Shifting the Paradigm:A Fresh Look at Physical Activity Frequency and Its Impact on Mental Health,Life Satisfaction,and Self-Rated Health in Adolescents

As adolescent mental health problems are becoming a more serious issue globally,this paper explores the relationship of physical activity in adolescents and its frequency on mental health as well as examines the mediating effects of life satisfaction and self-rated health in order to provide a reference for the promotion of mental health in adolescents.A sample of 3578 Chinese high school students completed questionnaires assessing their mental health,physical activity frequency,life satisfaction,and self-rated health.The mean SCL-90 value for adolescents was found to be 1.629%,and 24.73%of adolescents had varying degrees of mental health issue.Increased physical activity frequency is positively associated with improved mental health(p<0.001).Additionally,life satisfaction and self-rated health were found to play significant mediating roles in the relationship between physical activity frequency and mental health.Specifically,low-frequency physical activity had the most pronounced mediating effect on mental health through life satisfaction,while high-frequency physical activity exerted the most significant mediating effect on mental health through self-rated health.These findings underscore the importance of promoting physical activity among adolescents and highlight the distinct pathways through which physical activity frequency can influence mental health outcomes.Further research is needed to explore these relationships in diverse populations and settings,as well as to develop targeted intervention.

Is the whole greater than the sum of the parts? Self-rated health and transdisciplinarity

Self-rated health (SRH)—a person’s subjective evaluation of his general health—is a more valid and powerful predictor of morbidity and mortality than any other combination of objective and self-reported measures. However, current theoretical frameworks fail to explain this association. Here, we sought to investigate SRH in relation to health outcomes from a transdisciplinary perspective. Using a selective review of epidemiological, clinical and qualitative SRH literature, we analyzed the relationships between this global subjective self-perception of health (the whole) and its directly measurable constituents (the parts). Although SRH often predicts major health outcomes, its underpinnings vary from person to person. Factors influencing individual’s health interact in complex ways evade reductionist methods assessing the parts, and may be best captured by global self-perceptions of health. The study of SRH from a transdisciplinary perspective exemplifies the notion that the whole is greater than the sum of its parts. Insight into individual’s experience of “health”, their association with physiological processes, and impact on the health/disease continuum may contribute to the development of individualized strategies for health care and promotion with aging. In particular, this should be most valuable for addressing non-communicable health conditions where cross-talk between health domains (biological, psychological, social, behavioral, spiritual) may significantly contribute to pathophysiology.

Association between glucose levels of children with type 1 diabetes and parental economic status in mobile health application

BACKGROUND The glycemic control of children with type 1 diabetes(T1D)may be influenced by the economic status of their parents.AIM To investigate the association between parental economic status and blood glucose levels of children with T1D using a mobile health application.METHODS Data from children with T1D in China's largest T1D online community,Tang-TangQuan■.Blood glucose levels were uploaded every three months and parental economic status was evaluated based on annual household income.Children were divided into three groups:Low-income(<30000 Yuan),middle-income(30000-100000 Yuan),and high-income(>100000 yuan)(1 Yuan=0.145 United States Dollar approximately).Blood glucose levels were compared among the groups and associations were explored using Spearman’s correlation analysis and multivariable logistic regression.RESULTS From September 2015 to August 2022,1406 eligible children with T1D were included(779 female,55.4%).Median age was 8.1 years(Q1-Q3:4.6-11.6)and duration of T1D was 0.06 years(0.02-0.44).Participants were divided into three groups:Low-income(n=320),middle-income(n=724),and high-income(n=362).Baseline hemoglobin A1c(HbA1c)levels were comparable among the three groups(P=0.072).However,at month 36,the low-income group had the highest HbA1c levels(P=0.036).Within three years after registration,glucose levels increased significantly in the low-income group but not in the middle-income and high-income groups.Parental economic status was negatively correlated with pre-dinner glucose(r=-0.272,P=0.012).After adjustment for confounders,parental economic status remained a significant factor related to pre-dinner glucose levels(odds ratio=13.02,95%CI:1.99 to 126.05,P=0.002).CONCLUSION The blood glucose levels of children with T1D were negatively associated with parental economic status.It is suggested that parental economic status should be taken into consideration in the management of T1D for children.

Compliance to Medication Management and Mental Health Status of Elderly Hypertensive Patients: Basis of Educational Health Program

Objective:The study aimed to assess medication management compliance and mental health in elderly patients with hypertension.Method:The study evaluated medication compliance and mental health status of elderly hypertensive patients in China using simple random sampling.Data was collected using the Morisky Medication Compliance Questionnaire,Hospital Anxiety and Depression Scale,and a checklist.Ethical practices were strictly observed.Results:A study of 100 elderly hypertensive patients found poor drug management compliance,with female patients showing worse compliance.Female patients were more vulnerable to anxiety and depression.The study also found no significant association between gender,age,education level,marital status,living standards,and medication compliance.Barriers to medication management included food and daily necessities,lack of awareness about the importance of drug treatment,and basic family needs.The lowest-ranked barriers were lack of support from government health clinics,low income,and lack of family support.Conclusion:Based on the results,the study proposes an educational plan for elderly hypertensive patients and their families,to be evaluated and implemented by the hospital and township community service center.The plan aims to improve medication management and lifestyle modification compliance,encourage active participation,and provide access to medical and mental health clinics,support groups,and counseling services.

Understanding the Lifestyle Correlates with Chronic Constipation and Self-Rated Health

The objective of this study is to evaluate the healthy and unhealthy behaviors as risk factors for chronic constipation and self-rated health status. Eight hundred tenth students enrolled from a university in Miaoli city, Taiwan. Chronic constipation was assessed using Chinese questionnaire. Information of unhealthy and healthy lifestyles was interviewed by constructed questionnaire. Thirty-six percentage of university students were assessed as chronic constipation. Using multivariate logistic regression adjusted for age, sex, race and BMI, we found chronic constipation significantly correlated with frequency of consumption from snack, fast food, fried food, daily consumption of water, physical activity and junk food used as regular food. Moreover, these unhealthy behaviors significantly correlated with self-rated health status. Students with chronic constipation had poor self-rated health status. It is urgent to create healthy behaviors to reduce the risk for chronic constipation or upgrade self-rated health status in university students.

Influence of Built Environment in Hygienic City in China on Self-rated Health of Residents

Objective To assess the subjective perception of residents on the built environment in hygienic cities and its relation to the self-rated health(SRH)status of residents,providing a basis for a better promotion on construction of health-supportive environments.Methods The online survey was adopted with the respondents recruited from residents living in Chaoyang District of Beijing in January 2021.With SRH level as the dependent variable,two-category logistic regression analysis was conducted to analyze the impact of the built environment in hygienic cities on the SRH status of residents.Results A total of 1,357 respondents were enrolled in this study.After controlling confounding factors,four aspects in the built environment in hygienic cities were detected remarkable influences on the SRH level of residents,including enough green space in the living area[odds ratio(OR)=1.395,95%confidence interval(95%CI):1.055–1.845],clean and hygienic living environment(OR=1.472,95%CI:1.107–1.956),residents’confidence in drinking water safety in the living area(OR=1.856,95%CI:1.354–2.544)and residents’confidence in food safety in the living area(OR=1.405,95%CI:1.027–1.921).Conclusion Regarding city construction,the government should focus more on the subjective perception of residents on built environments to build a supportive environment benefiting the health of residents.

Social, Clinical and Psychometric Factors Affecting Self-Rated Oral Health, Self-Rated Health and Wellbeing in Adults: A Cross-Sectional Survey

Background: Many studies examined and reported oral and general health inequalities in clinical health, SROH and SRH. Objectives: The study aims to explore the social influences, gradients and predictors of self-rated oral health (SROH) and self-rated health (SRH) and wellbeing in Greek adults. Methods: Cross-sectional study, of men and women, aged 65 years and over (N = 743) in Greece. Descriptive and statistical analyses were performed for dentate and edentulous participants. For the association between socioeconomic exposures and binary outcomes, logistic regression was performed to estimate Odds Ratios and 95% Confidence Intervals (OR, 95% CI);levels of association and Cramer’s V were applied to calculate associations and p-values. Results: The objective socioeconomic measures, such as household income, education level and last main occupation were significant predictors and determinants of both SROH and self-rated health (SRH). For Satisfaction with life (SWL), there was a diversity in the results analogous to the dental status of the participants. Household income and SSS were predictors of SWL in dentate participants. In the total sample Household income, occupation and SSS, were predictors of SWL, while in edentulous participants only occupation and SSS were statistically significant (p < 0.05). Subjective social status was statistically significant for SROH, SRH and SWL (p < 0.01). More men than women reported their SROH and SRH as good. Household income and SSS were predictors of SWL, in dentate participants, thus the better the income and the higher the relative social status, the higher feeling of SWL was recorded. Place of residence had significant associations only with SWL. Household income, education, occupation and SSS had significant levels of association with SROH and SRH in dentate participants (p < 0.05). Conclusion: There are socioeconomic gradient inequalities in SROH and SRH in Greek adults living in Attica area. Subjective social status is a predictor of SROH, SRH and SWL. The need to prioritize interventions to eliminate disparities and inequalities in oral and general health and wellbeing of elders is evident.

Self-Rated Health in University Students from Rio Branco in the Western Brazilian Amazon

The objective of this study was to determine the prevalence and associated factors of unsatisfactory self-rated health in university students. A cross-sectional study was conducted in graduate students of a Public University in the city of Rio Branco in the Western Brazilian Amazon. The overall prevalence of unsatisfactory self-rated health was 23.0%. After adjusting for gender and age, the factors associated with unsatisfactory self-rated health were as follows: sedentarism during leisure time (prevalence ratio (PR): 2.26;95% CI: 1.56 - 3.29), consuming meals only in restaurants (PR: 1.48;95% CI: 1.14 - 1.94), insomnia (PR: 1.86;95% CI: 1.50 - 2.30), headaches (PR: 2.17;95% CI: 1.52 - 3.09), and back pain (PR: 2.03;95% CI: 1.58 - 2.60). Thus, a high prevalence of unsatisfactory self-rated health was identified in this group of university students. The findings suggest immediate implementation of programs to promote healthy behaviors and to prevent headaches, back pain and insomnia.

Modification in self-rated health in patients discharged by a geriatric rehabilitation ward

Self-rated health is a valuable outcome in geriatric rehabilitation besides objective results. The present work aims at measuring and analyzing overall health as it is perceived at admission into and at discharge from a geriatric rehabilitation ward. Overall health was self-appraised through a visual-analogue scale (VAS), spanning from 0 (worst) to 10 (best). We studied 1997 patients (70% females), aged 79 (standard deviation, s.d. 8.7) years;most were frail, either functionally, clinically and cognitively. 80% of patients were discharged to home after a length of stay lasting 47.5 (s.d. 22.7) days. At admission, 3/5 patients appraised favorably their overall health (VAS ≥ 6/10): at discharge, the proportion rose to 3/4, with a mean (s.d.) gain = 2 (2) points. The improvement in self-perceived health score positively correlates with the grade expressing clients’ overall satisfaction for the stay (p 0.001), and with discharge versus admission differences in: Barthel Index (BI) total score (p < 0.001), Tinetti total score, Mini Mental State Examination (MMSE), Geriatric Depression Scale (5?items GDS), pain (VAS 0 to 10). A Linear regression model predicting the changes in self-perceived health included changes in BI, MMSE, GDS, pain, dropping Tinetti test. Changes in self-rated health were positively correlated to functional gain adjusted for pre-morbid level, and to relative functional gain. By analysis of variance, health self-appraisal changed more favorably in patients discharged to home than for other social outcomes (all p < 0.001). As expected, trends in self-perceived health parallel improvements in objective functional gauges and subjective indicators.

Social integration: How is it related to self-rated health?

Social integration has well-established health benefits among older adults in observational studies. However, interventions designed to increase social integration have not improved health suggesting important knowledge gaps on how social integration influences health outcomes. This study developed a new measure of social integration, daily social contact, capturing the interpersonal nature of social integration and mobility of individuals, and providing a direct assessment of individuals’ real-time access to companionship and social support. The data used is the 2006-2007 American Time Use Survey (ATUS), which surveyed 25,191 individuals aged 15 years and older (n = 4378 aged 65 years and older). Generalized ordinal logistic regression analyses revealed positive, but non-parallel relationships between daily social contacts and the ordinal categories of self-rated health among older adults. This study may be used to identify populations that experience social exclusion, such that future research can determine more precisely how to intervene to improve health outcomes.

Social demographic factors and leisure time physical activity influencing the self-rated health and happiness of Chinese people

Background and aims:The holistic definition of health is not merely the absence of disease or infirmity,but a state of complete physical,mental,and social well-being.However,related research on the influencing factor of self-rated health and happiness have generally remained separate.Therefore,this study aimed to 1)find individual level determinants of the two facets of health;and 2)investigate the covariance of the two facets of health within individual levels.Methods:Multivariate multilevel analysis of self-rated health and happiness at level 1,were nested within 10,968 people at level 2.Data were obtained from the 2015 Chinese General Social Survey.Results:Lower happiness and self-rated health were found in 1)females;2)the elderly;3)people with a lower educational level;4)people who were presently single;5)people with a lower self-rated economic status;6)people who resided in urban areas;and 7)people with sedentary lifestyles as compared to those in other categories of the same variable.After adjusting the related individual level determinants,the correlation coefficient of two facets of health at the individual level is 0.19,which indicates that no robust covariance was observed.Conclusions:The current study indicates the existence of disparity in the subjective physical and psychological dimensions of health among the elderly in China.Our findings emphasize the importance of paying attention to different aspects of health simultaneously in investigations and the benefits of leisure time activities.

Oral health status in Sichuan Province: findings from the oral health survey of Sichuan, 2015–2016

To investigate oral health status in the residents of Sichuan Province, southwest China, a cross-sectional study was performed using the latest Oral Health Survey Basic Methods recommended by the World Health Organization. A multistage stratified random cluster-sampling method was used to enroll participants from the following three groups： children aged 3-5 years, adolescents aged 12 years, and people aged 65-74 years. In these three groups, the mean numbers of teeth that were affected by caries were 3.28, 0.86 and 5.13, respectively, resulting in a prevalence of 63.47%, 37.20% and 83.20%, respectively. Relative to the high rate of decayed teeth, the prevalence of fillings was very low in all age groups （0.97%, 7.24% and 5.43%, respectively）, In the 12-year-old adolescent group, only 3.61% had good pit and fissure sealing. In addition, the rate of dental fluorosis was 24.80%, and the Community Fluorosis Index value was 0.39. In the elder group, the community periodontal index was 2.92. The prevalence in the elderly of having lost at least one tooth was 75.54%. Additionally, 4.44% of these participants were edentulous. The incidence of dental prosthesis was 51.75%, the proportion with a removable partial denture, a fixed denture, full dentures, dental implants and an informal fixed bridge was 21.59%, 11.45%, 4.64%, 0 and 16.67%, respectively. In this study, 8.2% of the elderly participants were affected by different types of oral mucosal lesions. Among such lesions, recurrent aphthous ulcers were most prevalent （2.69%） and oral lichen planuses were second （1.6%）. The conclusion presented in this survey is that oral diseases, especially dental caries and periodontal disease, are frequent and common in Sichuan province, China. Moreover, the treatment rate is very low, and primary prevention and treatment options are therefore urgently needed in this population.

Social isolation and health-promoting behaviors among older adults living with different health statuses:A cross-sectional study

Objectives:To describe the characteristics and relationships of social isolation and health promoting behaviors of Chinese older adults with different health statuses.Methods:Totally 485 older adults were recruited.They were divided into three groups based on their health status:healthy group(n=72),group with one disease(n=183)and group with multimorbidity(n=230).Lubben Social Network Scale-6 and Health-Promoting Lifestyle Profile II were used to measure their social isolation and health-promoting behaviors,respectively.Results:Among the aged with one disease or multimorbidity,30.6%(56/183)and 31.7%(73/230)were socially isolated,respectively,based on the score of the Lubben Social Network Scale-6.The three groups differed significantly in health-promoting behaviors and scores on several subscales.The group with multimorbidity exhibited more social isolation and fewer health-promoting behaviors than other groups.Social isolation was among the factors adversely affecting health-promoting behaviors in older adults.Conclusions:Health care providers should help older adults with multimorbidity preserve the remaining abilities to improve health-promoting behaviors.Meanwhile,it is important to support healthy older adults to increase self-responsibility to achieve healthy aging.

Analysis of mental health status and related factors in patients with acute cerebral infarction

BACKGROUND Acute cerebral infarction(ACI)is characterized by a high incidence of morbidity,disability,recurrence,death and heavy economic burden,and has become a disease of concern in global researchers.As ACI has serious effects on patients’physical status,life and economy,often causing anxiety,depression and other psychological problems,these problems can lead to the aggravation of physical symptoms;thus,it is very important to understand the factors affecting the mental health of these patients.AIM To understand the elements that affect the mental health of patients who have suffered an ACI.METHODS A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals(Quanzhou First Hospital,Fuqing City Hospital Affiliated to Fujian Medical University,and the 900 Hospital of the Joint Service Support Force of the People’s Liberation Army of China)in Fujian Province from January 2022 to December 2022 using the convenience sampling method.ACI inpatients who met the inclusion criteria were selected.Informed consent was obtained from the patients before the investigation,and a face-to-face questionnaire survey was conducted using a unified scale.The questionnaire included a general situation questionnaire,Zung’s self-rating depression scale and Zung’s self-rating anxiety scale.All questionnaires were checked by two researchers and then the data were input and sorted using Excel software.The general situation of patients with ACI was analyzed by descriptive statistics,the influence of variables on mental health by the independent sample t test and variance analysis,and the influencing factors on psychological distress were analyzed by multiple stepwise regression.RESULTS The average age of the 220 patients with ACI was 68.64±10.74 years,including 142 males and 78 females.Most of the patients were between 60 and 74 years old,the majority had high school or technical secondary school education,most lived with their spouse,and most lived in cities.The majority of patients had a personal income of 3001 to 5000 RMB yuan per month.The new rural cooperative medical insurance system had the largest number of participants.Most stroke patients were cared for by their spouses and of these patients,52.3%had previously smoked.Univariate analysis showed that gender,age,residence,course of disease,number of previous chronic diseases and smoking history were the main factors affecting the anxiety scores of patients with ACI.Age,living conditions,monthly income,course of disease and knowledge of disease were the primary variables influencing the depression score in patients with ACI.The findings of multivariate analysis revealed that the course of disease and gender were the most important factors influencing patients’anxiety scores,and the course of disease was also the most important factor influencing patients’depression scores.CONCLUSION Long disease course and female patients with ACI were more likely to have psychological problems such as a high incidence of emotional disorders.These groups require more attention and counseling.

Effect of self-management program on health status of elderly patients with heart failure: a single-blind, randomized clinical trial

Objective:To determine the effect of self-management program on the health status of elderly patients with heart failure.Methods:The present study was a single-blind,randomized clinical trial,and conducted on 90 patients with heart failure of stages Ⅱ-Ⅲ at one teaching hospital in eastern Iran in 2017.The participants were randomly assigned into two groups:the intervention group and the control groups,with 45 patients in each group.Self-management programs including awareness and recognition,problem-solving process,diet,exercise,and stress management were carried out.The participants were trained for six weeks and were followed for two months.Data of the health status were collected before,after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire.Data analysis by chi-square,independent t-test,Fisher,ANOVA with repeated measures was conducted.Results:Patients in both groups were matched in terms of demographic characteristics before the intervention.There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention.However,the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001).Conclusions:Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms).Therefore,this supportive method can be used to improve the health of patients and manage problems caused by heart failure.

Heat stress affects dairy cow health status through blood oxygen availability

Background Rises in global warming and extreme weather occurrence make the risk of heat stress(HS)induced by high ambient temperatures more likely in high-yielding dairy cows,resulting in low milk quality and yield.In ani-mals,oxygen is involved in many physiological and metabolic processes,but the effects of HS on oxygen metabolism remain unclear.Thus,the current study aimed to investigate how oxygen metabolism plays a role in health status of dairy cows by measuring the milk yield,milk composition,and blood biochemical variables of cows under different levels of HS:none(No-HS),mild(Mild-HS),and moderate HS(Mod-HS).Results The HS significantly increased rectal temperature(Ptreat<0.01)and respiration rate(Ptreat<0.01).Under Mod-HS,greater Na+(P<0.05)and lower total CO_(2),and pH(P<0.05)were observed relative to those under No-HS and Mild-HS.Oxygen concentrations in both coccygeal artery and mammary vein(Ptreat<0.01)were lower under Mod-HS than under No-HS.Coccygeal vein concentrations of heat shock protein 90(HSP90)(P<0.05)increased during Mod-HS compared with those in cows under No-HS.Malondialdehyde increased during Mod-HS,and glu-tathione peroxidase(P<0.01)increased during Mild-HS.Coccygeal vein concentrations of vascular endothelial growth factor(P<0.01),heme oxygenase-1(P<0.01),and hypoxia-inducible factor 1α(P<0.01)were greater in cows under Mod-HS than those under No-HS.Red blood cell count(P<0.01)and hemoglobin concentration(P<0.01)were lower in the coccygeal vein of dairy cows under Mild-and Mod-HS than those of cows under No-HS.Conclusions Exposure to HS negatively impacts the health status and lactation performance of dairy cows by limit-ing oxygen metabolism and transportation.However,the specific mechanism by which HS affects mammary function in cows remains unclear and requires further exploration.

The Current Status and Challenges Regarding Tuberculosis Infection Control in Health Care Facilities in China

Health care facilities are a high-risk environment for generating and spreading respiratory infectious diseases such as tuberculosis （TB）. The TB prevention and treatment staff in health care facilities are responsible for the identification, diagnosis, treatment, supervision, and management of TB patients .

Health status assessment of axial piston pump under variable speed

The axial piston pump usually works under variable speed conditions.It is important to evaluate the health status of the axial piston pump under the variable speed condition.Aiming at the characteristic signals obtained under different wear levels of the port plate,a feature signal extraction method under variable speed conditions is proposed.Firstly,the combination of complete ensemble empirical mode decomposition with adaptive noise(CEEMDAN)energy spectrum and fast spectral kurtosis principle is used to accurately extract the intrinsic mode function(IMF)component containing the sensitive information of the degraded feature.Then,the aspect ratio analysis method of the angle domain variational mode decomposition(VMD)is used to process the feature index containing the sensitive information of the degraded feature.In order to evaluate the health status of the axial piston pump under variable speed,the vibration reliability analysis method for axial piston pump based on Weibull proportional failure rate model is proposed.The experimental results show that the proposed method can accurately evaluate the health status of the axial piston pump.

Influencing of students＇ health status and physical education

Schools and parents should pay attention to health education for students＇ health awareness and good health habits, to establish a correct concept of health. School mental health education should be the first place; school should create a positive learning environment for students to get knowledge and skills of exercising. Especially in the nine years of compulsory education stage, we should ensure necessary physical exercise, reasonable arrangements for extracurricular activities to improve students＇ physical fitness. We should improve the school＇ s sports facilities, and create a good campus atmosphere. Schools should actively carry out extra-curricular sports activities, improve the level of quality of physical education teachers, develop students＇ sports consciousness, and improve material conditions for the students to create a good learning environment, meanwhile, we should increase the content of education, and enrich the content of physical education to enable students to select and reach more sports.

Health status and health systems financing in the MENA region:roadmap to universal health coverage

Background:Since the declaration of the Millennium Development Goals(MDGs)in 1990,many countries of the Middle East and North Africa(MENA)region made some improvements in maternal and child health and in tackling communicable diseases.The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health,well-being,and universal health coverage.This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage.Methods:Time-series data on socioeconomics,health expenditures,and health outcomes were extracted from databases and reports of the World Health Organization,the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software.Countries were grouped according to the World Bank income categories.Descriptive statistics,tables and charts were used to analyze temporal changes and compare the key variables with global averages.Results:Non-communicable diseases(NCDs)and injuries account for more than three quarters of the disabilityadjusted life years in all but two lower middle-income countries(Sudan and Yemen).Prevalence of risk factors(raised blood glucose,raised blood pressure,obesity and smoking)is higher than global averages and counterparts by income group.Total health expenditure(THE)per capita in most of the countries falls short of global averages for countries under similar income category.Furthermore,growth rate of THE per capita has not kept pace with the growth rate of GDP per capita.Out-of-pocket spending(OOPS)in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care.Conclusion:The alarmingly high prevalence of NCDs and injuries and associated risk factors,health spending falling short of the GDP and GDP growth rate,and high OOPS pose serious challenges for universal health coverage.Using multi-sector interventions,countries should develop and implement evidence-informed health system financing roadmaps to address these obstacles and move forward toward universal health coverage.