The aim of this study was to analyse associations between crowded housing and children’s indoor living environment, respiratory and allergic disorders and general health.

A cross-sectional study.

Sweden, using data from the Swedish National Environmental Health Survey 2019.

The study sample included 48 512 children (aged 6–10 months, 4 years and 12 years). We also investigated associations in vulnerable subgroups, such as children with asthma and those living under unfavourable socioeconomic conditions.

Primary outcomes in the living environment were at least one sign of mould, poor indoor air quality, unpleasant odours, too warm indoors in summer and too cold indoors in winter. Primary outcomes for children’s health were asthma, airway problems, breathing difficulties, rhinitis symptoms, mould and mites allergy, pollen allergy, furred pet allergy and good general health.

About one in five children lived in an overcrowded home. Factors from the indoor living environment such as perceived poor indoor air quality and mould were significantly associated with crowded housing. Moreover, children who lived in overcrowded conditions were less likely to report good general health than children in non-crowded households (OR 0.64, 95% CI 0.54 to 0.76). This association was even stronger in children with asthma (OR 0.51, 95% CI 0.34 to 0.77). Few significant associations were, however, observed with the respiratory and allergic health outcomes.

Crowded housing is associated both with a poor indoor environment and with poorer general health in children. Children with asthma may experience even poorer general health.

Loneliness and adverse childhood experiences (ACEs) constitute significant risk factors for mental disorders, with loneliness emerging as a serious global public health concern. Recent research highlights the role of loneliness as a potential link between early life adversities and current psychopathology. However, most studies have been conducted in high-income, highly individualistic countries. This cross-sectional study explores the interplay between loneliness, social network size, recalled ACEs and depressive symptoms in Ethiopia—a low-income and collectivistic cultural context.

The study included 125 psychiatric outpatients at Jimma University Medical Center in Southwest Ethiopia diagnosed with major depressive disorder, bipolar disorder or psychotic disorders, as well as 131 non-clinical participants. Trained interviewers administered the University of California, Los Angeles (UCLA) Loneliness Scale, the Childhood Trauma Questionnaire, the Social Network Index and the WHO-5 Well-Being Index. We used Mann-Whitney U tests, partial correlation and mediation analysis for data analysis.

We found mild-to-moderate correlations between loneliness and ACEs (clinical group: rho=0.29, p1b₁=0.07, 95% CI (0.02 to 0.13); non-clinical group: indirect effect a₁b₁=0.03, 95% CI (0.01 to 0.07)). In contrast, social network size was neither correlated with ACEs nor did it mediate the association between ACEs and depressive symptoms in either group.

This study replicates previous findings that loneliness—rather than social network size—is associated with ACEs and mediates their impact on depressive symptoms. These results support the transcultural and transdiagnostic relevance of loneliness as a universal psychological mechanism, independent of societal structure.

To examine the association between individual social capital and depression in older adults in Iran and to test the hypothesis that higher levels of social capital are inversely associated with depressive symptoms.

Cross-sectional study using baseline data from a longitudinal cohort.

Community-based study conducted in primary care settings across urban and rural areas of Birjand County, Eastern Iran.

A total of 1348 community-dwelling individuals aged 60 years and older were recruited through multistage stratified cluster random sampling. Participants who were bedridden or had end-stage disease (life expectancy

The primary outcome was depression status, measured using the Patient Health Questionnaire 9 items, with a score≥10 indicating depression. The main explanatory variable was social capital, assessed using a validated 69-item questionnaire capturing domains such as collective activity, social trust and network structure. Univariable and multivariable logistic regression analyses were conducted to estimate adjusted ORs and 95% CIs for associations between depression and social capital dimensions. Statistical analyses were performed using Stata V.12.0

Of the total participants, 268 (19.94%) were identified as having depressive symptoms, with a significantly higher prevalence among women (27.44%) compared with men (11.88%). Depression was more prevalent among those in the lowest wealth quintile (32.09%) and individuals with low literacy levels (28.10%). Participation in collective activities was inversely associated with depression in the second (OR=0.62, 95% CI (0.42 to 0.93)), third (OR=0.45, 95% CI (0.29 to 0.71)), fourth (OR=0.59, 95% CI (0.37 to 0.93)) and fifth (OR=0.37, 95% CI (0.22 to 0.61)) quintiles. Social trust was also associated with lower odds of depression in the third (OR=0.62, 95% CI (0.39 to 0.99)) and fourth (OR=0.64, 95% CI (0.42 to 0.97)) quintiles. Furthermore, the second (OR=0.63, 95% CI (0.40 to 0.99)) and fifth (OR=0.38, 95% CI (0.23 to 0.63)) quintiles of social network structure were inversely related to depression. These findings suggest that higher levels of social capital, particularly in terms of collective participation, trust and social networks, are associated with a reduced likelihood of depressive symptoms in older adults.

Higher levels of social capital, particularly collective engagement, interpersonal trust and diverse social networks, are associated with lower odds of depression in older adults. These findings support the need for community-based interventions to strengthen social capital as a strategy for mental health promotion among the elderly in low-income and middle-income settings.

Prostate cancer (PCa) is the second most common cancer in men worldwide and genetic factors and family history significantly increase the risk of PCa. Men at increased risk for PCa often experience higher PCa-specific anxiety and distress. Comprehensive prevention strategies for men with familial or genetic PCa predisposition are lacking. Consequently, the psychological impact, facilitators and barriers for risk-adapted PCa prevention lack comprehensive study. The novel prospective registry and prevention clinic ‘ProFam-Risk’ (prevention clinic for familial PCa risk) at the University Hospital Düsseldorf offers personalised risk assessment and risk-adapted prevention recommendations for men with familial or genetic PCa predisposition. As part of this research project, this study (‘ProFam-Psych’ - risk-adapted prevention clinic for familial and genetic prostate cancer: psychosocial effects; funded by German Cancer Aid) aims to evaluate the longitudinal psychosocial trajectories associated with this novel prevention clinic.

In a longitudinal observational mixed-methods design, psychosocial outcomes will be assessed in participants of the prevention clinic (case group, CAG) and compared with urology patients without increased risk for PCa (control group, COG). Psychosocial outcomes will be collected at four time points in the CAG (T0: baseline; T1: after first visit; T2: after risk stratification consultation; T3: follow-up 6 months after T2) and at two time points in the COG (T0: baseline during inpatient stay; T1: post-inpatient stay). Recruitment started in 2023, and the recruitment target is n=225 participants (CAG) and n=118 participants (COG). Primary endpoint is the longitudinal course of PCa-specific anxiety (Memorial Anxiety Questionnaire for Prostate Cancer) in the CAG. Secondary endpoints include the comparison of T0 and T1 outcomes between the CAG and COG and the assessment of changes in perceived PCa risk and perceived personal control in the CAG. To assess facilitators and barriers to participation in the risk-adapted PCa prevention clinic, a minimum of n=12 semi-structured qualitative interviews will be conducted, with recruitment continuing until data saturation is reached. Qualitative data will be analysed using qualitative content analysis.

Ethics approval from the Medical Faculty of the Heinrich Heine University Düsseldorf was obtained (2023-2551). Results of the main objective and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal.

DRKS.de, DRKS00032350. Prospectively registered with the German Clinical Trials Register (DRKS) on 14 September 2023.

Urban green and blue space (UGBS) interventions, such as the development of an urban greenway, have the potential to provide public health benefits and multiple co-benefits in the realms of the environment, economy and society. This paper presents the protocol for a 5-year follow-up evaluation of the public health benefits and co-benefits of an urban greenway in Belfast, UK.

The natural experiment evaluation uses a range of systems-oriented and mixed-method approaches. First, using group model building methods, we codeveloped a causal loop diagram with stakeholders to inform the evaluation framework. We will use other systems methods including viable systems modelling and soft systems methodology to understand the context of the system (ie, the intervention) and the stakeholders involved in the development, implementation and maintenance phases. The effectiveness evaluation includes a repeat cross-sectional household survey with a random sample of 1200 local residents (adults aged ≥16 years old) who live within 1 mile of the greenway. The survey is complemented with administrative data from the National Health Service. For the household survey, outcomes include physical activity, mental well-being, quality of life, social capital, perceptions of environment and biodiversity. From the administrative data, outcomes include prescription medications for a range of non-communicable diseases such as cardiovascular disease, type II diabetes mellitus, chronic respiratory and mental health conditions. We also investigate changes in infectious disease rates, including COVID-19, and maternal and child health outcomes such as birth weight and gestational diabetes. A range of economic evaluation methods, including a cost-effectiveness analysis and social return on investment (SROI), will be employed. Findings from the household survey and administrative data analysis will be further explored in focus groups with a subsample of those who complete the household survey and the local community to explore possible mechanistic pathways and other impacts beyond those measured. Process evaluation methods include intercept surveys and direct observation of the number and type of greenway visitors using the Systems for Observing Play and Recreation in Communities tool. Finally, we will use methods such as weight of evidence, simulation and group model building, each embedding participatory engagement with stakeholders to help us interpret, triangulate and synthesise the findings.

To our knowledge, this is one of the first natural experiments with a 5-year follow-up evaluation of an UGBS intervention. The findings will help inform future policy and practice on UGBS interventions intended to bring a range of public health benefits and co-benefits. Ethics approval was obtained from the Medicine, Health and Life Sciences Research Ethics Committee prior to the commencement of the study. All participants in the household survey and focus group workshops will provide written informed consent before taking part in the study. Findings will be reported to (1) participants and stakeholders; (2) funding bodies supporting the research; (3) local, regional and national governments to inform policy; (4) presented at local, national and international conferences and (5) disseminated by peer-review publications.

Due to numerous comorbidities, complicated medical regimens and age-related difficulties, older adults frequently confront substantial treatment burdens and poor medication adherence, which could result in poor health outcomes. This study assessed the treatment burden and medication adherence among older adults in comprehensive specialised hospitals in the Amhara Region in Ethiopia.

A multicentre hospital-based cross-sectional study was conducted from 30 March to 30 July 2024.

The study was conducted at four comprehensive specialised hospitals in Northwest Ethiopia.

Patients were ≥65 years old, diagnosed with two chronic illnesses and were receiving medical attention for the relevant issue.

This study employed the Multimorbidity Treatment Burden Questionnaire to assess treatment burden and the General Medication Adherence Scale to assess medication adherence. Data analysis was conducted using STATA version 17. Linear and binary logistic regressions were used to analyse the dependent variables of treatment burden and medication adherence to the determining factors, respectively.

422 patients took part in this study. Regarding treatment burden, 75% report a high burden. Of the patients, 32.20% adhered well, whereas 67.80% did not. The medication regimen complexity index (MRCI; β=0.029, 95% CI 0.001 to 0.058; p=0.047), age (β=0.027, 95% CI 0.009 to 0.044; p=0.004) and number of medications (β=0.168, 95% CI 0.045 to 0.291; p=0.007) were associated with higher treatment burden. Variables associated with medication non-adherence included rural residence (adjusted OR 2.249, 95% CI, 1.356 to 3.732; p=0.002), care provided by relatives (1.744, 1.055 to 2.883; p=0.030), moderate Charlson comorbidity index (CCI; 2.241, 1.220 to 4.117; p=0.009), severe CCI (6.953, 3.526 to 13.715; p=0.000), polypharmacy (1.615, 1.055 to 3.230; p=0.044) and treatment burden (1.501, 1.023 to 3.090; p=0.015).

Of the older adult patients enrolled in this study, three-quarters had a high treatment burden, and more than two-thirds had poor adherence. A high treatment burden was associated with age, medication use and MRCI, whereas non-adherence was associated with self-management, residency, CCI, medication use, MRCI and treatment burden.

The study aimed to describe the ethical challenges global health programme (GHP) leaders encounter in their day-to-day work and to understand how they address these ethical challenges, as an important first step toward improving the relevance and precision of ethical guidance for GHPs.

We employed a qualitative case study approach using grounded theory data collection and analysis methods.

GHPs based at a major GHP hub in Decatur, Georgia, USA, providing a wide range of health services to more than 150 countries globally

Leaders of all 15 GHPs in the programme hub were invited to participate and 9 were available and consented to participate. Two senior leaders of the programme hub also participated in the study.

We identified 10 categories of ethical challenges encountered by GHP leaders: (1) ethical misalignment between funders and implementing partners; (2) budgets functioning as constraints on ethical decision-making; (3) the limited impact of programmes on improving host country capacity; (4) concerns about missed opportunities to benefit host country communities; (5) shortcomings in current ethics guidance (6) issues in data governance, stewardship and management; (7) navigating complex sociocultural contexts; (8) photography in the context of GHPs; (9) trustworthiness and reputational risks and (10) accountability for unintended consequences. The challenges often result in divided or conflicting loyalties for GHP leaders and uncertainty about what to do. We have characterised this form of uncertainty as ‘moral ambiguity,’ which we define as the inability to discern the best ethical way forward when there is tension or conflict among multiple stakeholder interests.

Our findings suggest that moral ambiguity is a common experience for GHP leaders and that current approaches to global health ethics fail to guide and support GHP leaders to recognise and address moral ambiguity and limit the distress it can cause. The experiences of GHP leaders offer important diagnostic insights for improving the way GHPs are imagined, financed, delivered and evaluated.

To compare the incidence and drivers of major adverse kidney events (MAKEs) between COVID-19 and non-COVID-19 acute respiratory distress syndrome (ARDS) patients, with a focus on long-term kidney outcomes.

Retrospective cohort study.

Single-centre intensive care unit in the Midlands, UK.

708 ARDS patients (458 COVID-19, 250 non-COVID-19).

The primary outcome was MAKE at 365 days (MAKE-365), defined as new renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR)

The incidence of MAKE-365 was significantly higher in the non-COVID-19 group compared with the COVID-19 group (66% vs 39%, p

Non-COVID-19 ARDS patients face a greater risk of MAKE-365 and adverse kidney outcomes due to higher RRT requirements and mortality rates. These findings underscore the importance of tailored interventions and long-term nephrology follow-up, particularly for patients with reduced eGFR, elevated bilirubin and comorbidities like diabetes and hypoalbuminaemia.

To determine uptake of the COVID-19 vaccine and identify the associated factors among health professionals in major cities of the Amhara region in Ethiopia.

Institution-based, cross-sectional study.

The study was conducted from July to September 2022 across 40 health centres and 13 hospitals, representing 10 major cities within the Amhara region.

1251 participants, all of whom were vaccine-eligible health professionals, were selected using a systematic random sampling procedure.

The level of vaccine uptake in the study was determined by the proportion of health professionals who had received at least one dose of a COVID-19 vaccine.

1251 health professionals participated, with 848 (67.8%) reporting that they had received at least one dose of a COVID-19 vaccine. Key findings from the multivariable logistic regression analysis revealed that health professionals aged 46 years and older were four times more likely to be vaccinated (95% CI, 1.656 to 9.510), married participants were 1.4 times more likely to take the vaccine (95% CI, 1.010 to 1.933) and those with good knowledge of COVID-19 vaccines were 1.75 times more likely to get vaccinated (95% CI, 1.307 to 2.331). Additionally, participants with a positive attitude towards vaccination were 3.65 times more likely to have received a vaccine (95% CI, 2.753 to 4.732).

The study reveals a commendable level of COVID-19 vaccine uptake among health professionals, emphasising their critical role in public health initiatives. However, the observed disparities in vaccination rates indicate the need for targeted interventions to improve vaccine coverage, particularly among younger professionals and those with limited knowledge of the vaccine. Addressing these gaps requires the implementation of tailored educational programmes that enhance understanding of COVID-19 vaccines. Furthermore, fostering positive attitudes through targeted campaigns, workplace-based initiatives and peer influence, particularly among younger and unmarried professionals, will be crucial. Encouraging vaccinated professionals to share their experiences and establishing regular follow-ups will also be essential strategies to improve vaccine acceptance and coverage in the region.

Non-adherence to antidiabetic medication remains a major barrier to achieve optimal health outcomes among individuals with diabetes, particularly in developing countries. This issue exacerbates poor health outcomes and leads to the wastage of limited healthcare resources.

This study aimed to assess the prevalence of non-adherence to antidiabetic medications and identify associated factors among adult type 2 diabetes mellitus (DM) patients in the North Wollo zone.

An institutional-based cross-sectional study.

The study was conducted in three randomly selected public hospitals in the North Wollo zone: Woldia Comprehensive Specialized Hospital, Lalibela General Hospital and Mersa Primary Hospital.

A total of 327 adult type 2 DM patients receiving follow-up care were included. Participants were selected proportionally from each hospital using consecutive sampling. Inclusion criteria included individuals aged ≥18 years, on antidiabetic treatment for at least 6 months and actively on follow-up care during the study period. Patients with hearing impairment, severe illness or incomplete medical records were excluded.

Adherence was assessed using the Morisky Medication Adherence Scale-8, a validated eight-item, self-reported questionnaire. Scores ranged from 0 to 8, with adherence levels classified as high (≥8), medium (6–7.75) and low (

Data were analysed using SPSS V.27. Descriptive statistics were used to summarise the data, and multivariable logistic regression analysis was performed to identify factors associated with non-adherence. A p value ≤0.05 was considered statistically significant.

The overall prevalence of medication non-adherence was 24.5%. Factors significantly associated with non-adherence included living with diabetes for less than 3 years (adjusted OR (AOR) 3.37, 95% CI 1.91 to 5.95), residing in rural areas (AOR 2.67, 95% CI 1.49 to 4.79), having comorbidities (AOR 2.99, 95% CI 1.67 to 5.34) and having no formal education (AOR 3.26, 95% CI 1.49 to 7.00).

The prevalence of non-adherence to antidiabetic medications (24.5%) exceeded the widely accepted benchmark of ≤20%. Key factors such as rural residence, comorbidities, lower education levels and shorter duration since diagnosis were significantly associated with non-adherence. These findings underscore the need for targeted interventions, including patient education, improved rural healthcare access and integrated care models, to enhance adherence and diabetes management outcomes.