Health and Risk Prevention (SHARP) survey, collected from 345,506 student respondents in Utah from 2009 to 2021, were analyzed using a machine learning approach. The survey included 135 questions assessing demographics, health outcomes, and adolescent risk and protective factors. LightGBM was used to create the model, achieving 70% accuracy, and SHapley Additive exPlanations (SHAP) values were utilized to interpret model predictions and to identify risk and protective predictors most highly associated with bullying victimization. Results Younger grade levels, feeling left out, and family issues (severity and frequent arguments, family member insulting each other, and family drug use) are strongly associated with increased bullying victimization - whether in person or online. Gender analysis showed that for male and females, family issues and hating school were most highly predictive. Online bullying victimization was most highly associated with early onset of drinking. Conclusions This study provides a risk and protective factor profile for adolescent bullying victimization. Key risk and protective factors were identified across demographics with findings underscoring the important role of family relationships, social inclusion, and demographic variables in bullying victimization. These resulting risk and protective factor profiles emphasize the need for prevention programming that addresses family dynamics and social support. Future research should expand to diverse geographical areas and include longitudinal data to better understand causal relationships.

Abstract Background Asthma is a common respiratory disease in children, and air pollution is a risk factor for pediatric asthma. However, how air pollution affects blood cells in pediatric patients with asthma remains unclear. Methods This retrospective observational study, performed in 2007–2018 at a medical center, enrolled non-trauma patients aged

Abstract Background Ischemic heart disease (IHD) remains a leading cause of mortality and morbidity globally. This study aims to evaluate the trends in IHD burden across different socioeconomic regions using data from the Global Burden of Disease Study 2021 (GBD 2021) and to understand the impact of the metabolic risk factors on these trends. Methods Data from GBD 2021 was analyzed to evaluate the global age-standardized death rates (ASDR) and disability-adjusted life years (ASRDALYs) linked to IHD. Key metabolic risk factors evaluated included high systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDLc), fasting plasma glucose (FPG), and body mass index (BMI). Temporal trends were assessed using estimated annual percentage changes (EAPCs), with further analysis by age, sex and socio-demographic index (SDI). Results Resource-abundant regions showed notable reductions in ASDR and ASRDALYs, largely due to effective management of SBP and LDLc, resulting in an EAPC of -3.43 (95% CI: -3.32, -3.53). In contrast, resource-limited regions, particularly among males, experienced stagnation or even increases in IHD burden. The EAPC of ASDR in low-, low-middle-, and middle-SDI regions ranged from − 0.12 (95% CI: -0.04, -0.19) to 0.16 (95% CI: 0.09, 0.23). Among males, the values ranged from 0.22 (95% CI: 0.14, 0.29) to 0.55 (95% CI: 0.47, 0.62). The increase in IHD burden in these regions was primarily driven by rising levels of FPG and BMI. Younger populations (15–49 years) were disproportionately affected, showing increasing exposure to these metabolic risks. Conclusion Regional disparities in IHD burden persist, primarily driven by metabolic risk factors. Resource-abundant regions have benefitted from effective control of SBP and LDLc, whereas resource-limited regions face growing challenges, especially related to FPG and BMI. The use of secondary data from the GBD 2021 database provides a comprehensive global perspective but may not fully capture local variations in disease burden. Targeted public health strategies and early interventions are essential to reduce the growing IHD burden in these vulnerable populations.

Abstract Background Adolescent pregnancy, also known as teenage pregnancy, is an unwanted pregnancy affecting girls aged 15–19 years. With a global prevalence of 25%, Africa has 18.8% of female adolescents become pregnant, preventing them from a better standard of living, such as good education and parental care, and adolescent pregnancy, which poses health risks, educational and career disruptions, financial strain, and lower academic achievement, while also increasing public costs and social service demand. This study aimed to determine the prevalence and factors associated with adolescent pregnancy among girls aged 15–19 years in Muhanga district, Rwanda. Methods The study involved 392 female adolescents aged 15–19 years in Muhanga district, Rwanda. The participants were selected through a multistage sampling method, and the study ensured voluntary participation whereby the assent and consent forms were signed. Data were collected through questionnaires and analyzed via STATA v.18, and statistical analysis, including chi-square tests and multivariate logistic regression, was used to control for confounders. Ethical approval was obtained from Mount Kenya University and Muhanga district administration. Results The study reported an adolescent pregnancy rate of 10.7% (95% CI: 7.7–13.7). Adolescents financially supported by others (not their parents or guardians) had higher odds of having pregnancy (AOR = 3.9, 95% CI: 1.431–10.467, p

Abstract Background Achieving viral suppression through effective treatment adherence is critical for adolescents with HIV; however, the role of treatment adherence self-efficacy—an individual’s confidence in their ability to consistently follow antiretroviral therapy (ART) regimens—remains under-explored among Chinese adolescents. This gap is particularly concerning given the United Nations’ “95-95-95” targets to end the AIDS epidemic by 2030. Objective The aim of this study is to investigate the treatment adherence self-efficacy levels of Yi ethnic adolescents with HIV in a county in Liangshan Prefecture, and to explore the association between self-acceptance, emotion regulation, and treatment adherence self-efficacy. Methods A cross-sectional study was conducted in a county of Liangshan Prefecture from November 2023 to March 2024. A convenience sampling method was used to select 205 participants. Multiple linear regression models were employed to examine the relationships between demographic variables, self-acceptance, emotion regulation and treatment adherence self-efficacy. A p-value

Abstract Background A significant number of primiparous women lack awareness of labor epidural analgesia, resulting in lower acceptance of labor epidural analgesia. Additional prenatal education may help primiparas understand labor epidural analgesia and increase labor epidural analgesia rates. This randomized controlled trial (RCT) will evaluate the effects of an online and offline prenatal labor epidural analgesia education program for primiparas to improve their labor epidural analgesia rate and to reduce their misunderstanding of labor epidural analgesia and fear of birth. Methods A single-blinded, randomized, controlled, parallel-design trial will be conducted. Based on the Theory of Planned Behavior, online and offline prenatal labor epidural analgesia education program has five modules: (a)elementary knowledge, (b)attitude, (c)subjective norm, (d) perceived behavioral control and (e)behavioral intention. Primiparous women will be recruited in the obstetrics department or midwife clinic of a tertiary hospital in Shenzhen, China. The participants (N = 196) will be randomly allocated to the intervention group (N = 98) that receives routine prenatal education and access to the online and offline prenatal labor epidural analgesia education program and the control group (N = 98) that receives routine prenatal education. Labor epidural analgesia rate will be extracted from the electronic medical record; misunderstanding and intention of labor epidural analgesia and fear of birth will be measured at baseline and immediately after the intervention. The study was ethically approved in November 2023. Discussion If the online and offline prenatal labor epidural analgesia education program has positive outcomes, it may offer an effective intervention program to decrease misperceptions of labor epidural analgesia and fear of birth and to improve the labor epidural analgesia rate for Chinese primiparas. As the first RCT study to evaluate the effect of the online and offline prenatal labor epidural analgesia education program with a strict research design and a theoretical framework, this research will provide evidence on prenatal labor analgesia health education for clinical practice in China. Trial Registration Registered at the Chinese Clinical Trials.gov on January 11th, 2024. Trial Registration Number: ChiCTR2400079767.

Abstract Background Depressive symptoms in adolescents can significantly affect their daily lives and pose risks to their future development. These symptoms may be linked to various factors experienced during both childhood and adolescence. Machine learning (ML) has attracted substantial attention in the field of adolescent depression; however, studies establishing prediction models have primarily considered childhood or adolescent features separately, resulting in a lack of analyses that incorporate factors from both stages. Methods We collected 39 features related to childhood and adolescence. Using the maximum relevance-minimum redundancy method and four ML algorithms, we determined the optimal feature subset for identifying depressive symptoms and constructed child-adolescent models. Stepwise logistic regression and four ML methods were employed to create demographic and combined models, respectively. The performance of each model was evaluated using a test set, and SHapley Additive exPlanations (SHAP) were utilized to interpret the models’ prediction results. Results The proposed child-adolescent models exhibited superior performance on the test set than the demographic and combined models (AUC: 0.835–0.879 versus 0.530 and 0.840–0.876, respectively). The optimal feature subset included two childhood features (relationship quality with peers and parental absence) and four adolescence features (social trust, academic pressure, importance of the internet for entertainment, and positive parenting behaviour). These features were found to be more effective than demographic characteristics in distinguishing depressive symptoms in adolescents. Conclusions This study demonstrates the correlation between adolescence depressive symptoms and specific factors from both childhood and adolescence, as well as the potential of ML to predict it. These findings may serve as a reference for future intervention studies.

Abstract Background Fitness to maintain an ideal body shape is becoming increasingly popular among college students. However, it also leads to many mental health issues. This study explores the pathways through which negative body image affects depression in college students. It also examines possible means of implementing depression interventions in college populations through the mediating roles of self-efficacy and physical activity, and the moderating role of social support. Method The present study employed a convenience sampling method to collect data from 600 university students using the Body Image Scale, Self-Efficacy Scale, Physical Activity Scale, General Social Support Scale and Depression Self-Rating Scale. Data analysis and structural equation modeling were conducted using SPSS, M-plus and R software. Result The result indicate that negative body image is positively correlated with depression. Self-efficacy and physical exercise play a chain mediating role between body image and depression. Additionally, social support moderates the effects of self-efficacy by predicting the pathway through which physical activity effects depression. Conclusion The study suggest that individuals with a negative body image are more prone to depression and that physical exercise can help alleviate their depressive symptoms. Self-efficacy is an important mediator, and social support moderates adherence to physical exercise. Therefore, attention should be paid to the mental health issues of college students with negative body images.

Abstract Background The prevalence of mental health problems among college students, both domestically and internationally, has emerged as a significant public health concern. College students are in a period of transition to independent living. Adopting a healthy lifestyle can have advantageous effects on their overall well-being. Thus, this study aimed to investigate the impact of healthy lifestyle choices on mental health problems among college students in China. Methods We conducted a cross-sectional online survey of college students from 2021 to 2023 at a university in Wuhan (N = 1826) using the cluster sampling method. We employed Chi-square tests and binary logistic regression to evaluate the association between healthy lifestyle choices and mental health and identify other influencing factors. Results A total of 969 (53.1%) students met standard criteria for poor mental health. Multiple analysis revealed that personal characteristics including female (1.280[1.035—1.582]), obesity (2.015[1.278—3.175]), general or poor health status (1.738[1.380—2.188]; 4.265[1.125—16.165]), occasionally attending health knowledge lectures or paying attention to health books and information (1.376[1.055—1.795]), healthy lifestyle choices including occasionally or seldom eating breakfast (1.393[1.105—1.757]; 1.825[1.287—2.587]), occasionally or seldom getting enough sleep (2.800[2.179—3.597]; 3.544[2.209—5.685]), a poor or very poor irregular schedule (1.792[1.222—2.628]; 3.619[1.380—9.486]), seldom or no physical exercise (1.395[1.053—1.847]; 1.377[1.066—1.779]), and often smoking (3.320[1.281—8.604]) were identified as significant predictors of poor mental health. Conclusion The prevalence of poor mental health among college students was high. A few types of healthy lifestyles, such as a lack of health knowledge and physical exercise, seldom eating breakfast, not getting enough sleep, an irregular schedule, and chronic smoking were closely related to abnormal psychological health symptoms. Interventions such as health education knowledge lectures and regular exercise programs should be given to college students to improve their mental health.

Abstract Background eHealth Literacy (eHL) is a set of competencies and skills encompassing the knowledge, comfort and perceived ability to identify, evaluate and apply electronic health information to health problems. Given its role in the appropriate use of health technologies, ensuring equitable access to health information and improving patient outcomes, this study aims to systematically retrieve, qualitatively and quantitative pool and critically appraise available experimental evidence on the effectiveness of eHL interventions across different population groups. Methods Following the PRISMA guidelines, we conducted a systematic review in PubMed/Medline, Scopus, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov, including original experimental studies quantifying the effectiveness of interventions aimed at increasing eHL, as assessed by the eHealth Literacy Scale (eHEALS) or other validated scales. We performed a random-effects model meta-analysis comparing changes in eHL levels before and after the interventions, and between the intervention and control groups. Heterogeneity was assessed using I2 statistics. Results Out of the 504 studies retrieved, 15 studies conducted between 2011 and 2023 met the inclusion criteria. Target populations of eHL interventions included adults in 7 studies, older people in 5 and young people in 4. The meta-analysis included 10 studies that used the eHEALS. Participants showed a mean increase in eHEALS scores of 5.81 points (95% CI = 3.36–8.26, N = 1025) following the eHL interventions compared to the pre-intervention period. In the analysis between the intervention and control groups, we found a statistically significant difference in eHL improvement in favour of the intervention group, with mean eHEALS scores 3.62 points (95% CI = 1.63–5.60, N = 1258) higher in the intervention group than in the control groups. Subgroup analyses by intervention type, stratified by Collaborative Learning (CL) or Individualistic Learning (IL) showed significant increases in eHealth Literacy in the pre-post intervention analysis (CL: UMD = 5.19, CI = 0.01–10.38, N = 402; IL: UMD = 6.05; CI = 3.14–8.97, N = 623) and in the intervention vs. control analysis in the IL group (DMD = 4.98; CI = 1.77–8.12, N = 540). Conclusions Our findings support the effectiveness of tailored interventions in significantly enhancing eHL, providing key insights for evidence-based intervention design targeted to different population groups.

Abstract Background Lifestyle and cardiovascular mortality and all-cause mortality have been exhaustively explored by traditional methods, but the advantages of machine learning (ML) over traditional methods may lead to different or more precise conclusions. The aim of this study was to evaluate the effectiveness of machine learning-based lifestyle factors in predicting cardiovascular and all-cause mortality and compare the results obtained by traditional methods. Method A prospective cohort study was conducted using a nationally representative sample of adults aged 40 years or older, drawn from the US National Health and Nutrition Examination Survey from 2007 to 2010. The participants underwent a comprehensive in-person interview and medical laboratory examinations, and subsequently, their records were linked with the National Death Index for further analysis. Extreme gradient enhancement, random forest, support vector machine and other machine learning methods are used to build the prediction model. Result Within a cohort comprising 7921 participants, spanning an average follow-up duration of 9.75 years, a total of 1911 deaths, including 585 cardiovascular-related deaths, were recorded. The model predicted mortality with an area under the receiver operating characteristic curve (AUC) of 0.862 and 0.836. Stratifying participants into distinct risk groups based on ML scores proved effective. All lifestyle behaviors were associated with a reduced risk of all-cause and cardiovascular mortality. As age increases, the effects of dietary scores and sedentary time on mortality risk become more pronounced, while the influence of physical activity tends to diminish. Conclusion We develop a ML model based on lifestyle behaviors to predict all-cause and cardiovascular mortality. The developed model offers valuable insights for the assessment of individual lifestyle-related risks. It applies to individuals, healthcare professionals, and policymakers to make informed decisions.

Abstract Introduction A considerable number of individuals born in the Nordic countries to immigrant parents are now entering youth and young adulthood, but we have limited knowledge about their health. This scoping review aimed to map and summarize existing knowledge on the health of this group. Methods This research followed guidelines from the Joanna Briggs Institute. The literature search was performed in the databases Ovid Medline, Embase, APA PsycInfo, CINAHL, Scopus, SveMed+, Cochrane Central Register of Controlled Trials Issue, and Epistemonikos. Two researchers screened titles and abstracts of all records, and then full-texts of potentially relevant studies. Any disagreements were solved by discussion. Reference lists of the included studies were screened for additional relevant articles. Included articles should report on health outcomes among persons aged 16–30 years, born in a Nordic country to immigrant parents. Evidence was extracted and summarized. Results The initial search resulted in 2452 unique records. A total of 11 articles were included in the final scoping review. Most of the studies were on mental health and concluded that descendants of immigrants had higher levels of self-reported mental health problems than native-background youths and young adults. They were, however, less likely to use mental health services. Conclusion Available studies suggest that young adults born in the Nordics to immigrant parents have a greater burden of mental health problems but use mental health services less, than natives. Further studies on the reasons for this are warranted to elucidate possible action points.

Abstract This short review addresses the pressing issue of lung cancer among firefighters, a population facing unique occupational hazards such as smoke inhalation and asbestos exposure. With lung cancer being a leading global cause of death, the study emphasizes the disproportionate burden on firefighters. Notably, wildfire smoke, containing carcinogenic elements, poses a rising significant threat to firefighters’ respiratory health. Despite evidence linking firefighting to increased lung cancer risk, few studies have explored the underlying mechanisms. This study conducts a comprehensive review employing PRISMA guidelines to synthesize existing literature from 1972 to 2022. We discuss the association between age, race, and time spent fighting fires with lung cancer development. Our review also underscores the scarcity of studies investigating specific carcinogens and their role in firefighters’ lung cancer risk, emphasizing the need for more targeted research. The study advocates for improved methodology, suggesting the use of individual-level exposure metrics like “fire-hours” to enhance causal inference. Despite limitations in current literature, the findings stress the urgency of understanding the intricacies of lung cancer development among firefighters and call for further research to inform preventive measures and potential screening protocols.

Abstract Background The study aimed to assess the prevalence and distribution of different levels of nutritional status among young people, to examine its association with social determinants of health, and to analyse its trend over time. Method The research was a secondary analysis of the data from four national health surveys of the Serbian population. The research sample included 11,243 respondents, aged 15 to 29, both genders. A multivariate logistic regression model was applied to examine the association between socio-demographic characteristics, lifestyle, health status, and the level of respondents’ nutritional status. The trend analysis of the levels of nutritional status by the research years was done using multiple linear regression in adjusted models. Results A total of 63.3% of respondents had body mass index (BMI) in the normal weight range, 11.7% were underweight, 18.5% were pre-obese, and 6.2% were obese. The average BMI of the study participants was 23.01 ± 6.01. The female respondents were more frequently underweight, and the male respondents were pre-obese and obese. Different factors were associated with different nutritional status levels - for underweight: female gender (OR: 5.29), age 15–19 (OR: 0.06), being married/ in a relationship (OR: 0.69), living in Belgrade region (OR: 1.35), presence of chronic diseases (OR: 0.56), consumption of psychoactive substances (OR:0.56) and non-smoking (OR: 0.70); for pre-obesity: female gender (OR: 0.38), ages 15–19 (OR:0.36) and 20–24 (OR:0.65), being married/ in a relationship (OR: 1.39), having high wealth index (OR:1.30) and non-smoking status (OR:1.32); for obesity: female gender (OR: 0.36), ages 15–19 (OR:0.35) and 20–24 (OR:0.51), being married/ in a relationship (OR:2.31) and primary education level (OR:2.17). The trend analysis of nutritional status level in the research period showed an increase in the average value of the BMI of the respondents in the entire sample, as well as the prevalence of obesity, while the prevalence of underweight and pre-obesity decreased. Conclusion The research provided insight into the specific factors associated with and trends of levels of nutritional status of the young, leading to the conclusion that preventive and interventional public health programs and strategies must be fully adapted to their specific needs.

Abstract Objective Understanding healthcare-seeking propensity is crucial for optimizing healthcare utilization, especially for patients with chronic conditions like hypertension or diabetes, given their substantial burden on healthcare systems globally. This study aims to evaluate hypertensive or diabetic patients’ healthcare-seeking propensity based on the severity of symptoms, categorizing symptoms as either major or minor. It also explores factors influencing healthcare-seeking propensity and examines whether healthcare-seeking propensity affects healthcare utilization and preventable hospitalizations. Methods A cross-sectional study was conducted in 2023 in rural areas of Dangyang city, Hubei province, and Xishui county, Guizhou province. A sample of 780 patients, including those with hypertension, diabetes, or both, was obtained using multistage stratified cluster sampling. Healthcare-seeking propensity was evaluated using a questionnaire with two subscales for major and minor symptoms, which were analyzed separately. Multiple linear regression was used to identify factors influencing healthcare-seeking propensity, while logistic regression was employed to examine the relationship between healthcare-seeking propensity and healthcare utilization, as well as preventable hospitalizations. Results Rural Chinese patients had an average healthcare-seeking propensity score of 5.43 ± 1.99 for major symptoms and 8.04 ± 1.66 for minor symptoms. Factors such as age, education level, income, accessibility to healthcare, and enrollment in family doctor services influenced healthcare-seeking propensity for both types of symptoms. Patients’ self-rated health status and the type of disease affected their healthcare-seeking propensity for major symptoms, while primary healthcare service quality solely impacted the propensity for seeking care for minor symptoms. Logistic regression demonstrated that after accounting for confounding factors, a higher propensity for seeking care for minor symptoms was associated with increased healthcare service utilization (AOR = 1.402, 95% CI: 1.259–1.562), whereas a higher propensity for major symptoms remarkably reduced preventable hospitalizations (AOR = 0.501, 95% CI: 0.428–0.587). Conclusions Rural Chinese patients exhibited different healthcare-seeking propensity depending on the type of symptoms. The healthcare-seeking propensity in the western region was lower than that in the central region, highlighting regional disparities. Seeking care for minor symptoms results in more outpatient visits, whereas addressing major symptoms reduces preventable hospitalizations. Establishing a robust network of primary healthcare facilities and emphasizing the role of family doctors can boost patients’ propensity to seek healthcare. Clinical trial number Not applicable.