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To describe the pedagogical design and implementation of the WHO European Autumn School on Quality of Care and Patient Safety, characterize participant profiles, evaluate feedback and learning outcomes, and identify lessons for leadership capacity building for quality of care and patient safety. A descriptive analysis of the program's design was conducted across three annual editions. The 2023 edition described aims and foundations, while the 2024 and 2025 editions were evaluated using a standardized post-course survey, analyzed descriptively and thematically. The curriculum evolved from a foundational pilot (2023) to a practice-oriented model (2025) building on competence- and problem-based learning. Participation grew from 14 participants (9 countries) to 35 (23 countries) and participants consistently reported high satisfaction with the immersive full week program. The clarity, accessibility and relevance of the course materials and a strong people-centered approach was highlighted by 91 and 94%, respectively, of the participants in the 2025 edition. The first three editions of the Autumn School were perceived as relevant for strengthening system- and policy-level leadership for quality of care and patient safety. Future editions should expand hands-on application and incorporate longitudinal follow-up to assess sustained impact.

Strategies to improve child maltreatment recognition in emergency departments (EDs) have been associated with increased detection. However, implementing new protocols in high-pressure environments is challenging, necessitating an understanding of healthcare professionals' perceptions. This study explored perceived barriers and facilitators for implementing a child maltreatment toolkit design in European EDs. The presented toolkit design included the Screening instrument for Child Abuse & Neglect (SCAN), training, and hospital policy. To assess barriers and facilitators for its implementation, a survey was developed using the 'Barriers and Facilitators Assessment Instrument' featuring statements on a 5-point Likert scale with additional open-ended questions. This pre-implementation survey was distributed to ED professionals through European emergency medicine societies and research networks (EUSEM, REPEM, and EuSEN) and additional contacts via snowball sampling. Descriptive statistics and thematic analyses of open-ended responses were conducted. A total of 204 respondents participated, representing 121 hospitals from 28 European countries (estimated response 36%-46%). Facilitators for implementation included the toolkit's alignment with the ED environment, covering time, financial and staff resources, ED staff motivation and the hospital policy's standardized hospital-wide implementation. Thematic analyses revealed comparable benefits, but additional disadvantages including cultural differences, risk of false positives, electronic health record (EHR) compatibility and ensuring practical over theoretical learning.  This pre-implementation study highlights generally positive perceptions among European ED professionals regarding a structured child maltreatment toolkit design. Concurrently, important contextual and ethical considerations, including screening performance, legal frameworks, system capacity and potential unintended consequences, were identified. This underscores the need for careful contextual adaptation and prospective effectiveness-implementation evaluation before broader adoption. • European EDs generally lack strategies to improve the recognition of child maltreatment. • Successful implementation of such strategies in EDs requires an understanding of healthcare professionals' perceived barriers and facilitators. • This study explores perceptions of European ED professionals regarding a child maltreatment toolkit design comprising the Screening instrument for Child Abuse and Neglect (SCAN), targeted training, and hospital policy guidance. • Addressing training costs, cultural variability, and concerns about false positives is essential to support implementation and to enable wider adoption, enhancing pediatric readiness for child protection across Europe.

Men, particularly those belonging to gender minority groups, often experience poorer physical health outcomes. This study examined global health and quality of life (QoL) across diverse male gender subgroups in Switzerland. While emphasising male gender diversity, we aimed to identify key sociodemographic risk factors associated with reduced global health and QoL. We analysed a subset of the Swiss Health Survey 2022, a cross-sectional nationally representative health-related dataset from the general Swiss population. Our sample included individuals falling into one of the three groups: cisgender men, transgender men (assigned female at birth with male gender identity) and men with 'other' gender identities (assigned male at birth but identifying as non-binary or non-specified gender identity). Global health and QoL were assessed using the Minimum European Health Module (MEHM) and the global QoL item of the WHOQOL-Bref. Four binary logistic regression models examined the association between male gender identities, sociodemographic data and MEHM and QoL outcomes. Our study comprised 3 505 801 male cases after weighting. Of these, 12.9% reported fair to very poor health. Key risk factors included being unemployed, migration background and being a transgender man. The strongest protective factor was higher education. Chronic conditions were reported by 33.3% men, with unemployment again being the most relevant risk factor. Identifying as a man with 'other' gender identities emerged as a protective factor. Regarding QoL, 8% stated impaired QoL, while the male gender identity 'other' was the strongest risk factor and tertiary school education the most relevant protective factor. Risk and protective factors vary across different global health outcomes and QoL in men. These findings highlight the importance of disaggregating male gender categories beyond the binary to better understand the complexity of health disparities. A differentiated, gender-inclusive approach is essential for accurately identifying vulnerable groups and tailoring public health interventions accordingly.

In low- and middle-income countries like Serbia, improving access to healthcare is a central objective of social and development policy, closely linked to the Sustainable Development Goals, particularly SDG 3 (Good Health and Well-Being) and SDG 8 (Decent Work and Economic Growth). However, healthcare expenditure is still frequently perceived as a fiscal cost rather than as a productive investment. Serbia, an middle-income country with a predominantly publicly financed healthcare system, offers a relevant case for examining how expanding healthcare access is intertwined with domestic economic structures and inclusive development outcomes. Using national input-output tables for 2019, this study applies standard input-output modelling to estimate output, income, employment, and value-added multipliers associated with the Serbian healthcare sector. The analysis captures direct, indirect, and induced effects, enabling an assessment of how healthcare spending propagates through domestic supply chains and labor markets. The findings show that healthcare in Serbia generates significant economy-wide spillovers that extend well beyond service provision. Output multipliers exceed unity, indicating strong domestic production linkages that support the availability and affordability of healthcare services. Employment multipliers rank healthcare among the leading job-generating sectors, contributing directly to SDG 8 by fostering stable and locally anchored employment. Most notably, the total value-added multiplier places healthcare among the top ten sectors of the Serbian economy, underscoring its capacity to retain expenditure domestically and to reinforce the economic foundations necessary for sustained healthcare access. The results demonstrate that investments aimed at improving healthcare access simultaneously advance broader economic inclusion and sustainable development objectives. Comparative benchmarking with European economies reveals structurally consistent patterns in health-sector integration across income levels, while also highlighting country-specific differences in income and employment transmission. By empirically linking healthcare access to macroeconomic returns, this study provides evidence to support policy frameworks that treat health expenditure as a strategic investment for achieving SDG-aligned, resilient, and inclusive growth in low- and middle-income countries.

Bronchopulmonary Dysplasia (BPD) is a frequent chronic complication of preterm birth. While clinical outcomes have been widely studied, evidence on the long-term impact on parents and caregivers - particularly beyond early childhood and across different countries - remains limited. The BronQ Family study investigates the health-related quality of life (HRQoL) and lived experiences of caregivers of children and adolescents with BPD. This multinational, cross-sectional study is conducted in six European countries and the United States. Parents and primary caregivers of preterm-born children (<37 weeks' gestation) under 18 years of age are recruited through international parent networks, healthcare professionals and social media. Data collection takes place between September 2025 and February 2026 via an online questionnaire including socio-demographic characteristics, child health status, caregiver HRQoL (Paediatric Quality of Life Inventory Family Impact Module), health literacy, support structures and economic burden. Group allocation (BPD vs comparison group) is based on reported diagnosis and proxy indicators of neonatal respiratory support. Analyses include descriptive statistics, regression modelling and subgroup comparisons; qualitative responses will be analysed using structured content methods. This study received a waiver by the Ethics Committee of Maastricht University Medical Center+, the Netherlands (MECT 2025-0285). Informed consent is obtained electronically, and data are anonymised and securely stored. Results will be shared with the general public and disseminated through peer-reviewed publications, conferences and stakeholder organisations. NCT07134387.

Asthma is a common chronic disease responsible for a considerable disease burden in China and around the world. Despite its burden, there is substantial unmet need for asthma care, including screening, diagnosis, treatment, and management. Symptom-based screening for asthma could support identification of undiagnosed asthma patients, as well as reference to higher-level hospitals for formal diagnoses and treatment. This study focuses on identifying suspected asthma patients and encouraging them to seek formal diagnoses and treatment. This approach aligns with the novel concept of population medicine, which aims to maximize overall population health rather than focusing on individual patients within the health system. We are conducting a two-arm population-based stratified clustered randomized controlled trial (cRCT) to evaluate the effectiveness of a population medicine multimorbidity intervention package. The intervention integrates community screening, chronic disease management, patient education, digital follow-up, and team-based care. The trial is being implemented in Xishui County, Guizhou Province, a mountainous low-resource county in Southwestern China, covering 26 townships and more than 300,000 permanent residents. We considered each of the 26 townships in Xishui County as a cluster and stratified them into large and small townships based on population size. Townships with an above-average population were designated as "large," and those with a below-average population were designated as "small." We randomized the same number of residents in each township stratum (large and small) to undergo the European Community Respiratory Health Survey (ECRHS) for identifying suspected asthma patients. Individuals identified as suspected asthma patients were considered study participants and subsequently enrolled in the intervention or control arm. All participants in the intervention arm are followed for one year, with one telephone follow-up at month three and in-person follow-ups at months six and 12, while participants in the control arm are followed only at baseline and 12&#xa0;months. Primary outcomes include the number of chronic conditions controlled, whether the participant received lung function testing, and Asthma Control Test (ACT) score. In addition, we are evaluating 42 secondary outcomes covering physiological and functional indicators such as lung function, health-related quality of life, mental health, behavioral risk factors, healthcare utilization, productivity loss, knowledge of asthma and chronic obstructive pulmonary disease (COPD), and care cascade indicators for asthma and other chronic diseases. This cRCT has been featured as an important case study in the Lancet Commission on Investing in Health report to evaluate the effectiveness of the integrated intervention package on priority conditions. The trial was designed under population medicine principles, with an aim providing holistic care and enhancing the overall health status of suspected asthma patients. The results of the trial will inform the next generation of multimorbidity management and population medicine practices among global health authorities and practitioners. ClinicalTrials.gov Identifier: NCT06457009. Registered on June 7, 2024.

On August 21, 2013, sarin gas was used as a weapon of war in multiple areas of Ghouta, rural Damascus, Syria, in the largest confirmed chemical weapons attack against civilians in the 21st century. Despite the scale of the attack, little is known about the long-term medical symptoms experienced by survivors. This study documents the lived experiences and the short- and long-term physical and psychological consequences of sarin exposure among civilian survivors more than a decade after the attack. We conducted a retrospective qualitative descriptive study using thematic analysis based on semi-structured narrative interviews with survivors of the 2013 Ghouta chemical attacks. Participants were selected based on confirmed exposure and willingness to provide detailed accounts of their health status, experiences, and healthcare-seeking behavior. Thematic analysis was used to identify recurrent patterns and outcomes across different domains. Participants reported several medical symptoms ranging in severity, including chronic respiratory issues, neurological complaints, fatigue, and sensory disturbances. The psychological impact was universal, with widespread reports of anxiety, nightmares, panic attacks, and social withdrawal. Most participants experienced significant disruption to their quality of life and described barriers to accessing healthcare. The long-term consequences of sarin exposure in Ghouta extend far beyond the initial event, affecting nearly every aspect of survivors' lives. These findings suggest a substantial long-term burden of self-reported physical and psychological symptoms among survivors. They highlight the need for sustained medical, psychological, and social support, and underscore the importance of integrating survivor perspectives into post-conflict recovery and health system responses.

Aim: This study aims to provide a comprehensive analysis of the administrative-legal assurance of the reliability and ethics of medical decision-making in wartime conditions, combining normative analysis with empirical data from a frontline Ukrainian hospital. Materials and Methods: The normative framework includes international standards of the World Health Organization, the International Committee of the Red Cross, professional medical associations, the European Charter of Patients' Rights (2002), European Union legislation, and the national healthcare and wartime legislation of Ukraine. The empirical component comprised a cross-sectional anonymous survey conducted between May and September 2025 among 40 healthcare workers at a rural hospital located near the active frontline in the Dnipropetrovsk region. The questionnaire assessed decision-making complexity, perceived probability of errors, stress impact, resource availability, preparedness, and willingness to report incidents. Results: Wartime conditions significantly increase the perceived complexity of clinical decision-making, particularly in resource allocation, evacuation prioritization, and surgical interventions. Respondents reported elevated stress levels and increased risk of errors, primarily associated with limited resources, disrupted logistics, and administrative constraints. The reliability and ethical integrity of medical decisions were found to depend on the availability of updated clinical protocols, state monitoring mechanisms, organized evacuation systems, and guaranteed minimum healthcare services. Conclusions: Effective administrative-legal support is a prerequisite for ensuring both the reliability and ethical soundness of medical decisions in wartime. Strengthening institutional safeguards, resource allocation mechanisms, and clear regulatory guidance is essential to maintain medical standards under extreme conditions.

Understanding the interplay between nutrition, lifestyle, and environmental awareness is increasingly critical in shaping effective public health strategies. This study aimed to culturally adapt, extend and validate the nutritional and social health habits (NutSo-HH) scale for use in the Italian context. Cultural adaptation included forward and backward translation, expert review, and pilot testing. In line with current evidence and guidelines promoting health-enhancing and environmentally responsible diets, the Italian version was revised and expanded into the NutSo-HH-Ita inventory, comprising 4 domains: Nutrition and food choices, Nutritional risk behaviors, sustainability and media influence, and lifestyle and wellbeing. Structural validity was examined through confirmatory factor analysis in a sample of four hundred three Italian adults. Construct validity was evaluated through known-group comparisons. Reliability was assessed using McDonald's omega for internal consistency, factor score determinacy coefficients for factor quality, and intraclass correlation Coefficients for test-retest stability. Confirmatory factor analysis (CFA) confirmed the theoretical structure of the inventory, yielding satisfactory to excellent fit indices across the 9 factors (comparative fit index [CFI] = 0.943-0.997; Tucker-Lewis index [TLI] = 0.922-0.994; root mean square error of approximation [RMSEA] = 0.015-0.048). Known-group analyses further supported construct validity. Omega values ranged from 0.51 to 0.80, with highest reliability observed for Environmental awareness (&#x3c9; = 0.80; FSD = 0.92) and Digital influence (&#x3c9; = 0.78; FSD = 0.92). Protein sources and Physical activity showed the lowest internal consistency (&#x3c9; = 0.51 and 0.54, respectively). Test-retest stability was moderate for most factors, except Media influence, Social Habits, and Sleep quality, which demonstrated poor stability. The NutSo-HH-Ita is a valid and contextually relevant inventory for assessing dietary habits, lifestyle, and the sustainability of nutritional choices in the Italian context. It offers valuable support for epidemiological research, public health intervention planning, and the monitoring of nutritional and environmental behaviors.

The impact of respiratory syncytial virus (RSV) is increasingly being recognized in older adults, however economic burden data is sparse. This study describes the burden of RSV and associated direct and indirect costs in adults aged 60&#x202f;+&#x202f;years in real-world clinical practice across five European countries. Data were drawn from the Adelphi RSV Disease Specific Program (DSP&#x2122;), a cross-sectional survey of physicians and patients in France, Germany, Italy, Spain, and the United Kingdom conducted December 2023-June 2024. Patients aged 60&#x202f;+&#x202f;with a confirmed RSV diagnosis were included. Physicians provided data on resource use and supportive care needs, and patients on paid and unpaid productivity loss. Country-specific unit costs were used to calculate direct and indirect costs. Patients were stratified by symptom duration from onset (acute- [A-]RSV: <4, ongoing- [O-]RSV: 4-&#x202f;<&#x202f;12, and post-acute- [P-]RSV: 12-52&#x202f;weeks) and need for hospitalization (hospitalized [H-]RSV). All analyses were descriptive. Physicians (n&#x202f;=&#x202f;682) provided data on 1,581 patients with RSV (15.0% A-RSV, 12.4% O-RSV, 37.2% P-RSV, and 35.4% H-RSV). For their current RSV infection, patients had a mean of 4.3 visits to any healthcare provider (A-RSV: 3.1-H-RSV: 4.6). H-RSV patients received nearly four times as many tests as A-RSV patients, with 54.8% receiving drugs (versus <37% in other subgroups). Overall, 87.4% of H-RSV patients stayed in hospital overnight (mean stay duration: 7.2 nights). Of all patients, 36.8% required supportive care, with 93.3-98.4% receiving non-professional care. Mean overall work impairment was 53.0% (n&#x202f;=&#x202f;24), with 18.0% of the 373 patients who responded reporting unpaid productivity loss. Mean direct costs per patient ranged from &#x20ac;320-&#x20ac;6,900 for A-RSV and H-RSV respectively, with hospitalization driving costs in H-RSV. Drug costs trended higher with disease duration. The indirect cost of supportive care was consistent across groups (&#x20ac;140-&#x20ac;191), meanwhile paid productive loss cost was between &#x20ac;52-&#x20ac;797 and unpaid productivity loss between &#x20ac;25-&#x20ac;415 in A-RSV and P-RSV, respectively. RSV poses a high economic burden in older adults across disease stages, increasing numerically with symptom duration and need for hospitalization, highlighting a need for prevention and continued monitoring.

Health literacy (HL) is a key determinant of health behaviors and health outcomes. However, the lack of validated Hindi-language instruments limits its assessment in India. This study aimed to translate, culturally adapt, and psychometrically validate 3 internationally recognized tools-the Short Assessment of Health Literacy in English (SAHL-E), the All Aspects of Health Literacy Scale (AAHLS), and the European Health Literacy Survey Questionnaire (HLS-EU-Q47)-for Hindi-speaking adults in rural North India. A community-based cross-sectional study enrolled 250 adults from 5 villages in Uttar Pradesh. Translation followed forward-backward procedures with expert review and pretesting. Psychometric evaluation included internal consistency (Cronbach &#x3b1;), test-retest reliability (intraclass correlation coefficients, ICC), construct validity (exploratory factor analysis), convergent and known-groups validity, and feasibility indicators (completion rates and interview duration). All instruments demonstrated strong psychometric performance. Cronbach &#x3b1; values were 0.84 (SAHL-E), 0.87 (AAHLS), and 0.93 (HLS-EU-Q47), and ICCs ranged from 0.86 to 0.94. Factor structures aligned with theoretical expectations. Convergent correlations ranged from 0.42 to 0.61 (p<0.001), and known-groups validity analyses showed significant differences according to education and occupation. Completion rates exceeded 98%, and the mean interview duration was approximately 32 minutes. The Hindi-adapted SAHL-E, AAHLS, and HLS-EU-Q47 demonstrated strong reliability, validity, and feasibility for assessing HL among rural adults in India.

Socioeconomic disadvantage is associated with severe maternal morbidity (SMM), across high-income countries. However, neighbourhood-level measures of disadvantage, often used in population-based studies, may underestimate the effect of individual socioeconomic disadvantage. This study aimed to compare the strength of the associations between individual- and neighbourhood-level measures of socioeconomic disadvantage and SMM risk in a high-income country. We conducted a nationwide, population-based cohort study using the Dutch Data InfrAstructure for ParEnts and childRen (DIAPER). The cohort consisted of 832&#x2009;866 women who gave birth in the Netherlands between 1 January 2012, and 31 December 2021. Multilevel multivariable Poisson regression was used to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for individual and neighbourhood-level measures of socioeconomic disadvantage. The role of pre-existing physical and mental health conditions in this association was examined using causal mediation analysis. Individual-level measures of socioeconomic disadvantage showed the strongest association with SMM, with the largest risk ratio of SMM between women with individual low educational attainment compared to those with high educational attainment (aRR 1.41, 95% CI 1.33-1.50), whereas the aRR for low compared to high neighbourhood education was 1.21 (95% CI 1.14-1.28). Physical health conditions mediated between 11% and 29% of the association with SMM across the different measures of disadvantage. Individual measures of socioeconomic position are more strongly associated with SMM than neighbourhood-level measures and pre-existing physical health conditions are important factors in this association. Future research should recognize the potential underestimation of risk when using neighbourhood-level disadvantage as a proxy for individual disadvantage.

Gastric cancer continues to impose a substantial health burden in Europe. The European Council Recommendations have called for consideration of implementing measures aimed at reducing gastric cancer-related mortality. This manuscript reviews current gastric cancer prevention initiatives in Europe. The GISTAR study in Latvia has been enrolling participants from the general population for Helicobacter pylori screen-and-treat intervention together with serological testing for pepsinogens. The EUROHELICAN study was the first to evaluate an H. pylori screen-and-treat strategy in young adults, which has been expanded within the TOGAS project. In addition, TOGAS has addressed stakeholder perspectives, the cost-effectiveness of screen-and-treat strategies, and the prevalence of gastric precancerous conditions among individuals participating in colorectal cancer screening. The GISTAR cohort has also enabled the assessment of long-term outcomes following H. pylori eradication. The EUGastScreen project, carried out within the EUCanScreen Joint Action, aims to evaluate the feasibility of simultaneous screening for H. pylori infection and colorectal cancer using a stool-based test. The European Registry on H. pylori Management (Hp-EuReg) supports the collection of important clinical data from routine clinical practice. Furthermore, the development of European guidelines for gastric cancer prevention has been initiated as part of the European Commission Initiative on Gastric Cancer and is expected to continue until 2027. The recently published 5th edition of the European Code Against Cancer includes recommendations on H. pylori management for the first time. Ongoing initiatives will provide important evidence to support the future implementation of gastric cancer prevention strategies, including data on feasibility, acceptability among the general population and stakeholders, and cost-effectiveness. However, additional implementation studies for gastric cancer prevention will be required.

Against the backdrop of population ageing and growing labour shortage, Healthy Life Expectancy (HLE) in working age represent a key resource for individual wellbeing and economic growth. This study investigates how age-specific trends shape the development of HLE within working age and whether these trends differ between health indicators. We used the German Socioeconomic Panel to calculate HLE between age 18 and 64 for three periods between 2002 and 2022 (N&#x2009;=&#x2009;232&#xa0;393) based on Self-rated Health (SRH), mental and physical Health-related Quality of Life (p/mHRQoL). We decomposed changes in HLE over time into the contributions by age group and distinguished between morbidity and mortality contributions. For men, HLE increased in terms in SRH but remained largely unchanged in terms of mHRQoL and pHRQoL. For women, HLE decreased in terms of SRH and pHRQoL while it remained stable for mHRQoL. Deteriorating health in younger working-age groups strongly contributed to decreases in HLE while improving health at older working age fostered increases in HLE. Mortality contributions were minor. We found divergent contributions to trends in HLE by age group with the younger working-age population fostering decreases in HLE while older age groups fostered an increase. Furthermore, trends differed by health indicator, which underlines the importance of analysing more than one indicator whenever possible. The findings are worrying and suggest that the labour force may decline not only due to population ageing, but also due to the deteriorating health, posing growing challenges for both health and labour market policies.

Diabetes mellitus (DM) is currently one of the main public health challenges, not only because of its physical complications, but also because of the emotional impact associated with its chronic management. Diabetes distress (DD) is defined as the emotional response that results from living with DM and the consequent self-care required to manage it. The Diabetes Distress Scale (DDS-17) is an instrument used to assess DD. The aim of this study was to translate and culturally adapt the DDS-17 into European Portuguese, assessing its psychometric properties. Cross-sectional study divided into three phases: translation and back-translation; cultural adaptation with pre-testing in 30 patients; and psychometric validation (descriptive analysis of the items, exploratory factor analysis and reliability analysis) with 170 patients with type 2 DM from three Primary Care Units of the Braga Local Health Unit. The European Portuguese version of the DDS-17 replicated the four original factors. Internal consistency was high (total Cronbach's alpha = 0.89), with all subscales scoring above 0.70. The overall DD was considered low (M = 1.68), but the "emotional burden related to DM" subscale showed values suggestive of moderate DD (M = 2.07). The European Portuguese version of the DDS-17 showed adequate validity and reliability and could be used in clinical and research contexts to better understand and manage DD in patients with type 2 DM in Portugal.

BACKGROUND This cross-sectional observational study evaluated whether the severity of menopausal symptoms, insomnia, and depression is associated with decreased quality of life in peri- and postmenopausal Polish women. MATERIAL AND METHODS A total of 287 peri- and postmenopausal white European women aged 45 to 60 years were included. Exclusion criteria were hormone replacement therapy, chronic diseases or cancer, drug or alcohol addiction, psychiatric disorders, and cognitive impairment. Menopausal symptoms, insomnia, depression, and quality of life were assessed using the Greene Climacteric Scale, Athens Insomnia Scale, Beck Depression Inventory, and WHO Quality of Life-BREF questionnaire, respectively. RESULTS Postmenopausal women reported more severe psychological (10.5 vs 8.7, P=0.027) and vasomotor menopausal symptoms (2.2 vs 1.2, P<0.001) and had lower overall quality of life (3.4 vs 3.6, P=0.019), physical health (3.7 vs 3.9, P=0.014), and social relationships scores (3.5 vs 3.7, P=0.007) compared with perimenopausal women. Perimenopausal women living in rural areas experienced more severe psychological menopausal symptoms than those in urban areas (11.4 vs 8.2, P=0.036). Among postmenopausal women, lower educational level was associated with more severe vasomotor symptoms, compared with a university degree (2.6 vs 1.9, P=0.036). Severity of insomnia and depression did not correlate with education, residence, or marital status (P>0.05). Lower educational level and single marital status were associated with poorer quality of life. CONCLUSIONS Decreased quality of life was associated with greater severity of menopausal symptoms, insomnia, and depression. Identification of factors reducing quality of life in peri- and postmenopausal women may support early intervention and improve long-term functioning.

The spouses of women with gestational diabetes mellitus (GDM) seem to be at risk of developing type 2 diabetes and cardiovascular diseases (CVDs). We comparatively analysed the risk factors, lifestyle, socioeconomic factors, and health of the spouses of women with (cases, n&#x2009;=&#x2009;599) and without (controls, n&#x2009;=&#x2009;586) GDM. This cross-sectional study utilized data from the Finnish Gestational Diabetes study. Data of the spouses were collected using a structured questionnaire: socioeconomic factors, smoking, alcohol consumption, health, own perinatal health, and family history of diabetes and CVDs. Age-adjusted odds ratios (aORs) were analysed using multivariate logistic regression. The mean ages of the cases and the controls were 33.5&#x2009;years and 31.2&#x2009;years, respectively [mean difference: 2.4&#x2009;years, 95% confidence interval (CI): 1.68-3.02]. The mean body mass index of the cases (26.9&#x2009;kg/m2) was 0.78&#x2009;kg/m2 (95% CI: 0.34-1.21) higher than that of the controls. Fewer cases attained the highest educational level (13.5% vs. 16.9%, aOR 0.64, 95% CI: 0.46-0.90). The cases reported more often alcohol consumption (85.4% vs. 78.7%, aOR 1.59, 95% CI: 1.16-2.17); chronic disease, impairment, or disability (17.4% vs. 12.6%, aOR 1.43, 95% CI: 1.03-2.00); or mental disorder (8.0% vs. 5.1%, aOR 1.63, 95% CI: 1.01-2.64). The cases reported more risk factors for adverse health outcomes, more chronic diseases and mental disorders than the controls. Therefore, lifestyle counselling should also be provided to the spouses of women with GDM.

Mycotoxin contamination remains a persistent threat to food safety in the Democratic Republic of the Congo (DRC) and neighboring countries, driven by conducive tropical agroecological conditions, inadequate post-harvest practices, and limited regulatory governance. This critical narrative review (2009-2024) synthesizes the occurrence data for major staple foods (maize, peanuts, cassava, sorghum, millet, and beans) and dairy products compiled from Google Scholar, ScienceDirect, MDPI and institutional sources. It examines the co-occurrence patterns, exposure pathways, and analytical and regulatory gaps. Warm, humid lowland environments favor Aspergillus and aflatoxins, whereas cooler, humid highland zones promote Fusarium, fumonisins, and deoxynivalenol. Across commodities, contamination intensifies along food value chains through inadequate drying, non-hermetic storage, insect damage, and prolonged handling, with processed products generally exhibiting the highest levels of mycotoxins. Regulated mycotoxins, including aflatoxins, fumonisins, trichothecenes, ochratoxins, and zearalenone, frequently exceed European Union (EU), East African Community (EAC), and Codex Alimentarius Commission (CAC) limits in staple foods. Their co-occurrence is widespread, including emerging mycotoxins such as beauvericin and enniatins, particularly in maize- and peanut-based products, raising concerns about potential additive or synergistic effects. Aflatoxin M1 in milk highlights plant-feed-animal-human transfer within a One Health framework. Despite increasing evidence, the available data remain fragmented and heterogeneous; rapid tests dominate, while few studies employ multi-mycotoxin LC-MS/MS methods. Cross-border trade between countries, such as Uganda, Tanzania, Zambia and Angola, facilitates the circulation of contaminated commodities in the absence of harmonized standards and risk-based controls. Priorities include harmonized regional surveillance, biomarker-based co-exposure assessment, cost-effectiveness evaluation of mitigation strategies, and regulatory alignment at borders. Coordinated, multisectoral action is essential to reduce chronic dietary exposure and improve food safety across the region.

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, requires consistent high-quality care to reduce variation in patient experience and improve outcomes. The IBD Standards previously published in 2009, 2013 and 2019 have provided an aspirational framework for best practice. Since 2019, two rounds of national benchmarking with patient engagement, healthcare professional (HCP) consultation and new evidence have highlighted areas for quality improvement (QI). We aimed to develop the 2026 IBD UK Standards of healthcare for adults and children, ensuring they reflect current and aspirational best practice and to support future QI initiatives. A multidisciplinary working group of 18 HCPs and 4 people with lived experience assessed the 59 IBD standards from 2019, categorising them as needing no change, minor or major amendment or deletion. New standards were developed through iterative drafting and consensus review, with feedback incorporated from 47 external HCPs and a patient workshop. The 2026 standards remain aspirational, structured across seven domains: the IBD service, pre-diagnosis, newly diagnosed, flare management, surgery, inpatient care and ongoing care. The 2026 IBD UK Standards comprise 60 statements: 6 unchanged from 2019, 48 updated, 7 deleted and 6 new. Key themes include multidisciplinary, coordinated care with defined leadership; age-appropriate transition pathways; timely referral from primary care, access to diagnostic tests, treatments and surgery; patient-centred care, including better communication, personalised care plans, shared decision-making and support for self-management; holistic assessment and management of physical, nutritional and psychological need; QI and audit supported by electronic systems; research participation and innovation. The 2026 IBD UK Standards provide a contemporary aspirational framework to drive consistent, high-quality, personalised care across the UK. They aim to reduce inequality, improve experience and outcomes through support for patient-centred shared decision-making, national benchmarking, service development, patient involvement and QI.