The research team, led by Tetsuji Minami of the National Cancer Center Japan alongside collaborators from several Japanese institutions, broke the 8.6 percent figure into distinct categories: 4.9 percent identified as gay or lesbian, 1.1 percent as bisexual, 1.0 percent as asexual or unsure of their attraction, and 1.6 percent as gender-diverse, meaning their current gender identity did not match the sex assigned to them at birth or fell outside the binary altogether. These estimates align with the 7.0 to 16.8 percent range reported in earlier Japanese studies conducted by private companies, government agencies, and sociologists, but earlier efforts suffered from convenience sampling, inadequate statistical adjustment, and narrow cohorts that limited their generalizability. By contrast, the new study calibrated its web-based sample against the Japanese government’s 2019 Comprehensive Survey of Living Conditions using a statistically demanding technique called inverse probability weighting.

The technical machinery behind the estimates deserves attention because it addresses a well-known weakness of internet surveys. Participants were drawn from a panel of 2.3 million people managed by Rakuten Insight, with stratified multistage sampling by age and sex, and a response rate of 65.7 percent among those invited. The researchers then applied two pre-set algorithms to screen out inattentive respondents, or “satisficers,” who straight-line their answers or fail directed attention checks, removing 9 percent of the raw sample. Sampling weights were predicted from a logistic regression model comparing the web survey respondents with the census-calibrated national survey, adjusting for area of residence, marital status, education, housing tenure, self-rated health, and smoking status. The resulting inverse probability weights allowed the team to produce population-level estimates with 95 percent confidence intervals, computed with a robust variance estimator, treating the findings explicitly as weighted distributions rather than causal effects, in line with modern descriptive epidemiology frameworks.

Measurement of sexual orientation and gender identity followed the internationally recommended “two-step approach,” which asks separately about sex assigned at birth and current gender identity, supplemented by a romantic and sexual attraction item to classify sexual orientation among cisgender respondents. Gender-diverse respondents were deliberately not reclassified by sexual orientation, and the authors caution that the gender-diverse category aggregates heterogeneous subgroups, including transgender, non-binary, and questioning individuals, because the survey instrument could not capture finer self-descriptions. Similarly, respondents who selected neither or unsure on the attraction item were grouped under an inclusive “asexual cisgender or unsure” label, an operationalization the authors urge readers to interpret cautiously since it may blend true asexuality with ongoing questioning. Inattentive respondents who reported anything other than male or female for assigned sex at birth were excluded as quality controls, consistent with Japan’s family register system, and were not intended to exclude minority identities.

Beyond headline prevalence, the study mapped striking demographic and socioeconomic patterns. All sexual and gender minority groups were younger on average than heterosexual respondents, with mean ages of 44.7 years for gay and lesbian participants, 38.3 for bisexual, 40.0 for asexual, and 38.4 for gender-diverse respondents, compared with 48.8 for heterosexual participants, and prevalence was concentrated under age 30. Gay respondents were more often male, while bisexual and asexual respondents were more often female, and gender-diverse respondents were evenly split by assigned sex. Marriage and partnership rates told a more complex story: only 47.7 percent of gay and lesbian respondents and 38.1 percent of gender-diverse respondents were married or partnered, versus 65.1 percent of heterosexual respondents, and a substantial share of gay and lesbian participants reported opposite-sex marriages or partnerships, a pattern the authors link to Confucian family norms emphasizing marriage and procreation, the absence of legal same-sex marriage recognition, and structural stigma.

Socioeconomic disparities emerged with unusual clarity because the national calibration allowed income, education, employment, insurance, and housing comparisons. Lower household equivalent income was more common among minority groups, particularly male sexual minorities and female gender-diverse respondents, and women had lower incomes than men within every category. Educational attainment diverged sharply from Western patterns: whereas studies in the United States and Europe generally find gay and bisexual men more educated than heterosexual men, Japanese gay, lesbian, and bisexual male respondents showed the opposite trend, with heterosexual men most likely to hold degrees. Employment differences also inverted expectations in places, with female sexual minorities more likely to be employed than heterosexual women, plausibly because married Japanese women are often outside the labor force while minority women marry less often. Health insurance coverage was lower among minority respondents of both sexes, and housing tenure varied significantly only among men, with asexual men and lesbian women least likely to own homes.

Health indicators painted a mixed picture that partially contradicts Western literature. Psychological distress, measured with the Kessler-6 scale, was consistently more common among minority respondents of both assigned sexes, echoing minority stress theory, which holds that stigma and marginalization drive mental health disparities. Body mass index patterns were also distinctive: underweight was more common among female minority respondents, while overweight and obesity clustered among male bisexual and asexual respondents and female asexual respondents. Perhaps most surprising, current smoking and habitual drinking showed limited or reversed differences, with minority groups tending to drink less than heterosexual respondents, contrary to consistent findings from England, Canada, and the United States. Substance use other than tobacco and alcohol was higher among minority respondents but remained rare overall. Medical comorbidity did not differ significantly once results were stratified by assigned sex at birth, and self-rated health differences disappeared under stratification, prompting the authors to call for future studies with covariate adjustment and clinical data linkage.

The significance of these findings extends well beyond Japanese borders. Until now, virtually all nationally representative data on sexual and gender minority populations came from Western countries, including the United States, the Netherlands, Sweden, Portugal, Canada, and the United Kingdom, creating a geographic evidence gap the authors argue reflects both research neglect and, in parts of Asia, legal environments where same-sex acts remain criminalized. Japan presents a distinctive hybrid context: same-sex relationships were historically tolerated within certain cultural traditions, cross-national analyses suggest relatively low structural stigma and low non-disclosure, yet Japan remains the only G7 nation without comprehensive anti-discrimination legislation or marriage equality. The study’s documentation of opposite-sex marriages among gay and lesbian respondents, observed at levels between the low Western figures of 3 to 9 percent and the much higher Chinese figures of 33 to 51 percent, offers rare quantitative grounding for understanding how family norms and legal structures shape minority lives in East Asian settings.

The authors draw direct policy implications from their data. They recommend that national administrative surveys routinely incorporate sexual orientation and gender identity items and household modules that recognize diverse partnership structures, enabling ongoing surveillance of socioeconomic disparities and targeted resource allocation. They call for accessible mental health support and anti-discrimination efforts in schools and workplaces to reduce the psychological burden the Kessler-6 results document, and for longitudinal and panel designs that oversample small subgroups and analyze intersections of age and assigned sex. Acknowledging limitations, including self-reported data, potential social desirability bias, residual web-survey selection bias that weighting could reduce but not eliminate, and the coarse aggregation of gender-diverse subgroups, the team nevertheless positions the work as a foundational step. With an estimated 8.6 percent of Japan’s population identifying as a sexual or gender minority, the study transforms a population previously invisible in national statistics into a measurable, monitorable constituency whose health and socioeconomic well-being can now be tracked, compared, and protected.

Subject of Research: National estimation of the proportion and characteristics of sexual and gender minorities in Japan using a nationwide cross-sectional internet survey

Article Title: Estimation of Sexual and Gender Diversity Among People Aged 15 Years and Older in Japan: A Descriptive Epidemiological Study Using a Nationwide Cross-Sectional Internet Survey

Article References: Minami, T., Inoue, M., Matsushima, M., Yoshioka, T., & Tabuchi, T. (2026). Estimation of Sexual and Gender Diversity Among People Aged 15 Years and Older in Japan: A Descriptive Epidemiological Study Using a Nationwide Cross-Sectional Internet Survey. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03515-0

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03515-0

Keywords: sexual orientation, gender identity, sexual and gender minorities, Japan, descriptive epidemiology, national survey, LGBTQ, health disparities, minority stress, inverse probability weighting, bisexual, transgender

The finding is striking precisely because all of the children studied were already participating in organized community sport, a setting often assumed to nurture the building blocks of physical literacy. Fundamental movement skills, often abbreviated as FMS, encompass the basic locomotor and object-control abilities, such as running, jumping, throwing and kicking, that underpin virtually all later physical activity. Decades of research have linked strong motor competence in childhood to higher levels of physical activity, better cardiorespiratory fitness, healthier body weight and sustained participation in sport and recreation through adolescence and into adulthood. Conversely, children with weak motor foundations tend to withdraw from physical activities, creating a self-reinforcing cycle of inactivity and further skill delay that public health researchers describe as a downward spiral.

To measure motor competence, the team used PLAYbasic, one of the Physical Literacy Assessment for Youth tools developed in Canada, which involves direct observation of children performing standardized tasks rather than relying on parental or self-report. Each child was asked to run, hop, throw, kick a ball and hold a balance, with trained assessors scoring technique against developmental criteria. In addition to the skill assessment, children completed the Physical Activity Questionnaire for Older Children, a validated self-report instrument known as the PAQ-C, while parents and guardians provided proxy-reported information on moderate-to-vigorous physical activity, outdoor play, the mode of travel to school, parental education and participation in coached sport.

The statistical analysis centered on multivariable linear regression, a technique that allows researchers to estimate the independent contribution of each factor while holding the others constant. In the primary adjusted model, two variables stood out as significant predictors of total FMS scores: older age and participation in coached sport. Together with the other covariates, the model explained 47.8 percent of the variance in skill scores, a substantial proportion for research in this field, with an adjusted R-squared of 0.454. The association between age and skill is expected, since motor competence typically improves as children mature and accumulate practice. The independent effect of coached sport, however, is the finding with the clearest practical implications, because unlike age, it is a potentially modifiable characteristic that communities and policy makers can act upon.

One of the more technically interesting results concerned kicking. The researchers detected a significant interaction between age and gender for kicking performance, meaning that the estimated difference between boys and girls in this skill was not constant across the age range but grew larger among older children. This pattern suggests that gender-related gaps in object-control skills may widen during the middle childhood years, possibly reflecting differences in the types of sport activities, practice opportunities or social encouragement that boys and girls receive as they get older. The authors note that such interactions are important to document because averaged effects can mask diverging developmental trajectories that matter for intervention design.

Perhaps counterintuitively, physical activity levels did not hold up as significant predictors once other factors were accounted for. Both child-reported physical activity on the PAQ-C and parent proxy-reported moderate-to-vigorous physical activity were associated with FMS scores in simple bivariate analyses, but neither remained statistically significant in the fully adjusted model. This dissociation between being active and being skilled carries an important message: the quantity of movement a child accumulates may matter less for motor development than the quality and structure of that movement. Unstructured play, while valuable for many aspects of health, may not by itself provide the instruction, repetition and feedback that children need to refine techniques such as a mature throwing pattern or a well-coordinated kick.

The study fills a notable gap in the literature because most motor competence research has been conducted in large urban centers, and evidence from northern and small-city Canadian settings has been scarce. Geographic context can shape skill development in multiple ways, from the availability and cost of sport programs to the length and severity of winters, the distances families must travel to facilities, and the capacity of local organizations to train coaches. Prince George, the northern British Columbia city where the study took place, experiences long winters and serves scattered surrounding communities, conditions that can constrain year-round access to structured physical activity programming. Understanding how motor competence develops in such settings is essential for designing equitable interventions rather than importing models validated only in major metropolitan areas.

The work was carried out as part of the Physical Literacy for Communities initiative, known as PL4C, which was supported through the Healthy Canadians and Communities Fund of the Public Health Agency of Canada along with financial and in-kind contributions from Sport for Life and its partners. The researchers partnered with Engage Sport North, a regional organization that helped recruit participants and facilitated data collection, and they acknowledge the children, parents, student volunteers and research assistants who made the assessments possible. The study received harmonized research ethics approval through the British Columbia RISe system under protocol H22-01044, and written informed consent was obtained from parents or guardians before any data collection began.

For the authors, the central takeaway is that participation alone is not enough. Even among children already connected to community sport, motor competence clustered at the lowest classification levels, indicating that enrollment does not guarantee the developmental instruction and deliberate practice that skill acquisition requires. They argue that structured, developmentally appropriate opportunities for instruction and skill practice should be embedded within community sport programming, with particular attention to children who join programs late or who receive less coaching exposure. The significant role of coached sport in their models suggests that expanding access to quality coaching, especially in northern and smaller communities where such resources are often limited, could be a concrete lever for improving child motor development and, by extension, long-term physical activity and health.

The researchers are careful to frame their conclusions within the limits of the study design. As a cross-sectional analysis, the study captures a single moment in time and cannot establish whether coached sport causes better motor skills or whether more skilled children are simply more likely to stay in coached programs. The sample of 166 children, while adequate for the regression models employed, was drawn from a single city, and two-thirds of the participants were boys, factors that may limit generalizability. The authors call for longitudinal and intervention studies to clarify the causal relationships and to identify concrete strategies for supporting fundamental movement skills, motor competence and broader physical literacy in northern and small-city contexts. Until such evidence accumulates, the study stands as a warning that the assumed pipeline from community sport participation to physical literacy may be leaking badly, and that deliberate, well-coached skill instruction is the repair it likely needs.

Subject of Research: Fundamental movement skill competence among children aged 6 to 12 participating in community sport programs in a northern Canadian city

Article Title: Fundamental movement skills among children participating in community sport programs in a northern Canadian city: implications for equitable access and physical literacy development

Article References: Fundamental movement skills among children participating in community sport programs in a northern Canadian city: implications for equitable access and physical literacy development. (n.d.). https://doi.org/10.1186/s12889-026-29440-4

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29440-4

Keywords: fundamental movement skills, physical literacy, motor competence, community sport, children, coached sport, physical activity, health equity, northern Canada, PLAYbasic, BMC Public Health, public health

The study was carried out between September 2025 and January 2026 in government-run shelters located in a low-resource region of eastern Iran. Researchers recruited thirteen homeless women through a combination of convenience and purposive sampling, a strategy that allowed them to capture both readily accessible participants and women with particular experiences relevant to the research question. Each participant took part in a semi-structured, in-depth interview that was audio-recorded and later transcribed verbatim. The interviews explored how the women perceived the conditions, circumstances, and structural forces that influenced their day-to-day health, from the availability of food and shelter to their interactions with health services and the communities around them.

To analyze the transcripts, the team applied a manual thematic analysis following Boyatzis’s methodological approach, a well-established technique in qualitative health research that involves systematically coding data and clustering codes into themes. The researchers used the Healthy People 2030 framework, developed by the United States Department of Health and Human Services, as their conceptual guide. This framework organizes social determinants of health, sometimes called social drivers of health, into five domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Anchoring the analysis in this framework allowed the Iranian findings to be compared with a global body of research on how social conditions shape health outcomes.

The analysis revealed twenty-four social determinants of health distributed across the five framework themes. Two domains stood out for their weight in the women’s lives: Economic Stability and Social and Community Context. These two themes encompassed the highest number of determinants, underscoring, the authors argue, their influential role in the ultimate health outcomes of homeless women. In practical terms, this means that the women’s health was shaped less by individual clinical risk factors alone and more by the grinding arithmetic of poverty, income insecurity, and the presence or absence of supportive relationships and community ties. For a population with no stable housing, economic shocks translate directly into skipped meals, untreated illness, and exposure to unsafe environments.

The emphasis on Economic Stability reflects conditions specific to the border region studied. Eastern Iran’s provinces adjacent to Afghanistan are characterized by pronounced socioeconomic and healthcare disparities, and they host communities affected by migration flows, unemployment, and limited public infrastructure. Homeless women in this setting face a compounding set of disadvantages: they are women in a context of gendered economic exclusion, they are homeless in a region with thin social services, and many are affected by the broader instability associated with the Afghan border. The study’s findings suggest that any intervention aimed at improving these women’s health must begin with economic levers, including income support, employment pathways, and reliable access to basic material needs.

The second dominant domain, Social and Community Context, points to the relational side of health that is often overlooked in clinical settings. For homeless women, social isolation, stigma, family breakdown, and the absence of trusted support networks can be as damaging to health as any pathogen. The interviews captured how the women navigated relationships with shelter staff, other residents, family members, and the wider community, and how the quality of those relationships influenced their willingness to seek care, their mental wellbeing, and their sense of dignity. The researchers note that these findings hold particular value for low-resource settings, where formal health systems cannot alone compensate for the absence of social support structures.

The remaining three themes of the Healthy People 2030 framework also yielded concrete determinants. Education Access and Quality captured how limited literacy and schooling constrained the women’s ability to find work, understand health information, and advocate for themselves. Health Care Access and Quality encompassed barriers such as cost, distance, documentation status, and experiences of discrimination when seeking treatment. Neighborhood and Built Environment covered the physical conditions of shelters and streets, including safety, sanitation, and exposure to environmental hazards. Together, the twenty-four determinants form what the authors describe as a comprehensive list of social determinants of health for homeless women, one of the most granular portraits assembled for this population in the region.

Methodologically, the study demonstrates the value of qualitative inquiry in settings where quantitative data on homeless populations are scarce or unreliable. Homeless women are frequently missed by censuses, surveys, and routine health information systems, meaning their needs remain statistically invisible even as their suffering accumulates. By sitting down with thirteen women and systematically coding their accounts, the research team surfaced determinants that would never appear in administrative datasets. The use of a recognized international framework strengthens the study’s utility, allowing local findings to inform global conversations about housing, health equity, and the social drivers of disease, while remaining grounded in the specific realities of Iran’s eastern borderlands.

The authors conclude that the study highlights the pivotal role of governments in addressing the health of homeless women. Because the determinants identified span income, education, healthcare, housing, and community life, no single ministry or program can tackle them in isolation. Effective responses, the findings imply, require coordinated policy action: social protection schemes that reach women without fixed addresses, shelters that connect residents to healthcare and education, anti-discrimination measures in health facilities, and investment in the infrastructure of neglected border regions. The research was funded by Birjand University of Medical Sciences and approved by the university’s ethics committee, with informed consent obtained from all participants and their anonymity strictly protected throughout collection and analysis.

Beyond its immediate regional significance, the study offers a template for understanding homelessness as a public health issue rather than merely a social welfare problem. The twenty-four determinants mapped by the researchers illustrate how health is produced, or eroded, long before a patient reaches a clinic, in the labor market, the classroom, the neighborhood, and the family. For the homeless women of Iran’s Afghan border regions, the path to better health runs through economic security and human connection as much as through medicine. The study’s comprehensive inventory gives policymakers, clinicians, and advocates a concrete starting point, and it gives a long-invisible population something it has rarely been granted: a documented, systematic account of the forces shaping their lives.

Subject of Research: Social determinants of health among homeless women in Iran's border regions with Afghanistan

Article Title: Social determinants of health among homeless women in border regions of Iran with Afghanistan: a qualitative study

Article References: Khosravi, M., Khosravi, F., Mohammadi, F., Rezaei Qazravan, Z., & Hajiaghaye, Z. (2026). Social determinants of health among homeless women in border regions of Iran with Afghanistan: a qualitative study. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00470-y

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00470-y

Keywords: social determinants of health, homeless women, Iran, Afghanistan border, qualitative study, Healthy People 2030, economic stability, healthcare access, shelters, health equity, Birjand University of Medical Sciences, public health

The scale of the analysis is what sets it apart. Most previous research on migrant tuberculosis screening has focused narrowly on detecting active disease or on modelling the cost-effectiveness of screening for tuberculosis infection, the asymptomatic stage in which the bacteria persist without causing illness. Few studies have examined large-scale national programmes, reported age-stratified yields, or traced the full cascade of preventive treatment from diagnosis through completion. By linking screening results collected by all 25 Municipal Public Health Services to national notification data, the researchers were able to follow nearly 150,000 individuals from the moment of their first chest X-ray or infection test through to treatment outcomes.

The headline finding concerns the stark difference between two migrant categories. Among 87,511 immigrants, defined as labour migrants, international students and others arriving through regular channels, entry screening detected 69 cases of active tuberculosis, a yield of 79 cases per 100,000 people screened. Among 61,703 asylum seekers, screening identified 170 cases, a yield of 276 per 100,000, more than three times higher. The gap reflects both the higher tuberculosis burden in the countries from which asylum seekers predominantly arrive, including Eritrea, Afghanistan, Somalia and Algeria, and the adverse conditions of the migration journey itself, which can reactivate dormant infection through malnutrition, stress and crowding.

Country-level yields sharpened the picture further. Among asylum seekers, screening prevalence exceeded World Health Organization incidence estimates for their countries of birth in every case except Afghanistan, with the highest yields recorded among people from Sierra Leone at 888 per 100,000, Eritrea at 704, Somalia at 581, the Gambia at 562 and South Sudan and Sudan at 519. Among immigrants, by contrast, prevalence at entry was lower than WHO estimates for every country contributing more than five detected cases, with the highest yields among those from Indonesia at 291 per 100,000 and the Philippines at 241, and comparatively low yields among immigrants from India and South Africa. The researchers interpret this as evidence of the healthy migrant effect: people who migrate for work or study tend to be younger, healthier and more affluent than the general population of their country of origin, and therefore carry a lower tuberculosis risk than WHO national averages imply.

Perhaps the most consequential finding for clinical practice is the weakness of symptom-based detection. Of the 202 migrants diagnosed with pulmonary tuberculosis through screening, only 27.2 percent reported a cough, the symptom that anchors most passive case-finding strategies. The proportion was lower still among immigrants, at 13.8 percent, compared with 32.6 percent among asylum seekers. In other words, nearly three in four screen-detected pulmonary cases would have been missed by symptom screening alone. This aligns with a growing body of evidence on what the WHO now terms asymptomatic tuberculosis, and with community prevalence surveys in high-incidence settings showing that roughly half of bacteriologically confirmed pulmonary cases report no suggestive symptoms. Because such individuals can transmit the infection unknowingly for months, the study argues that systematic radiological screening retains clear value for populations at elevated risk, catching disease before symptom onset and before onward transmission occurs.

The diagnostic profile of detected cases supports the programme’s technical rigour. Overall, 56.5 percent of the 239 screen-detected tuberculosis cases were bacteriologically confirmed, rising to 63.9 percent among pulmonary cases, and 44 individuals had acid-fast bacilli visible on microscopy, indicating potentially infectious disease. Only two cases involved multidrug-resistant tuberculosis. Treatment outcomes, however, revealed a care gap: 92.8 percent of immigrants with tuberculosis were recorded as cured or having completed treatment, compared with 81.2 percent of asylum seekers, a difference driven mainly by loss to follow-up, including five asylum seekers who never initiated treatment and others who left the country before completing therapy. The authors point to the need for tailored support and stronger cross-border collaboration to maintain continuity of care for mobile populations.

The study’s second major contribution is its analysis of tuberculosis infection screening among more than 20,000 immigrants, the first time this component has been included in the Dutch national evaluations. Infection prevalence rose sharply with age: 0.6 percent among children under 12, 4.4 percent among adolescents aged 12 to 17, and 12.9 percent among adults screened from the highest-incidence countries. Among adults, prevalence exceeded 20 percent for immigrants from Kenya, Nigeria and Zimbabwe, while remaining markedly lower at 4.9 percent for those from South Africa. The Dutch algorithm, which uses an initial tuberculin skin test followed by confirmatory interferon gamma release assay when the skin test measures 10 millimetres or more, likely suppressed false positives; only about half of adults with a positive skin test had infection confirmed by IGRA, and confirmation rates fell below 10 percent in young children, where prior BCG vaccination may drive false-positive skin reactions.

The cascade of preventive treatment offered encouraging evidence that a well-structured public health system can convert infection diagnoses into completed therapy. Preventive treatment was initiated in 68.6 percent of infected children under 12, 85.2 percent of adolescents and 70.3 percent of adults, and among those who started, completion exceeded 92 percent in every age group, most commonly with a short three-month regimen of rifampicin and isoniazid. Combining initiation and completion, between 64.6 and 81.5 percent of infected individuals across age groups successfully finished preventive therapy, figures that outperform pooled international estimates of roughly 52 percent. The weaker uptake among young children, attributed largely to parental reluctance to medicate healthy children, combined with their very low infection prevalence, prompted the National TB Guideline Committee to recommend exempting immigrant children under 12 from mandatory screening, a concrete example of epidemiological data reshaping national policy.

The findings arrive at a moment when tuberculosis control in Europe increasingly depends on migrant-focused strategies. In 2024, 37.6 percent of people notified with tuberculosis in the EU and European Economic Area were of foreign origin, a share exceeding 80 percent in several countries including the Netherlands, which recorded just 4.3 cases per 100,000 population overall. The study supports maintaining divergent screening thresholds, with asylum seekers screened from countries with incidence of 50 per 100,000 or above and immigrants from countries at 100 or above, and it strengthens the economic case for infection-based follow-up screening, which Dutch modelling suggests is more cost-effective than repeated chest X-rays for asylum seekers. Emerging tuberculosis-antigen skin tests may further improve specificity and cost-effectiveness. The authors conclude that targeted screening of migrants, combining disease detection with infection testing and high-quality preventive treatment, is a core and demonstrably effective component of tuberculosis elimination in low-incidence settings, provided that screening strategies continue to be refined with timely, age-specific and group-specific national data.

Subject of Research: National evaluation of tuberculosis disease and tuberculosis infection screening among migrants in the Netherlands from 2019 to 2023

Article Title: Tuberculosis disease and infection screening among migrants in the Netherlands 2019–2023: a national retrospective observational study

Article References: de Vries, G., Mulder, A., Spruijt, I., Huisman, E., Schimmel, H., Siebers, M., Vrubleuskaya, N., Zandbelt-Smits, M., van Gageldonk-Lafeber, R., & van den Hof, S. (2026). Tuberculosis disease and infection screening among migrants in the Netherlands 2019–2023: a national retrospective observational study. The Lancet Regional Health – Europe, 70, Article 101856. https://doi.org/10.1016/j.lanepe.2026.101856

Image Credits: AI Generated

DOI: 10.1016/j.lanepe.2026.101856

Keywords: tuberculosis, migrant health, screening, asylum seekers, tuberculosis infection, preventive treatment, public health, Netherlands, epidemiology, low-incidence countries, chest X-ray, IGRA

The relationship between the urban environment and public health is one of the most robustly established findings in modern epidemiology. The quality of housing, the design of transport infrastructure, the availability of green space and the walkability of neighbourhoods all measurably influence the risk that residents will develop life-threatening conditions. Poorly connected communities with limited access to parks and active travel options show elevated rates of obesity, cardiovascular disease, respiratory illness and several cancers. Yet despite decades of evidence, improving urban environments as a preventative public health measure remains extraordinarily complex, because it demands coordinated action from multiple actors with different mandates, budgets and priorities. Planning authorities, housing developers, transport agencies and health services each hold only part of the levers required to create healthier places, and no single organisation bears the full cost of the diseases that bad design can produce.

It is precisely this fragmentation that the researchers set out to address. To assess how economic evidence could support more integrated decision-making, the team conducted 167 qualitative interviews with key stakeholders drawn from across England’s urban development system, spanning national and local government, private industry and civil society. The interviews explored in depth how the HAUS tool could support collaboration and informed decision-making across sectors that rarely share a common evidence base or a common metric of success. What emerged was a striking consensus: stakeholders recognised the value of HAUS as a new way to support shared decision-making and to create incentives for organisations to work together toward better health outcomes, precisely because it assigns an economic value to impacts that have historically been invisible in development appraisals.

The technical core of HAUS is a valuation model that links specific features of the environment to health outcomes and their associated economic costs. The tool quantifies and monetises changes in disease occurrence and premature mortality linked with different urban development interventions and affecting local populations. In practical terms, a proposal to add walkable streets, expand green infrastructure or improve housing quality can be assessed not only in terms of construction costs and property values, but also in terms of the expected reduction in NHS treatment costs, productivity losses and the broader societal burden of illness. By translating health outcomes into economic terms, the tool helps decision-makers grasp the long-term value of healthier urban environments and supports more informed investment and planning decisions that might otherwise be dismissed on short-term financial grounds.

The tool did not appear from nowhere. It was initially developed during an earlier research pilot and was further refined throughout the project in collaboration with the UK’s Ministry of Housing, Communities and Local Government, giving it an unusually direct route from academic prototype to policy application. That collaboration has now borne institutional fruit: the ministry has adopted HAUS in its appraisal guides for local authorities, embedding health valuation into the standard machinery of English planning assessment. For a field in which public health arguments have long struggled to compete with housing delivery targets and economic growth imperatives, this represents a significant shift in what evidence counts when the future of a city is decided.

Dr Andrew Barnfield, Senior Lecturer in public health at the University of East London and co-author of the study, emphasised that the tool changes what decision-makers are able to see. ‘The HAUS tool enables decision makers to account for health costs that are linked with the urban environment,’ he said. ‘As our work shows, this is vital for making healthier and more equitable places.’ The equity dimension matters because the health burden of poor urban design falls disproportionately on disadvantaged communities, which are more likely to live near major roads, in lower-quality housing and with limited access to green space. By making these costs explicit, HAUS gives advocates for those communities a quantitative argument that resonates in boardrooms and town halls alike.

Professor Sarah Ayres, from the University of Bristol’s School for Policy Studies, framed the development as a genuine methodological milestone. ‘The collaboration between TRUUD and the Ministry of Housing, Communities and Local Government has created a version of the Health Appraisal of Urban Systems model which is to be used for housing, community and local government interventions,’ she said. ‘For the first time, there are now methods to quantify and value the potential health impacts of urban interventions for specific populations.’ The reference to TRUUD, the research consortium on urban health decarbonisation and decision-making of which the three universities are part, underlines the scale of the effort required to move such tools from theory into the working routines of government.

Dr Geoff Bates, from the University of Bath’s Institute for Policy Research, argued that the economic framing is not a concession to fiscal orthodoxy but a strategic necessity. ‘Making the economic case to pursue preventative policies is one way that can persuade policymakers to act to improve long-term health and wellbeing,’ he said. ‘Improving policymaker access to evidence and tools like HAUS that demonstrate the savings to the public purse from investing in healthier housing and urban environments is a step towards improving public health.’ The logic is familiar from other domains of preventative policy: the costs of disease are diffuse and delayed, while the costs of intervention are immediate and concentrated, and only tools that render future savings visible can rebalance that asymmetry in political decision-making.

The findings arrive at a moment when the pressures on urban systems are intensifying. Rising obesity rates, an ageing population, persistent air pollution and the health impacts of climate change all converge on the built environment, and health services across the developed world are increasingly looking upstream toward prevention. The researchers conclude that HAUS provides valuable evidence to encourage cross-sector collaboration and to embed preventative public health into urban development decisions, shifting the question from whether cities can afford to prioritise health to whether they can afford not to. If the tool’s adoption by national government spreads through local authority practice, the healthier city may cease to be an aspiration and become, at last, an audited line in the appraisal.

Subject of Research: Economic valuation of public health impacts in urban development decision-making

Article Title: Economic tool could help cities prioritize public health in urban development

Article References: Economic tool could help cities prioritize public health in urban development. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: urban development, public health, HAUS tool, economic valuation, planning policy, prevention, health equity, built environment, stakeholder interviews, England, University of East London, ministry adoption

The study, published in Nature Mental Health by an interdisciplinary team led by Yiling Zhou and Douwe Postmus of the University of Groningen’s University Medical Center, together with colleagues in nephrology, psychiatry and endocrinology, is among the first to map the long-term cardiorenal illness trajectories of newly treated hypertensive patients according to ADHD status. Rather than asking a single question such as whether ADHD raises the risk of one event, the team used multistate modeling to trace how patients move through a sequence of health states: from apparently healthy hypertensive treatment, to the onset of complications such as heart failure hospitalization or chronic kidney disease, and ultimately, in some cases, to cardiorenal death.

This trajectory-based approach matters because hypertension is rarely a one-act story. Standard cardiovascular risk tools typically estimate the probability of a first event, but clinicians and patients also care deeply about what happens afterward: whether a person who survives a stroke or develops kidney disease faces elevated risk of dying from a cardiorenal cause. By modeling the entire pathway, the researchers could distinguish between transitions, asking, for example, not only whether adults with ADHD were more likely to develop heart failure, but whether, once heart failure appeared, they were more likely to die from it.

The scale of the analysis lends its findings unusual statistical weight. The cohort included 706,414 adults aged 18 to 90 who initiated antihypertensive medications between 2007 and 2021, with no prior cardiovascular disease or chronic kidney disease recorded. Just over half, 52.2 percent, were women. Within this population, 10,689 individuals had a documented ADHD diagnosis. The data came from Dutch national registers held by Statistics Netherlands, linking medication dispensing, hospital records and cause of death at the level of individual citizens, an infrastructure that permits follow-up across nearly the entire population rather than a select insured sample.

The headline results are stark. After adjusting for age, sex, comorbidities, medication class, lifestyle-related factors and other covariates, adults with ADHD had a 46 percent higher rate of hospitalization for heart failure after starting antihypertensive treatment, with a hazard ratio of 1.46 and a 95 percent confidence interval of 1.12 to 1.90. Their adjusted rate of stroke was 19 percent higher, with a hazard ratio of 1.19. These are not marginal signals confined to subgroups; they persisted across a large, unselected nationwide population followed for years after treatment initiation.

Perhaps more troubling are the findings on what happens after complications emerge. Once hospitalized for heart failure, adults with ADHD showed a 79 percent higher adjusted rate of subsequent cardiorenal death compared with adults without ADHD, a hazard ratio of 1.79. After the onset of chronic kidney disease, their rate of cardiorenal death was more than two and a half times higher, with a hazard ratio of 2.57. Put together, the ten-year trajectories that pass through heart failure or kidney disease and end in cardiorenal death were consistently more common among patients with ADHD than among otherwise comparable hypertensive patients without the diagnosis.

Why should ADHD, a neurodevelopmental condition most often associated with inattention, impulsivity and hyperactivity, shape the course of cardiovascular and kidney disease so profoundly? The study was not designed to isolate mechanisms, but the authors and related literature point to several converging explanations. One candidate is medication adherence. A companion multinational cohort study cited by the team found that adults with ADHD are less likely to adhere to antihypertensive treatment, and interruptions in therapy blunt the very protection these drugs are meant to provide. ADHD medications themselves, particularly stimulants, have also been scrutinized for cardiovascular effects, although the new analysis focused on newly treated hypertension and adjusted for a range of factors, leaving the contribution of ADHD pharmacotherapy an open question.

Broader biological and social pathways likely contribute as well. Recent genetically informed research has documented familial co-aggregation and shared heritability between neurodevelopmental conditions and cardiometabolic disease, hinting at shared physiological roots. Adults with ADHD also carry higher burdens of obesity, smoking, sleep problems and other somatic conditions across the lifecourse, and they frequently encounter barriers in healthcare systems, from fragmented follow-up to challenges in self-management of chronic therapy. Heart failure and chronic kidney disease, in particular, demand sustained engagement: daily medication regimens, fluid and dietary vigilance, and prompt recognition of worsening symptoms. Where engagement falters, outcomes deteriorate.

The clinical implications are hard to ignore. Current hypertension guidelines stratify patients by age, blood pressure severity and comorbidity, but ADHD rarely appears in the risk calculators that guide treatment intensity and follow-up schedules. The new findings suggest it should. A newly diagnosed hypertensive patient with ADHD may warrant closer monitoring of blood pressure control, more deliberate selection of antihypertensive agents, proactive screening for early heart and kidney involvement, and targeted support for medication persistence. The researchers emphasize that their results describe elevated risks and trajectories in an observational setting; they do not establish that ADHD causes worse outcomes, and residual confounding cannot be excluded. Still, the consistency of elevated hazard ratios across multiple transitions, from first complication to death, argues that ADHD belongs in the conversation about cardiorenal risk management.

For the study’s authors, the multistate framework is as much a message as the numbers themselves. Illness after hypertension unfolds as a chain of events, and each link in that chain represents a moment where intensified care could change the trajectory. The analysis code has been released publicly, and the underlying microdata remain accessible to accredited researchers through Statistics Netherlands under strict legal safeguards. As populations age and hypertension remains the leading modifiable risk factor for death worldwide, the study adds a new and sobering dimension to the growing evidence that mental health conditions cast long physical shadows, and that treating blood pressure alone may not be enough to equalize the odds for the one in twenty adults living with ADHD.

Subject of Research: Long-term cardiorenal illness trajectories after antihypertensive medication initiation in adults with and without ADHD

Article Title: Long-term cardiorenal illness trajectories after initiation of antihypertensive medications in adults with and without ADHD: a nationwide cohort study

Article References: Long-term cardiorenal illness trajectories after initiation of antihypertensive medications in adults with and without ADHD: a nationwide cohort study. (n.d.). https://doi.org/10.1038/s44220-026-00718-1

Image Credits: AI Generated

DOI: 10.1038/s44220-026-00718-1

Keywords: ADHD, hypertension, antihypertensive medications, heart failure, chronic kidney disease, stroke, cardiorenal death, multistate modeling, nationwide cohort study, medication adherence, cardiovascular risk, epidemiology

Type 2 diabetes is among the most consequential public health challenges of the twenty-first century, ranking as the eighth leading cause of death and disability worldwide. The burden is unevenly distributed, not only between countries but between the sexes, and the reasons are deeply tied to biology. Before menopause, women tend to enjoy a metabolic advantage that men do not, largely because estrogen enhances insulin sensitivity, supports glucose-stimulated insulin secretion, and protects insulin-producing beta cells from apoptosis. After menopause, that advantage erodes. Estrogen levels fall, insulin resistance rises, and body fat shifts toward the abdomen in an androgenic pattern, all of which converge to raise diabetes risk in older women above that of men in the same age groups. Epidemiological evidence reinforces this picture: women who reach menopause before the age of forty, or who lose their ovaries surgically, face markedly higher diabetes rates than those who reach menopause after fifty, a pattern attributed primarily to prolonged estrogen deficiency.

While the influence of individual reproductive factors, such as breastfeeding, parity, age at menarche, and age at menopause, has been studied extensively, the results have often been contradictory. Breastfeeding appears protective, abortion may raise risk, and findings on menarche and menopause timing conflict across studies. What researchers behind the new study argued was missing was a unified metric: the total duration over which a woman is exposed to estradiol-dominant menstrual cycles across her reproductive life. To their knowledge, no prior investigation had examined how this cumulative exposure relates to the incidence of type 2 diabetes, despite earlier work by the same group linking estrogen exposure duration to fractures, chronic kidney disease, cardiovascular outcomes, and hypertension.

To address the gap, the team turned to the Tehran Lipid and Glucose Study, a population-based cohort launched in 1998 with 15,005 participants aged three and older, selected through multistage cluster sampling and followed at three-year intervals across seven completed study phases. From this resource, the researchers identified 6,273 postmenarchal women aged twenty or older who had at least one follow-up visit. After excluding women with prevalent diabetes, insufficient follow-up, hormone replacement therapy use, surgical menopause, or incomplete data, the analytic sample comprised 3,411 women, of whom 1,053 developed type 2 diabetes over a median follow-up of approximately 17.6 years. Diabetes was defined rigorously according to American Diabetes Association criteria, using fasting plasma glucose of 126 mg/dL or higher, two-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test, or the use of antidiabetic medication.

The study’s central methodological innovation lay in how exposure was quantified. Endogenous estrogen exposure duration was defined as the interval between menarche and whichever came first: natural menopause, the onset of diabetes, or the end of follow-up. Critically, the investigators subtracted periods during which the estradiol-dominant follicular phase was absent, including pregnancies calculated at forty weeks per birth and twenty weeks per abortion, hormonal contraceptive use, months of breastfeeding per child, and the roughly two-week progesterone-dominant luteal phase of each menstrual cycle. This refinement aimed to isolate the estrogen-dominant portions of reproductive life, producing a z-score that could be entered into Cox proportional hazards regression models, adjusted first for age and body mass index and then for a fuller set of covariates including cholesterol fractions, triglycerides, physical activity, prediabetes, family history of diabetes, and gestational diabetes history.

The results were consistent across both models. In the fully adjusted analysis, each one-standard-deviation increase in the estrogen exposure z-score was associated with a 10 percent lower hazard of developing type 2 diabetes, a highly significant effect. The relationship was most pronounced among premenopausal women, who made up nearly 81 percent of the sample. In that subgroup, the age- and BMI-adjusted hazard ratio indicated a 16 percent risk reduction per standard deviation of longer exposure, and the fully adjusted estimate of 0.87 remained significant. Among the 657 postmenopausal women, the association was directionally similar and of comparable magnitude, with a fully adjusted hazard ratio of 0.88, but the wider confidence interval that touched 1.0 meant the finding fell just short of conventional statistical significance, likely reflecting the smaller subgroup size.

The baseline data contextualize these findings. Women who went on to develop diabetes were older, heavier, and had a less favorable lipid profile, with higher total cholesterol and triglycerides and lower HDL cholesterol. They also carried a substantially higher burden of prediabetes, affecting 39.5 percent of future cases compared with 11.7 percent of those who remained diabetes-free, along with more frequent histories of gestational diabetes and family history of the disease. Yet the protective association between estrogen exposure and diabetes incidence persisted after adjustment for all of these factors, suggesting the relationship was not merely an artifact of baseline metabolic differences. Adjusted survival curves also revealed that postmenopausal women showed consistently lower cumulative diabetes-free survival than premenopausal women, with the gap widening over time.

The biology underlying the association is increasingly well understood. Oestrogen receptors are expressed in the brain, liver, skeletal muscle, adipose tissue, and pancreatic beta cells, and activation of these receptors modulates glucose balance across multiple tissues simultaneously. Estrogen suppresses hepatic gluconeogenesis through transcriptional mechanisms involving Foxo1, curbs low-grade inflammation linked to insulin resistance, and influences energy equilibrium and body composition, with menopausal loss of these effects promoting visceral fat accumulation and further insulin resistance. Interestingly, the authors caution that estrogen’s metabolic actions are not universally beneficial: evidence from type 1 diabetes and insulin-deficient animal models suggests that in autoimmune, insulin-deficient contexts, estrogen can worsen vascular and metabolic instability. The protective association observed in this cohort, they argue, likely reflects estrogen’s favorable role in the insulin-resistant physiology that defines type 2 diabetes, a fundamentally different metabolic environment.

The study’s strengths are considerable: its long follow-up, large sample size, objective laboratory-based diabetes ascertainment repeated across seven phases, and careful statistical modeling of confounders. Limitations remain, however. Reproductive histories, including ages at menarche and menopause and durations of breastfeeding and contraceptive use, were self-reported and therefore vulnerable to recall bias, although three-yearly reassessment in the cohort supports consistency. The subtraction of a uniform two-week luteal phase is an approximation, fasting insulin data were unavailable precluding HOMA-IR analysis, the cohort was urban, and the observational design means the findings establish association rather than causation.

Even so, the implications are striking. If cumulative estrogen exposure can be incorporated into diabetes screening tools, clinicians may be able to identify women with short reproductive life spans, early menopause, or surgically induced menopause as candidates for intensified monitoring and personalized prevention. With Iranian diabetes prevalence at 15.14 percent among adults aged 25 and older and projections approaching 9.2 million cases without effective intervention, and with women worldwide shouldering rising risk after menopause while often receiving less guideline-recommended treatment than men, the study underscores the need for sex-specific approaches to diabetes prevention. Future research, the authors conclude, should clarify precisely how estrogen exposure duration shapes metabolic trajectories and translate that knowledge into targeted primary prevention strategies for the women at greatest risk.

Subject of Research: The association between cumulative endogenous estrogen exposure duration and the incidence of type 2 diabetes in women

Article Title: Diabetes Type 2 in Women: The Impact of EndogenousOestrogen, A Population‐Based Study With About 2 Decades of Follow‐Up

Article References: Ramezani Tehrani, F., Mousavi, M., Farhadi‐Azar, M., Mahboobifard, F., Azizi, F., & Farahmand, M. (2026). Diabetes Type 2 in Women: The Impact of EndogenousOestrogen, A Population‐Based Study With About 2 Decades of Follow‐Up. Endocrinology, Diabetes & Metabolism, 9(5), Article e70267. https://doi.org/10.1002/edm2.70267

Image Credits: AI Generated

DOI: 10.1002/edm2.70267

Keywords: type 2 diabetes, endogenous estrogen exposure, menopause, women's health, insulin resistance, reproductive factors, cohort study, Tehran Lipid and Glucose Study, estrogen, diabetes risk, hormonal exposure, epidemiology

The study, led by Cesar Camilo Calderon Torres and Yang Guo of Hebei Medical University together with Jiashuo Huang and Jie Chang of Capital Medical University, drew on the China Health and Retirement Longitudinal Study, one of the country’s most important population health surveys. The team followed 6,298 postmenopausal women across survey waves from 2011 to 2018, tracking whether and when they developed combinations of hypertension, diabetes, and dyslipidemia, the three metabolic conditions that together drive much of the global burden of cardiovascular disease. Metabolic multimorbidity was defined as the co-occurrence of two or more of these disorders, a state that is far more dangerous than any single condition alone because the diseases amplify one another’s effects on the heart, kidneys, and brain.

To measure the relationship between menopause timing and disease risk, the researchers categorized self-reported age at menopause into three groups: early menopause before age 45, normal menopause between 45 and 55, and late menopause after 55. They then applied Cox proportional hazards models, a statistical technique that estimates how a given exposure changes the rate at which an event occurs over time, adjusting for a battery of sociodemographic and lifestyle factors including education, residence, body mass index, and health behaviors. This adjustment is critical in observational research, because women with different menopause timing may also differ in weight, smoking habits, socioeconomic status, and access to healthcare, any of which could confound the apparent relationship.

The results were unambiguous for late menopause. Over 12,632 person-years of follow-up, 583 women developed metabolic multimorbidity, and those who experienced menopause after age 55 had a 48 percent higher risk of doing so compared with women whose menopause fell in the normal window. The adjusted hazard ratio of 1.48, with a 95 percent confidence interval of 1.08 to 2.02, indicates a statistically robust association. Perhaps even more telling was the dose-response analysis: each additional year of age at menopause was associated with a 2 percent increase in multimorbidity risk. Restricted cubic spline analyses, which model the shape of the relationship between exposure and outcome without forcing it into a straight line, supported a pattern in which risk climbs steadily with later menopause timing.

When the researchers broke the outcome down into its individual components, the picture became more nuanced. Late menopause was most strongly linked to diabetes, with a hazard ratio of 1.49, meaning women with late menopause had roughly a 49 percent higher risk of developing the disease. Hypertension showed a more modest but still detectable linear increase, with each additional year of menopause age raising risk by about 1 percent. Dyslipidemia, by contrast, showed no significant association with menopause timing. This pattern is biologically plausible: prolonged ovarian estrogen production influences fat distribution, insulin sensitivity, and glucose metabolism, and extended exposure may promote the gradual accumulation of visceral adiposity and insulin resistance that culminates in type 2 diabetes.

What makes the finding counterintuitive is the long-standing assumption that later menopause is cardioprotective. Estrogen is known to exert favorable effects on lipid profiles and vascular function during reproductive years, and early surgical or natural menopause has repeatedly been tied to elevated cardiovascular risk. The new study did not contradict that literature entirely, because early menopause showed no significant association with metabolic multimorbidity in this cohort, with a hazard ratio of 0.93 that crossed the line of statistical significance. Instead, the data suggest a more complex curve in which both ends of the menopause timing spectrum may carry different types of risk, with late menopause favoring metabolic disease and early menopause potentially favoring other cardiovascular outcomes that this study did not measure.

The authors also examined whether the association varied across subgroups defined by educational level or urban versus rural residence, and found no significant interactions. That consistency matters for public health planning in China, where the population is aging rapidly and metabolic diseases are rising in both cities and the countryside. If the relationship between late menopause and metabolic multimorbidity holds across social strata, then menopause timing could serve as a simple, zero-cost marker that clinicians can record during routine history-taking to identify women who warrant closer metabolic surveillance in later life.

Several caveats deserve attention. Age at menopause was self-reported, and recall error is a known limitation in retrospective studies of reproductive history, particularly among older women surveyed years after the event. The CHARLS cohort is community-dwelling and middle-aged to older, so the findings may not generalize to women who died before recruitment or who experienced very early surgical menopause. Observational designs also cannot rule out residual confounding by factors such as parity, breastfeeding history, oral contraceptive use, or hormone therapy, none of which can be fully captured in a general aging survey. And because the outcome was incident multimorbidity during a relatively short follow-up window, longer studies will be needed to confirm whether the association persists and strengthens with age.

Even with those limitations, the study offers a valuable reframing of menopause as a metabolic event, not merely a reproductive one. The menopausal transition is increasingly recognized as a window of heightened vulnerability, when shifts in estrogen, body composition, and sleep converge to accelerate cardiometabolic risk. By showing that the timing of that transition predicts the likelihood of accumulating multiple metabolic diseases simultaneously, the researchers provide a concrete signal that preventive strategies, including glucose screening, blood pressure monitoring, and lifestyle counseling, could be tailored to menopause history. For the millions of women worldwide who experience late natural menopause, the message is not alarm but awareness: a longer reproductive lifespan may carry a metabolic bill that arrives later in life, and knowing that in advance is the first step toward paying it down early.

Subject of Research: The association between age at menopause and metabolic multimorbidity risk in Chinese postmenopausal women

Article Title: Age at menopause and major metabolic disorders among Chinese middle-aged and older women

Article References: Age at menopause and major metabolic disorders among Chinese middle-aged and older women. (n.d.). https://doi.org/10.1186/s12916-026-05225-9

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05225-9

Keywords: menopause, metabolic multimorbidity, diabetes, hypertension, dyslipidemia, women's health, China, CHARLS, estrogen exposure, aging, epidemiology, Cox proportional hazards

The study, led by environmental epidemiologist Amruta Nori-Sarma of Harvard T.H. Chan School of Public Health in collaboration with colleagues at Truveta, Harvard, and Boston University, exploited a technological capability that earlier generations of heat researchers lacked: continuously refreshed electronic health record data. Rather than waiting months for claims data to be processed and aggregated, the team drew on state-day counts of emergency department visits from 19 eastern states, allowing them to quantify the health burden of the summer 2025 heatwaves while the season was still underway. In total, the analysis encompassed 8,169,637 emergency department visits recorded during the warm seasons of 2023 through 2025, providing a robust historical baseline against which the 2025 episodes could be compared.

The two heatwaves under scrutiny were stark in their timing and severity. The first gripped the region from 22 to 25 June 2025, and the second returned from 10 to 13 August 2025, engulfing the eastern United States in conditions that triggered National Weather Service heat alerts across much of the study area. To estimate how many visits these episodes caused, the researchers compared observed visit counts during the heatwave windows with counterfactual predictions of what visits would have been under typical temperature conditions, using temperature-health associations estimated from the prior three warm seasons.

Technically, the analysis rested on a conditional Poisson model, a statistical framework well suited to time-series data on disease counts. The researchers stratified time by year, calendar month, and day of week, with stratum-specific fixed effects that absorb routine patterns in healthcare utilization, such as weekday and seasonal variation. This design effectively compares hot days with cooler days occurring under otherwise similar conditions, a strategy closely related to the time-stratified case-crossover approach widely used in environmental epidemiology. Temperature exposure was modeled using distributed lag non-linear models, or DLNMs, which capture two crucial features of heat’s health effects simultaneously: the non-linear dose-response relationship between temperature and risk, and the fact that effects unfold over multiple days, with heat stress on one day influencing emergency visits over a window of zero to four days afterward.

The headline numbers were striking. During the June 2025 heatwave, the researchers estimated that 9.2 percent of all-cause emergency department visits were attributable to heat over the zero-to-four-day lag window, with a 95 percent confidence interval of 6.2 to 11.6 percent. During the August heatwave, the attributable fraction was 8.3 percent, with a confidence interval of 6.0 to 10.1 percent. In plain terms, roughly one in every eleven or twelve people who walked into an emergency department in these nineteen states during those weeks was there, at least in part, because of extreme heat. Similar patterns emerged when the team examined cumulative lags and cause-specific outcomes, indicating that the association was not an artifact of a single modeling choice.

Because the underlying data included diagnostic information, the researchers could decompose the burden by cause. Beyond direct heat-related illness diagnoses, they tracked emergency visits for kidney disease and for mental health conditions, both of which have well-documented physiological links to heat exposure. Kidney disease is acutely sensitive to dehydration and thermal strain, while a growing body of literature connects high ambient temperatures to psychiatric crises, including exacerbations of mood disorders and substance-related emergencies. The lag-specific analyses showed that the association between the 99th percentile of daily maximum temperature, about 36.9 degrees Celsius, and the sample median of 27 degrees Celsius was strongest on the same day for direct heat illness, while kidney and mental health outcomes followed somewhat different lag structures, consistent with the diverse physiological pathways through which heat injures the human body.

Those pathways are worth spelling out. Extreme heat forces the cardiovascular system to work harder, shunting blood toward the skin to dissipate warmth and increasing cardiac output, changes that laboratory studies involving more than 400 controlled heat exposure experiments have documented in detail. In people with preexisting heart disease, this added strain can precipitate decompensation. Dehydration concentrates the blood and promotes the formation of kidney stones and acute kidney injury, particularly in older adults and in people taking common medications that impair thermoregulation or fluid balance. Meanwhile, heat disrupts sleep, alters neurotransmitter function, and can increase impulsivity and aggression, mechanisms that plausibly underlie the observed rise in mental health emergency visits during hot weather.

The heterogeneity analyses added an important dimension to the findings. By fitting subgroup models for six age groups, three US census regions, and both sexes, the researchers probed whether the temperature-emergency visit association varied across populations. The results, visualized in forest plots comparing rate ratios at lag zero, showed differences by age, region, and sex, echoing decades of evidence that the very young, older adults, and residents of areas unaccustomed to extreme heat bear disproportionate risk. The state-specific exposure-response functions also revealed geographic variation: states with historically milder summers tended to show steeper increases in emergency visits per degree of warming, a pattern consistent with the idea that populations adapt, physiologically and infrastructurally, to the temperatures they usually experience, and that anomalous heat is most damaging where it is least familiar.

Methodological sensitivity checks strengthened the study’s credibility. The team replicated the primary analysis using daily average temperature instead of daily maximum temperature, and separately extended the lag window from four to seven days; both variations reproduced the central findings. Exposure data were drawn from the Open-Meteo weather API and National Weather Service records, and heat alert dates by state were compiled from National Weather Service advisories, allowing the investigators to anchor their heatwave definitions in the same official warnings that reached the public during those weeks. All analytic code, including the data extraction scripts, DLNM fitting routines, meta-analysis, and attributable burden estimation, has been made publicly available on GitHub, an unusual and welcome degree of transparency for a rapidly produced surveillance analysis.

The broader significance of the study lies less in any single percentage than in what it demonstrates about the future of climate-health surveillance. Traditional epidemiology delivers its verdicts long after the disaster has passed, when the findings can inform the next heat season but not the current one. By contrast, a near-real-time pipeline built on continuously refreshed electronic health records can tell public health officials, while a heatwave is still unfolding, how many excess patients are arriving, which conditions are driving the surge, and where resources are most strained. The authors argue that this capability should become a standing component of heat preparedness, complementing heat action plans and warning systems whose effectiveness, demonstrated in cities from Philadelphia to Montreal, depends on knowing when and where the danger peaks. As climate change renders summers like 2025 more frequent and more intense, the study suggests that the emergency department itself, properly instrumented, can serve as an early-warning sensor for the health impacts of a warming world, and that the true toll of extreme heat is far larger than the narrow category of heatstroke diagnoses would suggest. Nearly a tenth of all emergency care during those scorching weeks was heat’s shadow, and counting it in real time may be the first step toward preventing it.

Subject of Research: Attribution of summer 2025 US heatwave emergency department visits using electronic health records

Article Title: Impact of the summer 2025 heatwaves on emergency department visits in the USA

Article References: Nori-Sarma, A., Cartwright, B. M., Zanobetti, A., Pastwa, A., Stucky, N., & Willis, M. D. (2026). Impact of the summer 2025 heatwaves on emergency department visits in the USA. Nature Health. https://doi.org/10.1038/s44360-026-00194-y

Image Credits: AI Generated

DOI: 10.1038/s44360-026-00194-y

Keywords: heatwaves, emergency department visits, electronic health records, extreme heat, public health surveillance, climate change, epidemiology, distributed lag non-linear models, heat-related illness, kidney disease, mental health, United States

The scale of the problem motivating the study is difficult to overstate. The impact of mass incarceration extends far beyond the isolated experiences of justice-involved individuals; the authors describe a reaching, multifactorial impact on the health of society as a whole. People who cycle through carceral facilities frequently return to communities with untreated chronic disease, unmanaged psychiatric illness, and histories of disrupted care. Healthcare providers must therefore be prepared to treat patients returning from prisons and jails, whether in emergency departments, primary care clinics, or community mental health settings. Unfortunately, as the research team notes, health professional programs often lack any correctional medicine curriculum whatsoever, leaving graduates to encounter this population with little preparation and, in some cases, with unexamined biases.

Bridges to Access was conceived as a direct response to that curricular vacuum. Organized as an interdisciplinary conference, the event brought together learners and practitioners from multiple health professions to learn about the effects of incarceration on mental health and overall health. The conference pursued three distinct educational objectives: to demonstrate the importance of education in correctional medicine, to illuminate the interplay of mental illness and incarceration, and to highlight the role healthcare providers can have in impacting change within justice-involved patient populations. Rather than targeting a single discipline, the event was designed to reach medical students, nursing learners, and other future professionals whose careers would intersect with justice-involved patients in different ways.

To measure whether the conference actually worked, the research team employed a pre- and post-conference survey design built around sixteen Likert-response styled questions. Each item assessed participants’ knowledge and perceptions of correctional healthcare, with responses anchored to specific numerical values so that quantifiable change could be detected. Participants completed the same instrument before and after the event, and their paired responses were averaged for each question before analysis. The investigators then applied a paired t-test to compare mean pre- and post-conference responses, setting statistical significance at a p-value of less than 0.05. This straightforward but rigorous design allowed the team to evaluate whether observed changes in attitude and knowledge exceeded what would be expected by chance alone.

The results were striking. One hundred and twenty-three participants completed both the pre- and post-conference surveys, providing a substantial analytic sample for an educational intervention study. Fourteen of the sixteen questions demonstrated statistically significant improvement with a p-value below 0.05. Statistical analysis, the authors conclude, demonstrated that the conference was an effective educational tool, and survey participants showed significant growth in their understanding of each of the three conference objectives. In practical terms, attendees left the event measurably better informed about why correctional medicine belongs in health professional education, how mental illness and incarceration reinforce one another, and what providers can do to advocate for justice-involved patients.

The findings arrive at a moment of growing national attention to carceral health. Incarceration rates in the United States remain among the highest in the world, and the transition between custody and community is widely recognized as a period of elevated risk, including elevated risks of overdose, psychiatric crisis, and preventable hospitalization. When clinicians understand the structural realities that shape their patients’ lives, such as interrupted prescriptions, stigma attached to incarceration histories, and limited access to continuity of care, they are better positioned to screen appropriately, coordinate transitions, and communicate without judgment. Educational interventions like Bridges to Access aim to seed exactly this kind of structural literacy early in professional training, before habits of practice and patterns of bias harden.

The methodological architecture of the study also illustrates how educational outcomes can be evaluated with the same statistical discipline applied to clinical interventions. By pairing each Likert response with a numerical value and subjecting averaged pre- and post-responses to paired t-tests, the investigators converted subjective self-assessments into analyzable data. The paired design is particularly important because each participant serves as their own control, reducing confounding from differences in baseline knowledge across attendees. That fourteen of sixteen items reached significance suggests the effect was broad rather than confined to a single domain of understanding, though the two items that did not reach significance are a reminder that not every perception shifts equally in response to a brief educational exposure.

The authors are candid about the limits of what a single conference can accomplish. Due to a lack of peer-reviewed literature addressing this topic, alongside several limitations inherent to the study design, they write that further research is required to establish best practices for correctional medicine education. Self-reported survey responses capture perceptions of knowledge rather than demonstrated clinical competence, and the durability of gains measured immediately after a conference remains an open question. The study itself was conducted under a minimal-risk exempt framework, evaluated by the investigators under federal regulations for exempt research, with written and oral consent processes for participants, and the event was free and open to the public, which broadens access but also introduces selection considerations typical of volunteer educational audiences.

Even with those caveats, the study carries a clear message for medical and health professions education: gaps in future clinicians’ understanding of justice-related healthcare are not immutable, and they can be measurably narrowed with targeted, interdisciplinary effort. As the justice-involved population continues to interface with mainstream healthcare systems, the demand for clinicians who can deliver equitable, informed, and humane care will only grow. Bridges to Access offers a replicable model, and its authors’ call for further research signals that this conference is best understood not as a finished solution but as the opening move in what will need to be a sustained, evidence-driven expansion of correctional medicine across the curricula that train tomorrow’s healthcare professionals.

Subject of Research: Educational intervention for future healthcare professionals' understanding of justice-related and correctional healthcare

Article Title: Bridging gaps in future healthcare professionals’ understanding of justice-related healthcare

Article References: Bridging gaps in future healthcare professionals’ understanding of justice-related healthcare. (n.d.). https://doi.org/10.1186/s12913-026-15453-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15453-7

Keywords: medical education, correctional medicine, incarceration, health equity, interdisciplinary education, mental illness, justice-involved patients, curriculum, health services research, BMC Health Services Research, Bridging, gaps