International Journal of Public Health

Background Italy experiences a substantial heat-related mortality burden, but evidence on cause-specific mortality across its heterogeneous climatic settings remains limited. We aimed to quantify cause-specific mortality attributable to summer heat in Italy at national and ecological region levels and to map its distribution across municipalities. Methods We analysed daily deaths classified by underlying cause in eight ICD-10 groups among individuals aged 18-64 years and 65 years or older across 7,864 municipalities during June-August, 2004-2023. Mortality data were linked to area-weighted ERA5-Land daily maximum temperature. Nonlinear temperature-mortality associations were estimated with Bayesian hierarchical Poisson models, fitted separately for each cause, age group, and ecological region, with municipality-level attributable fractions. Findings High temperatures were associated with mortality from a broad range of causes, particularly among individuals aged 65 years or older. Among the study population, heat-attributable fractions were highest for nervous system diseases (14.93%, 95% credible interval 14.22-15.69) and mental and behavioural disorders (14.47%, 13.55-15.39). Circulatory diseases accounted for the largest absolute burden, with 85,524 heat-attributable deaths (82,762-88,271) across the summers of the 20 years considered. Interpretation The mortality burden associated with summer heat in Italy extended well beyond circulatory and respiratory diseases, highlighting the relevance of a broader range of health outcomes. These findings support heat-health strategies that account for cause-specific and geographical differences in heat-related risk, with greater consideration of neurological and mental health outcomes alongside established cardiorespiratory risks. Funding NextGenerationEU (CUP: B53C23002660006); Imperial College Research Fellowship; NIHR Imperial Biomedical Research Center (BRC: NIHR203323).

Healthcare workers face substantial occupational demands and exposure to respiratory infections during winter, but evidence that probiotics improve their health and wellbeing remains limited. This exploratory, double-blind, randomised, placebo-controlled trial assessed whether daily Lab4 supplementation affected upper respiratory tract infection (URTI) frequency and supported wellbeing in 104 healthcare workers. Daily diaries recorded symptoms defining URTI episodes, general-practitioner visits, illness-related work absence and antibiotic use. Wellbeing was assessed at baseline and weeks 8 and 16, and faecal microbiota were assessed using 16S rRNA gene sequencing. Participants receiving Lab4 reported better wellbeing than those receiving placebo. For probiotic versus placebo, the risk ratio (RR) for URTI occurrence was 0.60 (95% confidence interval [CI]: 0.30-1.20; p=0.1477), the incidence rate ratio (IRR) for episodes was 0.58 (95% CI: 0.27-1.23; p=0.1581), and the mean ratio for episode duration was 0.98 (95% CI: 0.72-1.32; p=0.8776). For general-practitioner visits, the RR for at least one visit was 0.48 (95% CI: 0.21-1.07; p=0.0737) and the IRR was 0.44 (95% CI: 0.18-1.06; p=0.0677). For illness-related work absence, the RR for at least one day absent was 0.75 (95% CI: 0.18-3.22; p=0.6991) and the IRR for absence days was 0.74 (95% CI: 0.16-3.32; p=0.6914). For antibiotic use, the RR for any use was 0.48 (95% CI: 0.20-1.18; p=0.1111) and the IRR for antibiotic-use days was 0.42 (95% CI: 0.16-1.12; p=0.0820). No significant between-group differences in gut microbiota were detected in the subset providing faecal samples. Illness-related estimates generally favoured Lab4, although between-group differences were not statistically significant. These exploratory findings support evaluation in a larger, prospectively powered trial.

Background Short-term weather conditions can trigger paediatric hospital admissions, but evidence remains limited on the health relevance of intraday temperature variability, humidity, and precipitation, and generally on which subgroups are most susceptible. Methods We conducted a nationwide case time-series study of Swedish children and adolescents aged 6-18 years using linked register data. Associations between daily mean temperature, intraday temperature variability, relative humidity, and precipitation and inpatient hospitalisations were estimated with Poisson regression (individual fixed effects) combined with distributed lag non-linear models over lags 0-21 days. Outcomes included all-cause hospitalisation and cause-specific admissions. Effect modification was examined by sex, age group, socioeconomic indicators, region, and calendar periods. Findings Among 4,638,247 children and adolescents in the cohort, 1,070,702 (23.1%) experienced at least one inpatient hospitalisation, contributing 1,736,169 hospitalisation events. All-cause hospitalisation increased with higher mean temperature, with risk highest at hot extremes. Intraday temperature variability showed a U-shaped association, with higher rates at both lowest and highest exposure levels. Relative humidity showed no association with hospitalisation risk. Higher precipitation was associated with increased hospitalisation risk, but estimates at high rainfall levels were imprecise. Stratified analyses indicated modest differences by sex and socioeconomic indicators, but clearer heterogeneity by age and region, with the highest risks among younger children and in East Sweden; associations varied across calendar periods and were imprecise for most cause-specific outcomes. Sensitivity analyses mostly showed that the main curve shapes were robust. Interpretation Short-term exposure to hot temperatures, both low and high intraday temperature variability, and higher levels of precipitation were associated with an increased risk of all-cause hospitalisation among children in Sweden, with clearer variation by age group and region than by sex or socioeconomic position. These findings support targeting paediatric climate-health preparedness and early-warning systems toward younger children and higher-risk regions such as eastern Sweden and extending such systems beyond mean temperature to include intraday temperature variability, a distinct, currently overlooked driver of risk that heat-focused systems are not designed to capture. Fundings This research was funded by Formas the Swedish Research Council for Sustainable Development (grant no. 2023-01774 and 2022-01845) and the Swedish Research Council (2025-02804 and 2022-06599).

Objective: to estimate reconsultation risk and trajectories after a new episode of musculoskeletal pain in children and young people (CYP), and to determine routinely recorded prognostic factors associated with reconsultation. Design: Population based retrospective cohort study. Setting: Clinical Practice Research Datalink (CPRD) Aurum, 2005-2021. Participants: CYP aged 8-18 years consulting primary care for a new musculoskeletal pain episode (no musculoskeletal consultation in prior 12-months). Main Outcome Measures: Musculoskeletal pain reconsultation within 12-months, and 3-year musculoskeletal reconsultation trajectories derived using latent class growth analysis. Prognostic factors selected from a literature search and two-year symptom histories (sample prevalence >1%) were examined using regression models (conditional logistic; multinomial). Results: Among 313,830 CYP with >12 months' follow-up, 32% reconsulted for musculoskeletal pain within 12 months. Among 240,384 CYP with >3 years' follow-up, three trajectories were observed: single episode (62%), early reconsultation (18%), and persistent reconsultation (20%). Older age; female gender; hip, knee, multisite and back pain on index; previous headache; previous abdominal pain; and analgesic prescribing were associated with higher reconsultation risk. Asian or Black ethnicity, and residing in more deprived areas, were associated with lower recorded reconsultation. Conclusion: Most CYP had no further recorded consultation, but 38% followed early or persistent reconsultation trajectories. Routinely recorded prognostic factors, particularly index pain side and prior pain/symptom history, may differentiate groups who could benefit from proactive follow-up. Lower recorded reconsultation among Asian and Black individuals, and living in more deprived areas, should not imply lower need and warrants equity-sensitive monitoring of access, health-seeking, and coding.

Background: Valid and feasible measures of preschoolers' 24-hour movement behaviours are needed for population-level research. We developed a Japanese version of the Movement Behaviour Questionnaire-Child (MBQ-C) and evaluated its measurement properties and practicality. Methods: After translation and cross-cultural adaptation following the COSMIN procedure, including cognitive interviews, we evaluated the questionnaire in a cross-sectional validation study of Japanese children aged 3-6 years. Concurrent validity was assessed against hip-worn accelerometry and a 7-day diary; we also examined test-retest reliability, measurement error, agreement between response formats and modes, and practicality (completion time, burden, and clarity). Analyses used Spearman correlations, intraclass correlation coefficients, the SEM, smallest detectable change (SDC), and Wilcoxon signed-rank tests. Results: Of 208 children, 170 provided valid accelerometer and diary data for the concurrent-validity analysis, and 187 completed the MBQ-C for the questionnaire-based analyses. Concurrent validity was weak for active and energetic play (Spearman {rho} = 0.12-0.26), strong for total screen time (0.78-0.85), and moderate for total sleep (0.48-0.58). Test-retest reliability was moderate to good (ICC, 0.66-0.81), and within-child variability was lowest for sleep (CV 3%) and highest for the physical activity items (21-33%). The open- and closed-ended versions showed no significant differences; paper-electronic agreement was good for screen time and sleep but poor for active play. Completion took approximately 6-9 minutes, with low reported burden. Findings were robust in sensitivity analyses. At the group level, SDC for a mean was SDCind/{surd}N: 119.8/{surd}N, 74.0/{surd}N, 112.6/{surd}N, and 92.5/{surd}N min/day for active play, energetic play, total screen time, and total sleep, respectively (N = number of children surveyed). The systematic differences between the two test-retest occasions were +15.7, +6.5, +4.0, and -5.4 min/day, respectively. Conclusions: The Japanese MBQ-C is a practical option for assessing preschoolers' active play, screen time, and sleep at the group level. By quantifying its group-level measurement error, this study provides benchmarks for interpreting group-level differences and change, supporting the use of the MBQ-C in surveillance and evaluation of programmes delivered at scale.

Chronic disease accounts for most health care expenditures in the United States (US), highlighting the need for approaches that address health across interconnected spiritual, mental/emotional, behavioral, physical (including environmental), and social domains. Whole person health (WPH) is increasingly recognized as important for alleviating chronic disease burdens but has not been well-described across various sociodemographic groups of US adults. Using cross-sectional data from the 2025 National Health Interview Survey, we sought to describe the prevalence of WPH and its components among US adults overall and by age, sex, and race along with ethnicity. Participants responded to the nine-item Whole Person Health Index (WPHI), which we used to assess continuous scores (range: 9-45, where higher scores indicated improved health) and ''optimal'' (excellent/very good vs. good/fair/poor) overall and domain-specific WPH. Using survey procedures, we estimated medians (IQR) and prevalence (95% CI) and compared subgroups using multiple comparison correction. Among 23,884 NHIS participants aged 18 years and older (mean age (SE)=48 (0.2) years), representing approximately 261,620,640 US adults, the median WPHI score was 33 (28-37) and slightly over half (57% [56%-58%]) of adults were classified as having ''optimal'' overall WPH. Optimal social/family connections (72% [72%-73%]) were frequently reported; ''optimal'' sleep was infrequently reported (36% [35%-37%]). WPH and its components were generally highest among younger adults. Men and women differed in WPH domains but not in overall WPH. Non-Hispanic (NH) American Indian/Native Alaskan and NH-Black adults generally had lowest prevalence of optimal WPH and its components, which was often higher among Hispanic/Latino adults and highest among NH-Asian and White adults. These results showing variation in WPH in the US may inform future investigations of WPH, related predictors and health outcomes, and health disparities.

Background: Built environment characteristics have been associated with depressive symptoms, whilst active travel behaviour is linked to improved mental health. However, it remains unclear whether active travel buffers associations between increased exposure to the built environment and worse mental health. Methods: In this pre-registered study, participants were 10,310 mothers (mean age = 28.11, SD = 4.83) participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). A latent built environment factor was measured at study enrolment, active travel behaviour at a 2-year follow-up, and depressive symptoms at a 4-year follow-up. Moderation was examined using adjusted linear regression models including an interaction term between the built environment factor and active travel behaviour. Results: The built environment factor was positively associated with depressive symptoms ({beta} = 0.023, p = .012). Active travel behaviour was not associated with depressive symptoms ({beta} = -0.002, p = .854) and did not moderate the association between the built environment factor and depressive symptoms ({beta} = -0.002, p = .865), after adjusting for covariates, including age, familial depressive history, socioeconomic risk factors, physical activity, baseline depressive symptoms and smoking. Conclusion: Contrary to expectations, active travel behaviour does not modify associations between the built environment and depressive symptoms. These findings provide no evidence that active travel mitigates mental health risks associated with the built environment in this population.

Financial well-being (FWB) encompasses objective and subjective financial status and may influence health. We developed and validated a parsimonious FWB index using data from 23,006 Health and Retirement Study (HRS) participants aged 50 years and older from 2006 to 2022. The FWB-5 Index was derived using correlated two-factor confirmatory factor analysis accounting for household clustering. Indicators included household wealth, household income-to-poverty ratio, monthly financial strain, satisfaction with one's financial situation, and perceived financial mastery. We assessed convergent and discriminant validity using the Consumer Financial Protection Bureau Financial Well-Being (CFPB-FWB) Scale and Satisfaction with Life Scale, respectively. Associations with pre-baseline socioeconomic factors and subsequent depressive symptoms and health conditions were examined to assess construct and predictive validity. Model fit indices supported the two-factor structure (robust comparative fit index = 0.99; robust root mean square error of approximation = 0.05). Correlations were stronger with the CFPB-FWB Scale (Spearman P = 0.80) than with life satisfaction (Spearman P = 0.43). Associations with socioeconomic factors and subsequent health outcomes were in the hypothesized directions. These findings support the FWB-5 Index as a parsimonious measure for examining financial well-being and its associations with health across HRS waves, including those predating the CFPB-FWB Scale.

PurposeTo identify dietary patterns among adult childhood cancer survivors (CCSs), examine their determinants, and assess whether they differ according to cardiovascular disease (CVD) risk profiles. MethodsCCSs from the Swiss Childhood Cancer Survivor Study diagnosed before age 21 years (1976-2005), surviving [≥]5 years and aged [≥]18 years in 2017, completed a food frequency questionnaire (SCCSS-Nutrition). Factor and hierarchical cluster analyses of 52 food groups identified dietary patterns. We categorised CCSs as having CVD, CVD risk factors (obesity, hypertension, diabetes, high cholesterol), or being CVD risk-free. Multinomial logistic regression assessed associations between dietary patterns and CVD risk profiles. ResultsAmong 802 CCSs (median age: 35 years; IQR: 29-41; 50% male), we identified five dietary patterns: Mediterranean-inspired diet (22%), Western indulgence diet (38%), Western sweet & fatty diet (26%), restrained indulgence diet (9%), plant-based & alcohol-rich diet (6%). Male sex, younger age, German-speaking region, smoking, and living with others were associated with Western indulgence, Western sweet & fatty, and restrained indulgence diets. Higher Swiss socioeconomic position (Swiss-SEP) and education, and not having children, were associated with the plant-based & alcohol-rich diet, higher Swiss-SEP was also associated with the Western indulgence diet. No associations were observed between dietary patterns and CVD risk profiles. ConclusionsDietary patterns among adult CCSs were socially patterned and differed according to sociodemographic and lifestyle characteristics, but were not associated with CVD risk profiles. Implications for Cancer SurvivorsDietary counselling and broader lifestyle support should be considered as part of long-term survivorship care for CCSs.

Background: Vitamin D modulates innate and adaptive immunity and has been investigated for preventing pediatric respiratory infections. Objective: To assess the effects of vitamin D supplementation on respiratory tract infections (RTIs), including upper RTIs, lower RTIs/recurrent pneumonia, and hospitalization/clinical severity in children and adolescents. Methods: Systematic review and random-effects meta-analysis of 16 publications, of which 13 contributed to quantitative synthesis. Twenty-four effect estimates were pooled, eight per outcome. The odds ratio (OR) was analyzed on its natural logarithmic scale (logOR), using restricted maximum likelihood (REML) estimation and Knapp-Hartung (KH) adjusted inference. Where necessary, risk ratios (RRs), hazard ratios (HRs), and incidence rate ratios (IRRs) were approximated on the logOR scale. Results: For respiratory infection/upper RTI, pooled logOR was -0.284 (KH-adjusted 95% confidence interval [CI]: -0.678 to 0.110; OR 0.753; p = 0.132; I2 = 97.2%). For lower RTI/recurrent pneumonia, logOR was -0.445 (95% CI: -0.987 to 0.097; OR 0.641; p = 0.093; I2 = 89.5%). For hospitalization/clinical severity, logOR was -0.609 (95% CI: -1.134 to -0.083; OR 0.544; p = 0.029; I2 = 78.3%). Conclusions: Pooled estimates favored supplementation in direction for all three groups, although confidence intervals included the null for the first two. Heterogeneity was substantial, and the results are limited by approximations among effect measures, clinically diverse endpoints, and potentially correlated effects from individual studies.

Background: A large increase in mortality from severe acute respiratory infections (SARI) in Brazil in 2025 was mainly driven by influenza A and respiratory syncytial virus (RSV) among children and the aged, but 2026 data remain largely unpublished. Methods: Secondary data on SARI by age group (<2, 2-4, 5-14, 15-49, 50-64, 65+ years) and virus (Influenza A/B, RSV, SARS-CoV-2, adenovirus, rhinovirus, bocavirus, and metapneumovirus) were retrieved for 35 weeks of 2026. Weekly variations in infection rate (IR) and mortality rate (MR) were described by virus and age group. Case fatality ratio (CFR) and vaccine-preventable deaths from influenza, RSV, and SARS-CoV-2 were analysed by age group. Missing virus classification was estimated by multinomial regression. Poisson-based 95% confidence intervals (CI) were calculated for MR. Results: Influenza A infections quintupled during February and March, with a mortality peak in April, mainly due to H2N3. RSV and rhinovirus caused more deaths than influenza viruses, especially among young children (<2) and the aged (65+). The former were most frequently infected by RSV and the latter by rhinovirus. For those 50 years or older, influenza B reached a CFR of about 20%, compared with 5-15% for influenza A, metapneumovirus, rhinovirus, and other non-subtyped viruses. The highest vaccine-preventable MRs per 100,000 were 17.23 for the oldest and 8.62 for the youngest. Under ideal conditions, 6418 lives could have been saved, about half among children and adolescents <15 years old. Conclusions: Vaccine-preventable SARI in Brazil exerted a high toll in fall and winter 2026, mainly due to influenza A, RSV, and rhinovirus. Better vaccine coverage may significantly reduce this toll.

Background: Whether whole-body energy balance is associated with perceived stress in young adults is unclear. Aim: To examine associations of estimated free-living energy balance with physical and psychological stress during 28-day monitoring. Methods: This secondary analysis of an observational study included 18 Japanese male university students with at least 14 valid accelerometer days (at least 600 min/day). Energy intake was estimated using the Brief-type Self-administered Diet History Questionnaire; total energy expenditure was estimated from accelerometry plus resting metabolic rate. Physical and psychological stress were assessed before and after monitoring using 100-mm visual analog scales. Baseline-adjusted linear regression was used. Summary: Mean energy balance was -79 kcal/day (SD 531). Energy balance was not clearly associated with post-monitoring physical stress (B = 0.067 per 100 kcal/day, 95% CI -1.604 to 1.737; p = 0.933) or psychological stress (B = 0.314, 95% CI -2.571 to 3.199; p = 0.820). No clear association between estimated free-living energy balance and post-monitoring stress was detected.

Background: Previous studies indicated that regional fluctuations in COVID-19 impact were associated with socioeconomic, demographic and environmental factors early in the pandemic. It is unclear whether factors associated with regional COVID-19 mortality and SARS-CoV-2 infections changed over the course of the pandemic. Methods: We evaluated the association of ecological factors with municipality-specific COVID-19 mortality in the national population of Austria between January 2020 and June 2023. Analyses were conducted separately per calendar year and pooled across years via random-effects meta-analysis. Outcomes were analysed using univariable and multivariable zero-inflated negative binomial (ZINB) regression, including annually averaged environmental exposome exposure (including air pollution and UV radiation), socioeconomic, demographic and infection dissemination predictors with significance threshold set to p<0.005. Secondary analysis modelled SARS-CoV-2 infections using of negative-binomial model (NB). Two additional approaches for smaller predictor set selection were applied as sensitivity analyses. Results: Within the entire observation period 18,430 COVID-19 deaths were reported. In univariable analyses (pooled RR (99.5% CI)), COVID-19 mortality was significantly associated with the proportion of commuters (0.79 (0.73-0.86)), residents aged 75-84 (1.18 (1.01-1.37)) and [&ge;]85 years (1.29 (1.04-1.60)), residents with at most compulsory education (1.15 (1.02-1.29)), employed residents aged 15-64 (0.89 (0.85-0.93)), and homeowners (0.91 (0.83-0.99)), as well as with precipitation (0.94 (0.89-0.99)) and the average time with a mean temperature of 5-15 C (0.95 (0.90-0.99)). In multivariable analyses the share of population aged 85 or older (1.30 (1.09-1.54)) and home ownership (0.92 (0.87-0.98)) were independently significant. Mortality predictor estimates were relatively stable across pandemic years. Across 5,963,882 documented SARS-CoV-2 infections share of employed in 15- to 64-year-olds (1.01 (1.01-1.02)), part-time employment rate (1.01 (1.00-1.02)) and district level nursing care allowance recipiency (0.97 (0.95-0.98)) were associated with detected infections. Overnight stays, population 85 or older, income, compulsory education or less and air pollution all had multiple significant estimates with opposite directionality, leading to non-significant overall associations. Sensitivity analyses outcomes mirrored main analyses outcomes. Conclusions: Throughout the pandemic in Austria, demographic and socioeconomic factors were associated with COVID-19 mortality and infections, but many associations, especially for infections, were unstable over time. These findings underscore the importance of structural vulnerabilities in epidemic impact.

The COVID-19 pandemic led to significant disruptions in cardiovascular care and reductions in physical activity, but little is known about how exercise patterns changed after this period. This study assessed changes in weekly aerobic and strength training activity between 2020 and 2022 amongst adults aged 18 years or older who reported one or more cardiovascular diseases or risk factors. This study used National Health Interview Survey data from 2020 and 2022. Adjusted differences for moderate-to-vigorous physical activity (MVPA) were calculated using a linear regression model and for strength sessions using a Poisson regression, adjusting for sex and age. Changes in these outcomes were then stratified by age and sex subgroups. The weighted study population included 182,783,008 (standard error, +/-3,334,337) adults in 2020 and 185,388,060 (SE, +/-3,285,161) adults in 2022. Between 2020 and 2022, the overall weekly MVPA increased from 244.2 (SE, +/-4.5) minutes to 266.3 (SE, +/-5.7) minutes (adjusted difference, +22.1 [SE, +/-6.92] minutes). There were no statistically significant changes in the number of strength session per week overall or among sex and age subgroups. Across sex and age subgroups, increases in weekly MVPA were entirely concentrated among males and younger adults. The recovery from pandemic era reductions in aerobic and strength exercise training was uneven amongst demographic subgroups, which aligns with concurrent persistent disruptions in cardiovascular care.

Disability is an important population-health concern, but adult-specific evidence on its distribution and socioeconomic patterning remains limited in Somaliland. This study estimated the prevalence and distribution of reported disability among adults in Somaliland and examined socioeconomic inequality, reported mental/psychological illness, and their co-occurrence. We conducted a cross-sectional secondary analysis of the 2020 Somaliland Health and Demographic Survey. The analysis included 14,579 adults aged [&ge;]18 years who were usual residents, had the disability module administered, and had a defined reported mental/psychological illness measure. Reported disability was defined as at least one positive response across seven disability domains: sight, hearing, speech, learning, mobility, self-care, and mental. Survey-weighted prevalence estimates and design-based comparisons were calculated. Survey-weighted logistic regression assessed associations with household wealth and other covariates. Socioeconomic inequality was assessed using a concentration index and the normalized Erreygers concentration index. Co-occurrence was evaluated by comparing observed joint prevalence with that expected under statistical independence and by survey-weighted logistic regression. The survey-weighted prevalence of any reported disability was 7.30% (95% CI 6.65-8.02). Sight was the most frequently reported domain (3.83%, 95% CI 3.19-4.59), followed by hearing (1.54%, 95% CI 1.20-1.97) and mobility (1.39%, 95% CI 1.14-1.70). Disability prevalence increased markedly with age, from 4.15% among adults aged 18-29 years to 23.96% among those aged [&ge;]60 years. The crude wealth pattern was non-monotonic and was not statistically detectable after adjustment for residence and region. The concentration index for reported disability was 0.0584 (SE 0.0284, p=0.0415). Reported mental/psychological illness had a weighted prevalence of 0.71% (95% CI 0.50-1.00). Both reported disability and reported mental/psychological illness occurred in 0.5032% of adults, compared with 0.05185% expected under statistical independence; the observed-to-expected ratio was 9.70 (95% CI 7.60-11.81). After adjustment for age group and sex, reported disability was strongly associated with reported mental/psychological illness (OR 42.99, 95% CI 18.45-100.18). Reported disability affected approximately one in fourteen adults in Somaliland and showed a marked age gradient and substantial geographic variation. The crude socioeconomic pattern was attenuated after adjustment for geographic context, while concentration analysis indicated modest marginal concentration toward higher wealth ranks. Reported mental/psychological illness was uncommon but co-occurred with reported disability more often than expected under independence. These findings provide an adult population baseline for Somaliland while highlighting the need to distinguish survey-reported disability from the separate mental/psychological illness construct and to interpret the findings within the limitations of cross-sectional, survey-reported measures.

Background: Childhood experiences contribute to health and wellbeing across the life course, yet research from low- and middle-income countries has largely focused on a few outcomes rather than broader patterns of adult wellbeing, behaviors, and social and financial circumstances. Methods: In this cross-sectional analysis, we used a nationally representative sample of adults in India (N = 12,765; aged [&ge;] 18 years) from the Global Flourishing Study (GFS) Wave 1 (2023) to examine associations between eight retrospectively reported childhood experience items, 45 adult outcomes, and two composite flourishing indices. Survey-weighted linear, logistic, and proportional-odds models adjusted for age, gender, education, and residential setting, with Bonferroni correction were used to assess associations and effect modification by gender. Findings: Although the breadth and strength of associations differed across childhood experiences, less favorable childhood experiences were generally associated with poorer wellbeing and flourishing, greater odds of adverse health outcomes, and reduced access to resources and safety in adult life. However, outcomes related to prosocial behaviors showed a different pattern: childhood abuse (physical or sexual) was associated with greater odds of volunteering (OR 1.31, 95% confidence interval or CI [1.13,1.51]), feeling like an outsider in one's family with greater odds of donating (OR 1.80, 95% CI [1.52,2.13]), volunteering (OR 1.53, 95% CI [1.28,1.82]), and helping a stranger (OR 1.49, 95% CI [1.27,1.74]). Associations were broadly similar between females and males, with little evidence of gender differences. Interpretation: Associations of childhood adversity with poorer health and increased prosocial behavior in adult life may reflect unmeasured social, cultural, or dispositional factors and heterogeneous life-course responses. Nevertheless, these findings support strengthening child-protection, financial assistance programs, and mental health services in India.

Childhood experiences are important antecedents of adult flourishing, yet gender patterns in these experiences are under-studied in large global samples using a common survey instrument and population-based study design. From the Global Flourishing Study Wave 1 data (2022-2024), we analyzed responses from 203,430 adults (51% female, 49% male) in nationally representative samples from 21 nations on eight childhood-related items: experiencing physical or sexual abuse, feeling like an outsider in the family, feeling loved by one's mother or father, quality of relationship with one's mother or father, health growing up, and perceived family financial situation. Greater negative experiences were noted in more affluent nations (as measured by gross domestic product (GDP) per capita), with negative experiences generally reported more often among females than males, again especially in more affluent nations. Gender differences were more pronounced when it came to relationships with mothers compared to fathers. Perceptions regarding health and family finance while growing up did not show appreciable gender differences and had weaker correlations with other items.

Introduction Literacy is a determinant of mental health, wellbeing, and social participation. Although literacy interventions improve educational and socioeconomic outcomes, their effects on mental health and social participation are poorly evidenced. We aimed to assess the feasibility and acceptability of a group-based literacy and numeracy intervention and explore its effects on literacy, mental health, numeracy, wellbeing, and social participation. We also estimated implementation costs. Methods We conducted a mixed-methods study using an uncontrolled pre-post design among women in low-income urban communities in Lucknow, India. A total of 115 women were recruited to a 17-week group literacy intervention using the Accelerating Learning for All literacy intervention. Outcomes measured at baseline, midline, and endline used literacy and numeracy assessments and validated scales of mental distress, wellbeing, and social participation. Quantitative data were analysed using multilevel mixed-effects models. Qualitative interviews and focus groups were analysed thematically. Costs were calculated per participant. Results The intervention was feasible and acceptable with functional recruitment of 71% (82/115), 74/82 participants (90%) completed it (retention), and mean attendance of 69% of scheduled sessions. In multilevel mixed-effects models, mean literacy scores increased by 29.5 (95% CI: 23.6, 35.3) between baseline and endline, while mean mental distress (SRQ20) decreased by 3.4 (95% CI: 2.2, 4.6), mean mental wellbeing (WEMWBS) improved by 2.6 (95% CI: 0.1, 5.1), while social exclusion (P scale) declined by 4.1 (95% CI: 1.6, 6.5). Qualitatively, participants described greater confidence, autonomy, financial literacy, and social support. Implementation enablers included local facilitators. Implementation cost was US$25 per participant. Conclusion This low-cost literacy intervention was feasible and acceptable for women in low-income urban communities in India. Findings provide preliminary evidence of improvements in literacy, mental health, and social participation. Controlled studies are needed to establish causal effects, long-term outcomes, and scalability.

Features of urbanicity have been linked to poor psychiatric health in adulthood, but little is known about their relationship with biological age and cognition earlier in life. Using the Avon Longitudinal Study of Parents and Children (ALSPAC), we tested associations between the built environment and epigenetic ages (EpiAgeAltum, EpiAgeHorvath, EpiAgePACE) (n=2,452), brain age (n=751), and cognition (n=12,199). Analyses were replicated in Generation R and triangulated in the Millennium Cohort Study. The built environment was not associated with epigenetic ages ({beta}Altum range = 0.013-0.015, p range = .466-.689; {beta}Horvath range = -0.011-0.023, p range = .182-.728; {beta}PACE range = -0.045-0.013, p range = .131-.524) or brain age ({beta} range = 0.022-0.028, p range = .337-.429). A negative association with cognition was observed in Generation R. We provide no consistent evidence that childhood built environment exposure relates to biological age and cognition in adolescence, suggesting these relationships may emerge in later life.

Background: Aging is associated with physiological, biological, socioeconomic and psychological changes that may increase vulnerability to poor dietary intake, reduced muscle strength and elevated blood pressure. In Ghana, evidence on dietary intake in relation to functional and cardiometabolic health among community-dwelling older adults remains limited. This cross-sectional study assessed dietary intake, handgrip strength (HGS) and elevated blood pressure (BP), and examined associations between diet quality indicators and these health outcomes among older adults in five peri-urban communities in the La Nkwantanang-Madina Municipality, Ghana. Methods: Data were collected from 200 community-dwelling adults aged 60 years and above. Dietary intake was assessed using a multiple-pass 24-hour dietary recall, while physical activity, HGS and BP were measured using standardized procedures. Categorical variables were summarized as frequencies and percentages. Non-normally distributed dietary variables were compared between health outcome groups using the Mann-Whitney U test. Adjusted binary logistic regression was used to examine associations between diet quality indicators and HGS or elevated BP. Results: The mean age of participants was 69.8 {+/-} 7.3 years. More than half did not meet the dietary reference intake for protein, fat, fiber, magnesium, potassium and vitamin E, and no participant met the dietary reference intake for calcium. The prevalence of inadequate minimum dietary diversity (MDD) and inadequate mean adequacy ratio (MAR) exceeded 50%. Energy, protein, carbohydrate and selenium intake differed significantly by HGS status (p < 0.05). Mean adequacy ratio differed significantly by HGS status (p = 0.021) and BP status (p = 0.016). In adjusted models, each one-unit increase in MDD was associated with lower odds of elevated BP (AOR = 0.68; 95% CI: 0.46-1.00; p = 0.05), while each one-unit increase in MAR was associated with higher odds of normal HGS (AOR = 8.77; 95% CI: 1.33-64.08; p = 0.034). Conclusions: Dietary inadequacy was common among older adults in this peri-urban Ghanaian setting. Better diet quality indicators were associated with normal HGS and lower odds of elevated BP. These findings support the need for nutrition-focused strategies and further longitudinal or intervention studies to clarify the role of dietary intake in functional and cardiometabolic health among older adults.