Search Results (4,120)

Online health information spreads quickly across different publishers and platforms. However, little is known about how information source characteristics, together with cyberchondria, influence individuals’ trust and intentions to share and verify. Using a 2 × 2 × 3 between-subject design, the present study investigated the effects of cyberchondria severity (high/low), publisher type (verified/unverified), and platform type (health app/search engine/social media) on individuals’ trust in health information and their intentions to share and verify that information. A total of 204 participants were included in this experiment. The results show that verified publishers and health apps can increase trust and the intention to share. Individuals with high cyberchondria show higher trust and intentions to share and verify, only when the publisher was unverified. The findings suggest that external authority (verification of accounts and professional content apps) can moderate the effects of cyberchondria or its related anxiety. The present study contributes to the literature on the determinants of online health behaviours by using an experimental design, with practical implications for platform management and online health information publishers. Full article

Geriatric nutritional problems are increasingly characterized by the co-existence of undernutrition and obesity, yet community-level evidence from Southern Thailand remains limited. Grounded in the social determinants of health (SDH) framework, this cross-sectional study examines the prevalence and independent predictors of BMI categories and abdominal obesity among 13,458 community-dwelling older adults across 20 sub-districts in Southern Thailand. Anthropometric measurements and structured interview data were analyzed using chi-square tests and multinomial logistic regression, with normal weight as the reference category. Overall, 50.3% of participants were overweight or obese, 40.5% had abdominal obesity, and 7.7% were underweight. Advancing age, continued employment, and asthma were independently associated with higher odds of underweight, whereas abdominal obesity was the strongest predictor of elevated BMI categories, increasing the odds of overweight, obesity Class I, and obesity Class II. Female sex, literacy, dyslipidemia, hypertension, and diabetes were also associated with excess BMI categories. Moderate, regular physical activity was a protective factor. These findings support risk-stratified community interventions that integrate BMI with WC screening and address regional occupational, behavioral, clinical, and food culture determinants of nutritional health in older adults. Full article

Dementia is a growing global health challenge, yet many determinants of late-life cognitive decline emerge decades before symptoms appear. Midlife is a practical window for prevention because hypertension, diabetes, obesity, dyslipidemia, smoking, physical inactivity, unhealthy diet, sleep disturbance, and social isolation can be identified and modified before substantial brain injury becomes apparent. This narrative review synthesizes evidence linking midlife vascular and lifestyle exposures to late-life cognitive impairment and dementia. The most consistent data support a life-course model in which cumulative vascular, metabolic, inflammatory, and behavioral risks interact with neurodegenerative pathology and cognitive reserve. Vascular and metabolic factors act largely through small-vessel disease, endothelial dysfunction, and inflammation, whereas physical activity, healthy diet, sleep, and social engagement may strengthen resilience. Although observational evidence is vulnerable to confounding and single-risk trials may underestimate cumulative benefit, multidomain prevention remains biologically plausible and clinically actionable, as recent trials reaffirm. These priorities are especially salient in the rapidly transitioning Gulf Cooperation Council (GCC) countries, where midlife cardiometabolic risk is high and local evidence is limited. Dementia prevention should be embedded in routine midlife care, with vascular risk management and sustained lifestyle support treated as core elements of lifelong brain health. Full article

Health care empowerment is essential for self-care, informed decision-making, and appropriate use of health services among university students. This cross-sectional pilot study examined the association between selected social determinants of health and health care empowerment among university students in Peru. A sample of 336 undergraduate and graduate students from six universities completed an online survey that included the Empowerment Scale for Health Care Empowerment in University Students (ECSU). The instrument demonstrated adequate psychometric properties (Cronbach’s α = 0.859; McDonald’s ω = 0.835). Descriptive analyses and ordinal logistic regression were conducted to identify factors associated with health care empowerment and its dimensions. Income level, family type, and housing situation were associated with overall empowerment. Lower income levels and extended family structures were associated with lower empowerment levels, while university type and educational level were associated with specific dimensions related to decision-making and the ability to empower others. The explanatory capacity of the models was modest (pseudo-R² = 5.0–12.8%). These findings provide preliminary evidence on the relationship between social determinants and health care empowerment in university students. However, results should be interpreted with caution due to the cross-sectional design and convenience sampling. Future studies using probabilistic sampling and longitudinal designs are needed to confirm these associations. Full article

Importance: Chronic liver disease requires sustained engagement with the health system, which co-occurring social and functional risks may disrupt. Whether these risks form reproducible patterns with different mortality associations is uncertain. Objective: To identify social and functional risk patterns among US adults with chronic liver disease and evaluate their associations with all-cause mortality. Design, Setting, and Participants: Nationally representative cohort study of National Health Interview Survey sample adults interviewed from 2011 through 2018 and linked to the National Death Index through 31 December 2019. Participants were aged 18 years or older, eligible for mortality linkage, reported a chronic liver condition, and had no baseline liver cancer. Exposures: Latent class membership derived from 7 binary indicators: poverty, food insecurity, uninsurance, cost-related delayed care, no usual place of care, single-adult household status, and activity limitation. A complete 0- to 7-item count was a secondary exposure. Main Outcomes and Measures: All-cause mortality. Survey-weighted Cox models estimated hazard ratios (HRs) with sequential demographic, clinical, and liver-specific adjustment. Prespecified sensitivity analyses used 20 multiple imputed data sets, sampling-weighted pseudo-likelihood latent class models, complete-case re-estimation, a fixed 5-year horizon, and class-by-age interaction testing. Results: Among 3407 adults (weighted mean age, 54.0 years; 49.4% female), 529 deaths occurred over 17,297.6 person-years (median follow-up, 5.0 years [IQR, 3.0–7.0]). Four classes were retained: low social and access burden (weighted prevalence, 63.1%); functional limitation with financial strain (13.2%); poverty, single-adult household, and functional limitation (15.0%); and uninsurance with major access barriers (8.7%). Compared with the low-burden class, the functional-limitation/financial-strain class had higher adjusted mortality (HR, 1.95; 95% CI, 1.34–2.82; p < 0.001); the other 2 classes did not differ significantly. Sampling-weighted latent class analysis after multiple imputation reproduced 97.2% of modal assignments, and the association persisted with attenuation (HR, 1.55; 95% CI, 1.08–2.22; p = 0.02). Each additional risk was associated with higher mortality (exact count: HR, 1.24 [95% CI, 1.13–1.36]; imputed count: HR, 1.19 [95% CI, 1.10–1.29]). The class-by-age interaction was not significant (p = 0.41). Conclusions and Relevance: Among US adults with self-reported chronic liver disease, social and functional adversity was both cumulative and patterned. A profile combining functional limitation, food insecurity, and cost-related delayed care had the clearest independent mortality association despite largely retained insurance coverage. These profiles are not a validated clinical score, but the findings argue against reliance on any single indicator, particularly insurance status, as a marker of vulnerability. Full article

Flooding is the most devastating natural disaster in Southeast Asia, disproportionately affecting vulnerable communities and posing substantial public health challenges. This PRISMA 2020 systematic review, registered with PROSPERO, aimed to synthesize the determinants influencing community flood resilience among flood-affected communities in Southeast Asia. Five electronic databases and Google Scholar were searched for empirical peer-reviewed studies published between January 2015 and January 2026. Methodological quality was independently assessed using the Kmet standard quality assessment tool, and a convergent integrated synthesis design was applied for the synthesis. Eighteen studies (nine quantitative, six qualitative, and three mixed methods) from Indonesia, Thailand, Malaysia, Cambodia, Myanmar, and Vietnam met acceptable quality thresholds. Seven determinant domains were identified: (1) sociodemographic, (2) flood exposure, (3) socioeconomic, (4) socio-cultural, (5) environmental, (6) physical, and (7) psychological factors. Synthesized evidence revealed that community flood resilience is shaped by dynamic interactions among structural, social, environmental, and psychological determinants that collectively influence resilience capacities. Psychological factors, particularly risk perception and anxiety, served as cross-cutting influences on adaptive behavior, while vulnerability remained concentrated among older adults, women, low-income households, informal settlements, and rural agricultural communities. These findings highlight the importance of integrated and equity-oriented resilience strategies that strengthen community adaptation and improve public health outcomes in the region. Full article

Background: The prevalence of vision impairment (VI) has been increasing worldwide. However, limited population-based evidence currently exists on the relationship between VI and social determinants of health (SDH) scores in China. Even less is known about the association between SDH scores and early death, especially in people with VI. This study aimed to evaluate the association between SDH scores and VI, and further examine whether SDH scores were associated with premature mortality among middle-aged and older Chinese adults with VI. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed in this study. We examined the association between SDH scores and VI among 2559 adults aged ≥ 45 years, and further assessed the relationship between SDH scores and premature death in 8612 individuals aged ≥ 45 years with VI. Statistical analyses included Kaplan–Meier curves, Cox proportional hazards models, restricted cubic spline (RCS) analyses, subgroup analyses, and sensitivity analyses. Results: Kaplan–Meier analysis revealed that individuals with higher SDH scores had a lower risk of experiencing VI compared to those with lower SDH scores (log-rank test p < 0.001). Similarly, among individuals with VI, higher SDH scores were consistently associated with a reduced probability of premature death (log-rank test p < 0.001). In the fully adjusted model, each unit increment in SDH score was associated with a 6% lower risk of VI (HR = 0.94, 95% CI: 0.91–0.98, p = 0.002) and a 15% lower risk of premature death (HR = 0.85, 95% CI: 0.78–0.93, p < 0.001). Conclusions: Among Chinese adults aged ≥45 years, higher SDH scores were significantly correlated with a lower risk of VI. Furthermore, low SDH scores were associated with an increased risk of premature death in those with VI. These findings highlight the association between SDH and lower VI risk as well as longer life expectancy for individuals already living with VI among middle-aged and older populations. Full article

Background: Population ageing has increased the importance of maintaining the quality of life (QOL) of community-dwelling older adults. Resilience and social participation are considered important determinants of well-being in later life. However, little is known about how social participation involving mutual support relates to subjective QOL in Japanese community settings. This study examined associations between resilience and social participation, including mutual support and subjective QOL, among community-dwelling older adults. Methods: This cross-sectional survey was conducted in December 2021 among community-dwelling older adults in Japan. The study sample mainly comprised socially active older adults recruited through senior citizen clubs. Anonymous self-administered questionnaires were distributed to 434 individuals aged 65 years and older, and 258 valid responses were analysed. Subjective QOL was assessed using the Subjective QOL Scale, resilience using the Resilience Scale for Older Adults, and social participation, including mutual support, using a composite score based on neighbourhood relationships and participation in community activities. Results: Subjective QOL was positively correlated with resilience (ρ = 0.475, p < 0.001) and social participation including mutual support (r = 0.163, p = 0.009). After adjustment for self-rated health, the number of outpatient visits per month, and the number of daily medications, the association between subjective QOL and social participation including mutual support was no longer significant (pr = 0.104, p = 0.096), while resilience remained significantly associated with subjective QOL (pr = 0.417, p < 0.001). Participants with higher levels of social participation had significantly higher subjective QOL and resilience scores than those with lower levels of participation. Conclusions: In this study sample, resilience was more strongly associated with subjective QOL than social participation including mutual support. These findings highlight the importance of individualised community-based approaches that address both psychological resilience and opportunities for social participation when promoting well-being among older adults. Full article

Background: Nursing education has evolved in response to changing social, cultural, political, and healthcare contexts. Although Cultural–Historical Activity Theory (CHAT) has increasingly been applied in medical education research, its application to the historical development of nursing education remains limited. This study examined the historical evolution of Mongolian nursing education through the lens of CHAT to identify patterns of activity system transformation and their implications for contemporary nursing education. Methods: A historical documentary review was conducted using CHAT as the primary analytical framework. Historical evidence was interpreted through Engeström’s activity system model, and transformations across successive historical periods were analyzed by examining changes in the object, mediating tools, institutional rules, community, division of labour, and outcomes of nursing education. Results: The findings demonstrate that the development of Mongolian nursing education was shaped by four complementary analytical dimensions: the Social Determinants of Health (SDOH), Diversity, Equity and Inclusion (DEI), political ideology, and paradigm shifts. These factors collectively influenced the transformation of nursing education activity systems from traditional caregiving practices to a modern, research-oriented, and internationally connected educational system. The analysis further revealed how social reforms, ideological transitions, and educational restructuring generated successive transformations in the organization, objectives, and professional identity of nursing education. Conclusions: This study provides a theoretically grounded historical interpretation of Mongolian nursing education through the lens of CHAT. The findings demonstrate that nursing education evolves through dynamic interactions among social, political, cultural, and educational factors, offering valuable insights for curriculum development, educational reform, and the advancement of nursing education in rapidly changing societies. Full article

Managing one’s fertility and determining the timing of one’s pregnancies is integral to human flourishing. An emerging body of literature focuses on global measurement of human flourishing. Despite significant debates in the field, the goal of measuring human flourishing is to understand what it means to live life well. We conducted a modified scoping review of quantitative, qualitative, and mixed-method grey and white literature to identify the extent to which evaluations of interventions aiming to increase the use of voluntary family planning include measures of human flourishing. We searched for peer-reviewed articles published from 2007 to 2025 across four databases (PubMed, Google Scholar, Web of Science, and Science Direct). We completed a full-text review of 583 documents and identified 111 that contain both a behavioral measure of contraceptive use and the measurement of at least one flourishing construct. We captured both the flourishing constructs and measures used. The most measured flourishing constructs were self-efficacy, shared decision-making, social support, mental health, and agency. Less frequently, evaluations measured happiness/pleasure/joy, empowerment, emotional intimacy, physical health, meaning/purpose, social capital, autonomy, trust, and wellbeing. Among the 111 articles, 76 (68.5%) of them included both flourishing-related intervention components and evaluation measures. Twenty-three measured flourishing-related outcomes in the evaluation but did not explicitly include flourishing components in the intervention. Collectively, these findings suggest that there is room for growth to fully understand the relationship between voluntary family planning interventions and the construct of human flourishing. Full article

Chronic kidney disease (CKD) is a major public health challenge associated with substantial physical, psychological, social, and economic consequences. Although its clinical outcomes have been extensively investigated, less is known about how individuals progressively reconstruct their lives while living with an irreversible condition requiring long-term dialysis, particularly in contexts characterized by health inequities. This study aimed to develop a substantive theory explaining how adults reconstruct their lives while living with CKD on dialysis. A qualitative study was conducted using Strauss and Corbin’s Grounded Theory methodology. Eighteen adults receiving hemodialysis or peritoneal dialysis in Chile participated in semi-structured interviews. Data collection and analysis were conducted concurrently using theoretical sampling, the constant comparative method, memo writing, and theoretical saturation. The findings identified “Reconstructing Life While Living with Chronic Kidney Disease” as the central phenomenon. Life reconstruction emerged as a dynamic and ongoing process sustained by the interaction between resignation and survival and facilitated by three interrelated conditions: understanding the disease, social support networks, and nursing care. Through this process, participants progressively reorganized their identities, everyday lives, interpersonal relationships, and future life projects while living with an irreversible chronic condition. The resulting substantive theory provides a contextually grounded explanation of life reconstruction that integrates individual, relational, and social dimensions of living with CKD. By demonstrating that opportunities for life reconstruction are shaped not only by individual agency but also by supportive social and healthcare conditions, the findings contribute to nursing knowledge and provide a conceptual foundation for person-centered care, health equity, and future research on chronic illness. Full article

Retirement is a major later-life transition, yet existing reviews have often examined selected dimensions of well-being rather than integrating evidence across physical, mental, social, financial and spiritual or meaning-related domains. This umbrella review synthesised systematic review evidence on factors and interventions influencing well-being among retired older adults. Following Joanna Briggs Institute methodology and Preferred Reporting Items for Overviews of Reviews guidance, five databases were searched for systematic reviews published from 2015 onward. The protocol was registered in PROSPERO (CRD420251158970). Screening, quality appraisal and data extraction were completed independently by two reviewers, with disagreements resolved by a third reviewer. Eleven systematic reviews met the inclusion criteria. Findings showed that retirement well-being is multidimensional and context-dependent, shaped by social participation, physical health, psychological resources, retirement preparation, voluntary retirement, financial security and meaningful engagement. Social participation and social integration were among the most consistent determinants, while financial and spiritual or meaning-related well-being were less frequently examined. Intervention evidence was limited and focused mainly on physical activity, health behaviours and volunteerism. Retirement well-being is influenced by interacting personal, social and structural factors, highlighting the need for multidimensional interventions and more consistent measurement across well-being domains. Full article

Tuberculosis (TB) remains a leading cause of infectious disease-related mortality worldwide despite major advances in diagnostics, treatment, and programmatic control. Achieving the goals of the World Health Organization End TB Strategy requires a greater emphasis on prevention alongside improvements in diagnosis and treatment. This viewpoint examines evolving priorities in TB prevention and highlights key insights from studies included in the Special Issue ‘New Perspectives in Tuberculosis Prevention and Control’. The articles published in the Special Issue highlight the importance of identifying populations at increased risk of infection, disease transmission, and disease progression; strengthening the implementation of tuberculosis preventive treatment among household contacts and people living with HIV; and addressing the behavioral, social, and structural determinants that influence access to TB prevention and care. They also demonstrate persistent challenges related to medicine availability, healthcare worker capacity, patient initiation and follow-up, program monitoring, and the implementation of preventive interventions in resource-constrained settings. Emerging developments in diagnostics, biomarkers, vaccines, and digital health may contribute to the longer-term TB prevention agenda but require further evaluation of their feasibility, affordability, and programmatic relevance. Collectively, the evidence indicates that effective TB prevention extends beyond individual biomedical interventions and requires coordinated approaches involving healthcare systems, communities, surveillance systems, and social support mechanisms. Continued investment in implementation research, health-system strengthening, program management, economic evaluation, and multisectoral action will be critical to translate existing evidence into sustainable, equitable, and context-specific strategies for reducing the global burden of TB. Full article

Background: Environmental determinants of health (EnvDoH) are widely recognised as shaping health and behaviour, yet little attention has been given to how they are conceptually defined. This is notable given their use across disciplines and the lack of a consistent definition of “environment,” which contributes to inconsistencies in research, policy, and practice. Methods: Following PRISMA 2020 guidelines, we conducted a systematic review of peer-reviewed English-language publications addressing EnvDoH definitions, components, or relationships with other determinants. Searches of Scopus, PubMed, and EBSCOhost databases (including CINAHL, MEDLINE, and PsycInfo) included studies published up to 31 August 2025. Definitions and relationships were synthesised narratively, and components were analysed using inductive thematic analysis. Results: Among 1157 included publications, 52.3% originated from the United States, United Kingdom, Canada, and Australia, and 47.5% were published from 2020 onwards. Only in 77 publications (6.7%) we were able to identify a definition of EnvDoH, ranging from broad descriptions (“everything that is not genetic”) to multidimensional frameworks encompassing physical, natural, built, social, political, and behavioural domains. Components identified in 1147 (99%) publications were grouped into 56 themes and 12 domains, with food and physical/natural environments most frequently represented. Discussion: The absence of conceptual consensus on EnvDoH limits comparability across studies and may hinder research, policy, advocacy, and education. Greater conceptual clarity is needed to strengthen public health responses to accelerating environmental change. Limitations include single-reviewer screening for some full texts, possible omission of implicit determinants, exclusion of non-English publications and grey literature. Funding was provided by the Provincial Secretariat for Higher Education and Scientific Research of the Autonomous Province of Vojvodina, Republic of Serbia. The study was not registered. Full article

Latin America and Africa face complex public health challenges shaped by social, environmental, and epidemiological factors. This study conducts a comparative analysis of publicly available national health strategies and national policy documents from 52 countries in Africa and 12 countries from Latin America, supplemented with data from the World Health Organization (WHO) and Pan American Health Organization (PAHO). The analysis focuses on five domains: social determinants of health, environmental health, infectious diseases, non-communicable diseases (NCDs), and immunization. This study examines how these health priorities are represented in national policy frameworks. Across the reviewed country sample, national policy documents tend to emphasize challenges related to health care access, the growing burden of NCDs, and environmental risks. In selected Latin American countries, migration-related pressures, health system fragmentation, and uneven vaccination coverage are primarily highlighted. In selected African countries, policy priorities tend to focus on communicable diseases, infrastructure limitations, and large zero-dose populations. The study underscores policy priorities and highlights opportunities for cross-regional learning. Strengthening primary health care, improving domestic health financing, and enhancing environmental health governance emerge as key areas for policy development. These findings support the value of comparative policy analysis in informing context-sensitive and equity-oriented health strategies. Full article