Post-traumatic growth among parents of burn-injured children: A cross-sectional survey.

Global research consistently identifies significant disparities in the diagnosis of Autism Spectrum Disorder (ASD), strongly associated with family socioeconomic status and geographic location. However, such data from low-resource settings like Bangladesh is critically lacking. This case-control study aimed to characterize the socioeconomic and geographic profiles of children clinically diagnosed with ASD at a major tertiary centre in Bangladesh. The study was conducted at Department of Pediatrics, Mymensingh Medical College & Hospital, Bangladesh; Institute of Pediatric Neurodisorder and Autism (IPNA), BMU; Institute of Child and Mother Health (ICMH), Dhaka, Bangladesh from June 2021 to May 2022, enrolling 25 children with ASD and 25 typically developing controls aged 3-16 years. Data on key demographic indicators, including parental education, family income, place of birth and residence characteristics, were collected through parental interviews. Statistical analyses revealed profound disparities. Children with ASD were significantly more likely to come from families with higher parental education (Fathers: 80.0% vs. 16.0%; Mothers: 76.0% vs. 12.0%), higher monthly family income (92.0% vs. 44.0%) and an urban birthplace (80.0% vs. 32.0%). Furthermore, residence near a high-traffic road was a strongly associated environmental factor (92.0% vs. 44.0%). These findings highlight significant inequities in the pathway to an ASD diagnosis in Bangladesh, which are likely driven by differential access to specialized healthcare, varying levels of parental awareness and the urban concentration of diagnostic services rather than causal risk factors. The results underscore an urgent public health imperative: to develop and implement equitable strategies that enhance ASD awareness, decentralize diagnostic capabilities and ensure that all children in Bangladesh, irrespective of their socioeconomic background or place of residence, have an equal opportunity for timely identification and support.

This study examines school dropout as a multidimensional and process-oriented phenomenon by focusing on its underlying causes, emotional meanings, and prevention-oriented implications. Using an interpretative phenomenological design within a qualitative research framework, the study involved 24 participants with school dropout experience who varied in age, gender, educational level, dropout stage, occupation, place of residence, and income level. Data were collected through a semi-structured interview form developed by the researcher, reviewed through expert feedback, and refined after pilot implementation. The data were analyzed with the support of MAXQDA, drawing on Yin’s qualitative analysis cycle and Braun and Clarke’s stages of thematic analysis. The findings indicate that school dropout is shaped by the interaction of individual, familial, environmental, and structural factors. Economic hardship, work and family responsibilities, lack of institutional support, academic difficulties, negative peer influence, gender-based barriers, and limited rural opportunities emerged as prominent determinants. Participants interpreted dropout primarily in terms of sadness, disappointment, regret, and incompleteness, although some regarded it as a necessary decision under existing conditions. The results further suggest that dropout prevention requires integrated early warning systems, academic and psychosocial support, family-school collaboration, inclusive learning environments, career guidance, and flexible policies sensitive to socioeconomic inequalities. Overall, the study suggests that school dropout cannot be reduced to individual choice; rather, it should be addressed through student-centered, equity-oriented, and multi-stakeholder interventions.

This study aimed to determine the proportion of Nepali preschool children (3-4 years of age) meeting the World Health Organization (WHO) 24- hour movement guidelines for physical activity (PA), sedentary behaviour and sleep by sex (male vs. female) and place of residence (urban vs. rural) and evaluate their executive functions and motor skills. Furthermore, it evaluated the feasibility and acceptability of methods proposed for the main SUNRISE study in diverse settings. In this pilot study, a total of 99 preschool children, balancing sex and place of residence, each with one parent/caregiver, from Syangja District were recruited. Physical activity, sedentary behaviour and sleep were assessed using waist-worn ActiGraph accelerometers (ActiGraph wGT3x-BT) with ≥ 1 valid 24-hour period of data, motor skills (gross and fine) were evaluated using the NIH Toolbox motor battery, and executive functions were assessed using the Early Years Toolbox. Eight focus group discussions (FGDs) were carried out with parents/caregivers, and a short interview was conducted with eight Early Childhood Development (ECD) centre teachers to explore the feasibility and acceptability of implementing the SUNRISE protocol. Only 10% of children met all components of the WHO 24-hour movement guidelines (≥ 180min total PA, of which ≥ 60min were MVPA, ≤ 1h of screen time, and 10-13h of sleep). Proportions of those meeting the guidelines were higher for sleep (81%) and physical activity (79%) than for screen time (56%). Altogether, 96 children wore the accelerometer, of which 78 had at least ≥ 1 valid 24-hour period of data. Males and rural children accumulated more daily moderate-to-vigorous and vigorous physical activity than females and urban children, respectively. In contrast, females were more likely to meet screen time guidelines than males (66% vs. 42%, p = 0.018). Additionally, females had better inhibition control than males, and rural children had better working memory than urban children. Parent/caregivers and ECD teachers reported that the study procedures, including accelerometer use, were acceptable and feasible. Adherence to the full set of WHO movement guidelines was very low among preschool children in this study, with screen time emerging as the most challenging component. Targeted strategies are needed to promote healthier movement behaviours, particularly to reduce screen time. The findings support the feasibility and acceptability of conducting the main SUNRISE study in Nepal.

Dementia is one of the most serious health issues in an aging society, placing a significant burden on patients and their families, while also posing considerable socioeconomic challenges at the national level. In response, the Korean government introduced the National Responsibility for Dementia Care policy in 2017 to improve healthcare accessibility for patients with dementia and reduce their financial burden. This study utilized the cohort data of patients with dementia collected from Ajou University Hospital between 2012 and 2022. To quantitatively assess the changes in healthcare utilization, we applied panel multivariate negative binomial regression and panel multivariate gamma regression analyses. The analysis identified key factors influencing healthcare utilization, including place of residence, presence of comorbidities, age, and duration of dementia. After the policy was implemented, there was a general decline in outpatient visits and medical expenditure, suggesting a positive effect of the policy on alleviating the economic burden on patients with dementia. Significant changes in healthcare utilization were observed among patients in the early stages of dementia, highlighting the importance of early diagnosis and home-based care services. The findings indicate a need for personalized treatment and the expansion of community-based healthcare services for patients with dementia.

Although oral diseases are among the most prevalent chronic conditions affecting children and adolescents globally, access to preventive and treatment services remains uneven. These disparities are particularly pronounced among Indigenous populations and reflect long-standing structural and social inequities. This study examined the prevalence of, and ethnic inequalities in, refraining from dental care and inadequate toothbrushing frequency among Indigenous and non-Indigenous children and adolescents in Ecuador. A cross-sectional study was conducted using a nationally representative data from the ENSANUT 2018 demographic survey. Two preventive oral health outcomes were included: refraining from dental care in the previous 12 months and inadequate toothbrushing frequency (< 2 times/day). Ethnicity was self-reported and categorized as Indigenous or non-Indigenous (Afro-Ecuadorian, Mestizo, White, and Montubio). Survey weighted prevalence and absolute risk differences between ethnic groups were estimated to assess inequalities in the outcomes, with adjustment for sex, place of residence and region, and stratified by age group. Refraining from dental care was more prevalent among Indigenous than non-Indigenous children (50.6% vs. 37.3%), corresponding to an adjusted absolute risk difference of 9.2% points (95% CI: 4.4 ̶ 13.9). Inadequate toothbrushing was consistently higher among Indigenous children and adolescents, with an adjusted absolute difference of 12.8; 95% CI: (9.8 ̶ 15.9) and 11; 95% CI: (7.8 ̶ 14.3) percentage points, respectively. Substantial ethnic inequities in access to dental care services and preventive oral health behaviour persist among children and adolescents in Ecuador. These findings underscore the need for equity-oriented and culturally appropriate oral health policies targeting Indigenous populations.

BackgroundIntestinal parasite infections (IPIs) are significant public health concerns, particularly for those with HIV/AIDS. Low hygiene standards, tainted water, and inadequate sanitation all contribute to Ethiopia’s high frequency of IPIs. HIV patients are still susceptible to several parasitic illnesses even after antiretroviral medication (ART) and deworming efforts have been implemented. The data in the study area are restricted, despite the fact that few studies describe IPIs among HIV patients. Furthermore, by taking sociodemographic and clinical aspects into account, this study produced thorough 5‐year data. In order to fill in the gaps in local epidemiological data and guide focused treatments, this study evaluated the frequency of IPIs and the factors that are linked to them among HIV patients receiving ART.ObjectiveTo assess the frequency of IPIs and related variables in HIV/AIDS patients receiving ART at Debre Tabor Comprehensive Specialized Hospital (DTCSH), Ethiopia.MethodsA 5‐year retrospective hospital‐based study was conducted using medical records of 600 HIV patients on ART at DTCSH. Included were data registered between May 2020 and May 2025. Data on sociodemographic, CD4 counts, ART duration, and IPIs were extracted from patient cards using a convenient sampling technique. SPSS Version 26 was utilized for data entry and analysis. Descriptive statistics along with bivariate and multivariable analyses were conducted. All variables in the multivariable logistic regression were deemed statistically significant if their p value was less than 0.05 at a 95% confidence interval. Text, tables, and graphs were used to display the data.ResultsOut of 600 records, 33.5% of people have IPIs. Entamoeba histolytica (59.7%) and Giardia lamblia (33.3%) were the most common parasites found. Individuals with age over 60 years and those living in rural areas had considerably higher IPIs (p < 0.05). However, when comparing patient records examined in the first year to those in the fifth, the frequency of IPIs declined. Furthermore, those with low CD4 counts (less than 200 cells/μL), advanced WHO clinical stages (3‐4), and shorter ART durations (less than 5 years) had significantly higher likelihood of IPIs (p < 0.05).ConclusionAmong HIV patients receiving ART, IPIs remain prevalent. Important determinants of IPIs include age, place of residency, CD4 count, WHO stages, and adherence to ART. Long‐term ART adherence has shown protective advantages, underscoring its importance in reducing the burden of IPIs. Enhancing the management of parasitic infections and HIV requires integrated strategies that include improved sanitation, frequent testing, and health education. Future large‐scale research is also necessary.

Workplace health promotion (WHP) is voluntary activity of employers aimed at improving health and well-being of employees. This study aimed to assess the employees' perceptions of employer-provided WHP activities in Poland as well as to identify factors associated with reported WHP provision and the use of WHP activities among full-time employees aged 18-60 years. This questionnaire-based cross-sectional survey was carried out in December 2025 among 1030 full-time employees aged 18-60 years in Poland using the computer-assisted web interview (CAWI) methodology. Quota sampling was used, with gender, age, and place of residence included into stratification model. Among the respondents, 49.8% worked in private Polish company, 26.6% worked in companies with more than 500 employees. Most of the respondents rated their job satisfaction as rather satisfied (61.2%), 64.2% had non-manual work, and 58.5% worked on fixed daytime hours. Among the respondents (n = 1030), 42.2% declared that their employer offers WHP - 20.1% regularly and 22.1% occasionally. Half of respondents, often (40.7%) or very often (9.9%) used WHP activities available in their workplace. Lack of time was the most common (34.5%) barrier in the use of WHP activities. Job satisfaction was the only socio-demographic variable that differentiated (p < 0.001) uptake of employer-provided WHP activities. Age 18-54 (p < 0.05), living in cities over 500,000 residents (aOR: 1.58; 95%CI: 1.02-2.45; p = 0.04), working in private foreign-owned company (aOR: 2.56; 95%CI:1.72-3.79; p < 0.001), working in company with more than 500 employees (aOR: 2.74; 95%CI: 1.59-4.73; p < 0.001), being rather satisfied (aOR: 3.90; 95%CI: 1.94-7.72; p < 0.001) or very satisfied (aOR: 5.66; 95%CI: 2.65-12.11; p < 0.001) from the current job; manager, director level or executive position (p < 0.05), as well as shift work including night shifts (aOR: 1.90; 95%CI: 1.16-3.11; p = 0.01) or flexible working hours (aOR: 1.95; 95%CI:1.30-2.94; p = 0.001) were significantly associated with higher odds of reporting access to WHP activities. This study provides an overview of WHP activities in Poland. Less than half of full-time employees in Poland reported access to employer-provided WHP, with significant differences by sociodemographic and job-related factors.

Prelacteal feeding, which deprives newborns of colostrum, remains a major public health concern, particularly in low- and middle-income countries. This study aimed to determine the prevalence and predictors of prelacteal feeding among mothers in eastern Turkey. A cross-sectional study was conducted between January and August 2023, including 335 mothers with infants aged 0-24 months. Participants were recruited from volunteer mothers who met the inclusion criteria and attended the paediatrics and gynaecology clinics of a university hospital during the data collection period. Data were collected through face-to-face interviews conducted by the researchers using the Prelacteal Feeding Practices and Associated Factors Questionnaire (PFP-AFQ). Prevalence of prelacteal feeding was 17.9%. Common prelacteal substances administered include formula (51.7%), sugar water (28.3%), cow's milk (3.3%), and plain water (16.7%). Maternal education level, place of residence, employment status, family type, household income level, receipt of regular antenatal care, birth weight, breastfeeding education status, time of first breastfeeding after birth, knowledge regarding the importance and harms of colostrum, and the practice of administering colostrum immediately after birth were found to be significantly associated with prelacteal feeding (p<0.05). Furthermore, according to the multiple logistic regression analysis, income level, breastfeeding education, time of first breastfeeding after birth, knowledge regarding the importance and harms of colostrum, and the practice of administering colostrum immediately after birth were identified as significant predictors of prelacteal feeding (p<.05). In conclusion, prelacteal feeding remains a preventable but persistent practice influenced by maternal education, antenatal care, breastfeeding knowledge, and early initiation of breastfeeding. Integrating targeted educational interventions into prenatal and postnatal care may help reduce the prevalence of prelacteal feeding and improve breastfeeding outcomes.

Burn injuries have far-reaching physical, psychological, and social consequences for children and their families. The posttraumatic stress experienced by primary caregivers of burn-injured children can significantly influence the child's recovery process and overall prognosis while imposing a psychological toll on the caregiver. Exploring the posttraumatic stress of caregivers is therefore of critical clinical and practical importance. This study aimed to systematically evaluate the prevalence of posttraumatic stress among primary caregivers of pediatric burn survivors and identify the key factors that contribute to it. We conducted a cross-sectional study of the primary caregivers of children who were hospitalized for burn injuries between January 2024 and June 2025. Caregivers were assessed using the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C), which categorizes 17 symptoms of posttraumatic stress within three dimensions. To identify independent risk factors associated with PCL-C scores, we employed both univariate and multiple linear regression analyses. A total of 240 primary caregivers were included in the study; these caregivers had a mean (SD) PCL-C score of 41.22 (5.09). Among the three PCL-C dimensions, reexperiencing symptoms was the most prevalent, followed by hyperarousal symptoms and avoidance symptoms. Multiple linear regression analysis revealed the following independent PTSD risk factors: the severity of the child's burn injury (β = 0.122, P = 0.001); the caregiver's place of residence (β = 0.116, P = 0.04), educational level (β = 0.123, P = 0.02), and marital status (β = 0.125, P = 0.02); the monthly per capita household income (β = 0.109, P = 0.02); and witnessing the burn incident (β = 0.127, P = 0.005). The final regression model explained 59.5% of the variance in scores (F = 27.10, P < 0.001). Primary caregivers of children with burn injuries experience a high prevalence of posttraumatic stress, which is influenced by a combination of child-related, caregiver-related, and incident-related factors. Health care providers should develop individualized interventions addressing these specific factors to support caregiver mental health and ultimately improve outcomes for both children and their families.

ObjectiveThe aim of this study was to assess vaccination coverage and inequalities in childhood immunisation among children aged 12 months in Ethiopia.DesignPerformance monitoring for action Ethiopia implemented a nationally representative first-cohort longitudinal survey (2019–2021), collecting data at baseline, 6 weeks, 6 months and 1 year post partum to monitor reproductive, maternal, newborn and child health indicators.SettingsThe study was conducted from five Ethiopian regions: three predominantly agrarian (Amhara, Oromia and Southern Nations, Nationalities and Peoples), one pastoralist (Afar) and one urban (Addis Ababa).ParticipantsThe weighted sample comprised 1888 participants for full vaccine coverage (FVC) and 1677 for both incomplete vaccine coverage (IVC) and dropout rate (DOR) between pentavalent-1 and pentavalent-3 vaccines.Outcome measuresThe vaccine coverage and inequalities were assessed using three indicators: FVC, IVC and DOR (between the first and third doses of the pentavalent vaccine). Key dimensions of inequality included maternal age, economic status, education level, place of residence and subnational regions. The analysis was conducted using Health Equity Assessment Toolkit Plus software, employing seven summary measures of inequalities: Difference, Ratio, Population Attributable Risk, Population Attributable Fraction, Slope Index of Inequality, Relative Index of Inequality and the Theil Index.ResultThe study found that only 29.1% of 12-month-old children in Ethiopia had received full vaccination, whereas 67.2% had incomplete coverage and the DOR between the first and third doses of the pentavalent vaccine was 34.3%. Both simple and complex inequality measures revealed a high level of inequality in childhood immunisation indicators across wealth, education, place of residence and regions. FVC was higher among children of higher socioeconomic status and urban residence, whereas IVC and DOR were disproportionately higher among children from the poorest households, mothers with no education, rural residents and disadvantaged regions.ConclusionsChildhood immunisation coverage in Ethiopia remains low and marked by high inequality. Higher rates of incomplete vaccination and vaccine dropout are disproportionately concentrated among children from low socioeconomic backgrounds, rural residents and disadvantaged regions. These disparities reflect substantial health inequities in childhood vaccinations as they are unfair and avoidable with appropriate interventions. The study underscores that addressing socioeconomic and geographic inequalities could substantially improve the national immunisation coverage and accelerate progress towards universal health coverage targets.

ABSTRACT Bangladesh has a large population and one-third of it is the youth whose participation in community development activities is crucial for overall development of the country. This study explores youth attitudes and active participation in community development activities by using the Community Development Participation Scale (CDPS). Participants showed positive attitudes toward community development activities but demonstrate a slightly lower level of active participation. Attitude toward community development activities emerged as the strongest predictor of active participation. Participation also varied across youth gender and place of residence. Female and urban youth participation was comparatively lower than that of their male and rural counterparts. Youth participation in community development is hindered by various socioeconomic and political barriers. This study recommends providing adequate resources, skill development training, and youth inclusion in the policymaking process to enhance youth contributions to community development in Bangladesh.

BackgroundAbortion remains a significant public health concern in Ethiopia, contributing to maternal morbidity and mortality. Understanding the individual- and community-level determinants of abortion is essential to inform targeted interventions. This study aimed to assess the prevalence and multilevel determinants of abortion among women of reproductive age in Hawela Lida District, Southern Ethiopia.MethodsA community-based cross-sectional survey was conducted from February to March 2025 among 3,526 women of reproductive age who experienced a pregnancy within the 12 months preceding the survey. Data were collected using a structured, pretested questionnaire and analyzed with Stata v18. Multilevel mixed-effects logistic regression was employed to identify individual- and community-level determinants, adjusting for potential confounders. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported.ResultsThe overall prevalence of abortion was 18.5% (95% CI: 15.8–24.8). At the individual level, women without formal education were more likely to experience abortion than those with formal education (AOR = 2.61; 95% CI: 1.36–4.54). Women with unplanned pregnancies (AOR = 2.72; 95% CI: 1.62–4.68) and those who were non-autonomous in decision-making (AOR = 2.21; 95% CI: 1.51–5.02) also had higher odds of abortion. At the community level, rural residence (AOR = 2.19; 95% CI: 1.65–4.23), greater distance to the nearest health facility (AOR = 2.34; 95% CI: 1.21–5.01), and low mass media exposure (AOR = 1.82; 95% CI: 1.23–4.12) were significantly associated with abortion.ConclusionAbortion in Hawela Lida District was associated with both individual and community factors, including women’s education, pregnancy planning, autonomy, place of residence, mass media exposure, and health facility accessibility. Integrated interventions that strengthen family planning, promote women’s empowerment, improve service accessibility, and provide accurate reproductive health information are urgently needed to reduce abortion prevalence and improve maternal health outcomes in Ethiopia.

Early detection of colon cancer through screening is critical for improving long-term survival outcomes; however, only 54 % of the United States (U.S.) population that is eligible to have a colon cancer screening receive one. Previous research found that people who participate in physical activity (PA) are less likely to get screened due perception of having low risk. However, health organizations have lowered the age to initiate screening as more cases are being reported among younger U.S. residents. This study aimed to examine the association between colon cancer screening and self-reported health status for individuals meeting aerobic PA guidelines among individuals aged 45-54. We conducted a cross-sectional analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. We included all participants between the ages of 45 and 54 who responded to the questionnaire regarding colonoscopy and sigmoidoscopy examinations, and the supplementary module that features PA and sedentary behaviors. Among 1118 respondents, 503 (45.5 %) reported having undergone colon cancer screening via colonoscopy or sigmoidoscopy, whereas 615 (54.5 %) had not. Screening prevalence differed by insurance status (p=0.002), with higher rates among insured individuals (483/1034; 47.2 %) compared with uninsured individuals (11/65; 19.2 %). Screening also varied by race/ethnicity (p=0.022); rates were highest among White respondents (353/732; 49.9 %) and lowest among Asian respondents (16/60; 27.3 %). Screening did not significantly differ by education, sex, overweight/obesity status, transportation access, place of residence, or PA status (all p>0.05). Among respondents meeting aerobic PA guidelines (n=1048), 489 (47.0 %) reported screening. Neither cardiovascular disease (CVD) risk (adjusted odds ratio [AOR]=1.22, 95 % confidence interval [CI]: 0.87-1.70) nor self-reported good health (AOR=0.89, 95 % CI: 0.52-1.51) was associated with screening. Among those meeting both aerobic and strength training guidelines (n=541), 255 (48.8 %) reported screening. In this group, reporting good or better health was associated with lower odds of screening (AOR=0.37, 95 % CI: 0.15-0.90), while CVD risk remained nonsignificant (AOR=1.33, 95 % CI: 0.80-2.23). Our analysis found no link between colon cancer screening and self-reported health status for those meeting aerobic guidelines, but those who met both aerobic and strength training guidelines were less likely to get screened. Uninsured individuals and Asian Americans also had lower screening rates. These findings highlight the need for targeted public health campaigns to address screening disparities, particularly among active individuals and underserved communities.

Attention deficit hyperactivity disorder (ADHD) has been associated with comorbid conditions, especially psychiatric comorbidities. On the other hand, getting an ADHD diagnosis has been linked to children's relative age. The aim of this study was to describe diagnostic patterns of ADHD patients of all ages, and to compare comorbidity and birth month between ADHD patients and matched controls. This nationwide study cohort included incident ADHD patients with records of ADHD medication and/or ADHD diagnosis in Finland during 2015 to 2020, and with no such records during 2010 to 2014. Four controls were matched with each patient based on age, gender, and place of residence. Altogether 66,146 incident ADHD patients and 256,270 matched controls were identified, and their average follow-up time was 3.5 years. Mean age at the first ADHD diagnosis was 15.9 years for males and 22.3 for females. Prior to being diagnosed with ADHD, patients visited health care remarkably more often than controls. Comorbid diagnoses were the most prevalent at index date, and compared to controls, the prevalence of these comorbidities within 3 years preceding the index date increased more in ADHD patients. The odds of ADHD increased with later birth months across all age-gender groups, except among girls under 6 years of age. The association was more pronounced among males. ADHD is associated with a significant comorbidity burden across all age groups, even before ADHD diagnosis. Individuals who are younger in relative age are more likely to be diagnosed with ADHD.

BackgroundTobacco use remains a leading preventable risk factor for morbidity and mortality worldwide. Although global evidence indicates a general decline in tobacco use among women, it is unclear to what extent these trends and associated determinants apply to populations in East Africa. Therefore, this study aimed to examine the trends in tobacco use and its associated factors among women aged 15–49 across East African countries.ObjectiveTo examine trends in tobacco use and identify individual- and community-level factors associated with current tobacco use among women of reproductive age (15–49 years) in East Africa.MethodsWe analysed data from Demographic and Health Surveys (DHS) across multiple East African countries. Prevalence trends were assessed over four survey periods (1999–2005, 2006–2010, 2011–2015 and 2016–2022). A cross-sectional analysis of the most recent survey wave was used for the multilevel logistic regression models to identify individual-level and community-level factors associated with current tobacco use, including sociodemographic and socioeconomic characteristics (such as age, education, wealth status and marital status) and community-level factors (such as place of residence and contextual community characteristics). Country-specific trends were also assessed.ResultsA total of 543 013 women of reproductive age from 11 East African countries were included in this analysis. In each DHS survey, most respondents resided in rural areas. Of the pooled sample years, the overall prevalence of current tobacco use was 2.84% (95% CI 2.7% to 2.9%). After a slight increase from 3.74% (1999–2005) to 4.04% (2006–2010), the prevalence declined markedly to 1.35% (2011–2015) and then rose to 2.74% (2016–2022). Compared with cigarette smoking, the use of other tobacco products has consistently greater fluctuations. Country-specific trends showed a declining prevalence in most countries, although increases or fluctuations were observed in Madagascar and Zambia. In the multilevel analysis, age and education showed the strongest association with tobacco use. Women aged 35–49 years had significantly higher odds of tobacco use (adjusted OR (AOR) 2.86, 95% CI 2.44 to 3.36), and those aged 25–34 years (AOR 1.86, 95% CI 1.62 to 2.15) compared with women aged 15–24 years. Women with no formal education were substantially more likely to use tobacco (AOR 4.30, 95% CI 3.01 to 6.15) than those with higher education levels. Additional factors associated with increased odds included experience of child death (AOR 1.39, 95% CI 1.27 to 1.52) and abortion history (AOR 1.21, 95% CI 1.09 to 1.33). At the community level, urban residence (AOR 1.60, 95% CI 1.40 to 1.84) and lower altitudes of <1000 m (AOR 1.40, 95% CI 1.03 to 1.91) were also significantly associated with tobacco use.ConclusionTobacco use among women of reproductive age in East Africa remains relatively low but varies substantially across countries and over time. Older age, lack of formal education, reproductive factors and contextual community characteristics were important determinants. Targeted and context-specific tobacco control interventions are therefore required to reduce tobacco use among vulnerable populations in the region.

We previously reported a significantly increased risk of thyroid cancer due to radioactive iodine-131 (131I) after the 1986 Chernobyl nuclear accident in a cohort of children and adolescents from Belarus. Radiation-related cancer risks were five times higher among those with diffuse goiter, but the relationship between radiation dose and diffuse goiter is not well understood. We used logistic regression to analyze data from 10,278 study participants (mean thyroid dose=0.63 gray (Gy)) who were screened 10-15 years after exposure according to a standardized protocol, which specified thyroid size assessment by both ultrasound and palpation. Diffuse goiter was identified in 1,811 subjects and was significantly associated with 131I dose (P<0.001). The linear model provided the best fit to the data at doses <0.5 Gy (excess odds ratio per gray (EOR/Gy) = 1.45, 95% confidence interval (CI): 0.70, 2.41) and linear-exponential model at doses <1.5 Gy (odds ratio (OR) at 1 Gy = 1.84). Age at exposure and indicators of iodine deficiency both before the accident (place of residence) and during screening (urinary iodine levels) significantly modified the dose-response (all P-values < 0.01). The first systematic evaluation of radiation risks of diffuse goiter after environmental exposure found a strong, statistically significant association with thyroid dose. Our study shows that radiation exposure is associated with a significantly increased risk of developing diffuse goiter. Future epidemiological studies of iodine-deficient irradiated populations should assess thyroid size.

ABSTRACTIn recent years, several large outbreaks have shown that Q fever is a serious disease that unfortunately is underreported in Europe. Furthermore, no seroprevalence data for Coxiella burnetii in the general German population are available. The aim of this study is to examine the seroprevalence of C. burnetii in a normal, non‐risk population in Germany. To this end, blood donors in the federal states Baden‐Wuerttemberg and Hesse were screened for C. burnetii‐specific antibodies as well as associated risk factors. Of over 5000 participants without prior knowledge of a C. burnetii infection, 153 (2.96%) were seropositive for anti‐C. burnetii antibodies. Place of residence and contact with animals represent increased risk factors, as do occupations closely related to animals. Furthermore, it was shown that in high‐risk occupations, prevalence is higher in younger age groups than in older ones.

This study examined xenophobia and empathic tendency among 724 midwifery students from different regions of Turkey. Data were collected online using the Student Information Form, the Empathic Tendency Scale, and the Xenophobia Scale, and analyzed with non-parametric tests. Empathy tendencies differed in terms of the university attended, citizenship status, income level, intercultural friendships, and providing care to a foreign individual during clinical practice. Xenophobia levels, on the other hand, were significantly associated with the university attended, perceived income level, type of place of residence where they grew up, family type, and having taken a course on intercultural midwifery. No significant association was found between empathic tendency and xenophobia.

Intracerebral hemorrhage (ICH) is a life-threatening form of stroke associated with high morbidity and in-hospital case-fatality, particularly in low- and middle-income countries. This study aimed to identify clinical factors associated with in-hospital case-fatality among patients with ICH in southern Iran. This retrospective observational study included patients with ICH admitted to Namazi Hospital, a high-volume tertiary referral center in southern Iran, between March 2018 and February 2021. Demographic characteristics, comorbidities, and in-hospital outcomes were extracted from electronic medical records. The primary outcome was in-hospital case-fatality, defined as death during the index hospitalization. Statistical analyses included independent-samples t-tests, chi-square tests, and multivariable logistic regression to identify factors independently associated with in-hospital case-fatality. A total of 1,796 patients were included in the final analysis. Patients who died during hospitalization were older than survivors (64.6 ± 20.4 vs. 60.3 ± 20.7 years, p < 0.001). Sex, place of residence, and length of hospital stay did not differ significantly between groups in unadjusted analyses. Comorbid conditions, including hypertension, diabetes mellitus, chronic kidney disease, cardiovascular disease, malignancy, and COVID-19 infection, were more frequent among non-survivors (all p < 0.001). In multivariable analysis, diabetes mellitus (OR 3.46, 95% CI 1.40-8.55), hypertension (OR 4.76, 95% CI 3.62-6.27), chronic kidney disease (OR 6.98, 95% CI 3.00-16.27), cardiovascular disease (OR 7.15, 95% CI 4.42-11.57), malignancy (OR 8.83, 95% CI 4.21-18.55), and COVID-19 infection (OR 7.21, 95% CI 3.24-16.08) were independently associated with increased odds of in-hospital case-fatality. In this cohort of patients with ICH, several comorbid conditions were independently associated with in-hospital case-fatality. These findings may support early risk stratification in similar resource-limited settings. Further studies incorporating detailed clinical severity measures are warranted to improve risk prediction and interpretation.