Seafarers in the international maritime industry face longstanding mental health challenges due to the remote and demanding nature of their occupations. During the COVID-19 pandemic, these challenges were exacerbated by extended contracts, limited shore leave, and restricted access to essential services ashore. This study presents the first exploration of seafarers' mental health in Canada during the pandemic. A cross-sectional survey was conducted between February and December 2022 utilizing the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety. Eligible participants were those who worked in Canadian waters since the declaration of the COVID-19 pandemic in March 2020. Among 581 participants, 31.8% screened positive for anxiety and 39.4% for depression. Despite the high prevalence of symptoms, 77.2% to 80.8% reported good to excellent self-perceived mental health, indicating the need to interpret findings through a dual-continuum perspective that considers mental health and mental illness as distinct yet interconnected constructs. The findings underscore the necessity for proactive policy interventions to enhance mental health promotion in the maritime industry. By advocating for a dual-continuum approach that incorporates both mental illness and mental health, this study contributes to the growing recognition of mental health as a critical component of seafarers' overall well-being and productivity. Adapting Canadian mental health policies could improve the well-being and retention of a workforce essential to the national and international maritime industry.
The COVID-19 pandemic and intensifying climate-related disasters have highlighted the necessity of integrating psychosocial health and disaster risk management strategies. In the post-pandemic context, it is important to understand the psychosocial vulnerability factors that exacerbate stress and depression in order to inform interventions that enhance resilience during disaster preparedness and recovery efforts. Self-reported stress and depression were evaluated to assess risk and protective factors using questionnaires that were completed by 340 out of 446 participants in Durán, Ecuador in 2021. Considering social vulnerability factors of exposure, sensitivity and adaptive capacity at individual and urban levels, this study applied Kendall's tau and odds ratio analyses to explore associations between stress and depression, identifying risks and protective factors within the sample population. Women (68.5%) self-reported to be vulnerable to moderate stress (67.8%) and mild depression (29.6%). There was a positive association between stress and depression levels (0.42, p: < 0.02). Odds ratio indicated adults experienced moderately severe stress, while those who were in domestic partnership had a 20% reduced risk of stress. Participants living in collective housing and rooms in tenement housing and apartments were more likely to experience higher levels of stress. Depression levels are associated with chronic illnesses (p < 0.02), residing in areas lacking paved roads (p < 0.005), without access to water (p < 0.036), and without COVID-19 vaccination (p < 0.043). The Duran study revealed the complex nature of psychosocial health, shaped by individual vulnerabilities, deficient urban infrastructure, and limited capacities of city systems. In the long-term recovery process, the integration of mental health and disaster risk management (DRM) would focus on community-engagement for preparedness, equitable access to health/mental services, inclusive urban planning, and partnerships intervention to enhance community adaptive capacity to improve resilience and promote sustainable recovery. In line with the Sendai Framework for disaster risk reduction (DRR), humanitarian emergencies, climate and health crises, and compound risks offer critical opportunities to advance resilience in urban and health systems by addressing structural vulnerabilities, enhancing interinstitutional coordination, and integrating mental and psychosocial health into disaster risk reduction and management strategies.
Nipah virus (NiV) is a highly pathogenic zoonotic henipavirus associated with severe neurological and respiratory disease and a high case fatality rate. Although outbreaks have remained geographically limited, recurrent events in South and Southeast Asia highlight the persistent risk posed by NiV and the potential global consequences of delayed detection and response. In non-endemic regions such as Europe, preparedness presents distinct challenges due to the rarity of cases, stringent biosafety requirements, and reliance on specialised diagnostic and clinical capacities that may degrade without routine use. This narrative review synthesises evidence from peer-reviewed literature and international public health agency reports on NiV biology, epidemiology, diagnostics, treatment, and preparedness, with a particular focus on operational implications for Europe within a One Health framework. We examine determinants of zoonotic spillover and limited human-to-human transmission, outline constraints across the diagnostic pathway including specimen handling and biosafety requirements and summarise current approaches to clinical management and investigational medical countermeasures. Attention is given to how these factors inform risk assessment, diagnostic readiness, and clinical recognition in non-endemic health systems. Preparedness for NiV should be conceptualised as a continuous process of biomonitoring and response rather than an episodic emergency activity. Integrated surveillance across human, animal, and environmental domains is essential for early identification of spillover signals and proportionate public health action. For Europe, sustained preparedness depends on maintaining functional capacity across laboratory networks, clinical services, and public health systems, supported by cross-border coordination and the systematic integration of One Health intelligence.
An integrated assessment of the human-ocean coupled system is urgently needed for sustainable coastal management. This study introduces the Human-Ocean Health Index (HOHI) framework, which is a novel composite index that extends the Ocean Health Index (OHI) framework by integrating three interactive dimensions (sea use coordination, water cumulative effects, and ecosystem services) to evaluate the system health, using the bibliometric analysis method to determine the weights of each dimension, and applying it to Xiamen Bay, China, under four climate and management scenarios. Results indicate that (1) the baseline HOHI (0.751) classifies Xiamen Bay as healthy, with 44% of subzones in a sub-healthy state, particularly in industrial areas, (2) spatially, HOHI was most strongly associated with ecosystem services, though this correlation does not imply causation, (3) climate change alone reduced HOHI (-2.40%), whereas restoration management increased it (+1.5%), confirming the potential of interventions to mitigate impacts. Crucially, further expanded restoration led to a net decline in HOHI (-0.81%) due to exacerbated sea-use conflicts, revealing a critical spatial trade-off. (4) The HOHI demonstrated high analytical robustness: bootstrapping revealed minimal inherent uncertainty (coefficient of variation <0.11%, 95%CI width < 0.03), and a sensitivity analysis confirmed that core findings on scenarios ranking were independent of the weighting method. These findings offer an evidence-based diagnostic tool for evaluating the potential implications of marine spatial planning and ecosystem health assessment.
Poland, a Central European country with the population of 37.5 million and a steadily improving economic situation, has experienced a continuous increase in the number of international travels, exceeding 15 million annually. The aim of this article was to profile Polish travellers seeking pre-departure advice between 2024 and 2025 at the largest diagnostic and treatment center for tropical and travel medicine in Poland. This retrospective study was based on the analysis of medical records of patients seeking pre-travel consultations at the University Centre of Maritime and Tropical Medicine in Gdynia, Poland. The dataset included 2,197 visits recorded in 2024 and 3,073 visits in 2025. The analysis focused on the following variables: age, sex, and travel-related characteristics, including purpose of travel, duration of stay, month of departure, and planned destinations by continent and country. The scope of preventive measures recommended or administered during consultations, including immunoprophylaxis and chemoprophylaxis, was also evaluated. Additionally, the health status of patients presenting to the travel medicine centre was assessed. Patients seeking pre-travel advice were predominantly aged 18-35 years (49.5%) in 2024 vs. 46-65 years (50.5%) in 2025. Most of the examined patients travelled for tourism purposes, typically for up to 4 weeks, with departures most frequently planned for November, January, and February. The majority of travellers intended to visit Asia and Africa, most commonly Thailand (22.3% in 2024, 21.0% in 2025), Vietnam, Kenya, Indonesia, Tanzania, and India. The most frequently administered immunoprophylaxis included vaccinations against typhoid fever, hepatitis A, tetanus/diphtheria/pertussis/poliomyelitis and rabies. Other commonly recommended preventive measures included insect repellents, sunscreen, antidiarrheal medications, antimalarial drugs, and antithrombotic agents. Analysis of patient interviews showed that 41.4% of travellers admitted at the UCMTM in 2024 had underlying medical conditions. In contrast, among patients presenting for pre-travel consultations in 2025, as many as 62.0% reported various health problems. The most commonly reported medical conditions included allergies, thyroid disorders, cardiovascular diseases, psychiatric disorders, and gastrointestinal diseases. A substantial proportion of Polish travellers visit destinations associated with an increased risk of infectious diseases. At the same time, due to the ageing of the Polish population, individuals aged 46-65 travel more frequently, including patients with chronic diseases or disorders. Providing professional medical advice during pre-travel consultations plays a crucial role in reducing the risk of travel-related health problems and improving overall travel safety.
Wastewater-based surveillance represents a non-invasive approach to monitor pathogen circulation, but data on cruise ships are scarce, although this enclosed environment is prone to infectious diseases spreading. We conducted a pilot study in a Mediterranean seaport (Italy) between July and October 2024, combining wastewater monitoring with onboard clinical surveillance. Twenty wastewater samples (10 untreated and 10 treated) were collected from 10 cruise ships. Viral detection targeted 10 human respiratory and gastrointestinal viruses. Bacterial and viral indicators (total coliform, Escherichia coli, intestinal enterococci, and somatic coliphages) were analyzed to evaluate wastewater treatment performance. Aggregated clinical data were extracted from medical reports and categorized using ICD-10 codes for symptoms of likely infectious viral origin. Norovirus genogroup II was consistently detected in untreated sewage (100%), followed by SARS-CoV-2 (60%), human adenovirus (30%), enterovirus, rotavirus, and hepatitis E virus (10-20%). Viral loads decreased in treated samples, although wastewater treatment efficiency varied widely among vessels: some ships exhibited a logarithmic abatement of less than 2 log10 units, with effluents showing microbiological concentrations above the thermotolerant coliform benchmark established for sewage treatment plant certification by the International Maritime Organization (IMO) guidelines. Clinical surveillance recorded more respiratory than gastrointestinal cases, with COVID-19 and influenza confirmed in several arrivals. The integration of environmental and clinical data provided complementary insights, particularly for SARS-CoV-2 detection in wastewater, which occurred in around 85% of ship arrivals with clinically diagnosed COVID-19 cases. These findings demonstrate that wastewater monitoring can complement clinical surveillance on cruise ships, by offering information on viral circulation. The variability observed in treatment efficacy underscores the need for harmonized standards and supports the inclusion of wastewater monitoring in maritime preparedness and resilience strategies to strengthen public health security against emerging infectious threats and enhance system adaptability to future outbreaks.
Dear Readers, Welcome to this new issue of the International Maritime Health Magazine. Maritime medicine often advances not in times of stability but through the careful analysis of events that test existing systems. Whether we are managing a complicated medical repatriation, responding to an infectious disease outbreak, or striking a balance between clinical requirements and operational realities, dealing with a difficult situation will provide us with a lesson. This issue reflects that principle. An analysis of the outbreak onboard the MV Hondius included in this issue goes beyond the clinical aspects of infectious disease to examine the more general issues of operational decision-making, international coordination, communication, and public health responsibility at sea. Events such as this one remind us that, at times, the effectiveness of international frameworks depends not only on their existence, but also on how they perform under the pressures of real-world operations. This issue also marks the introduction of our new The Decision Deck section. The aim of this section is to encourage reflection and clinical reasoning, particularly in situations where decisions must be made with limited resources or conflicting operational priorities. In many respects, both the analysis of the MV Hondius and the case presented in The Decision Deck reflect the same principle: maritime medicine evolves through the continuous examination of difficult situations. Through this process of reflection and debate, our field continues to strengthen and adapt to a complex and constantly evolving maritime environment. We hope that this issue will foster an ongoing dialogue among the various disciplines that contribute to our maritime and hyperbaric medicine community.
Schistosomiasis remains a public health concern in sub-Saharan Africa, affecting over 250 million people. In endemic settings, schistosomiasis transmission is not always understood exclusively in biomedical terms. Community health workers (CHWs) contribute to schistosomiasis control through mass drug administration and health education, yet limited evidence exists on how they understand schistosomiasis transmission. This study explores how CHWs in Côte d'Ivoire, Kenya and Uganda explain schistosomiasis transmission and how these explanations relate to wider disease and training contexts. This paper draws on the CHW component of a larger mixed-methods study conducted in Côte d'Ivoire, Kenya and Uganda, with multiple respondent groups. We present findings from interviews and focus group discussions with CHWs. Data were analysed thematically, at both semantic (descriptive) and latent (interpretive) level, employing Kleinman's framework of explanatory models and Good's work on semantic networks to support interpretation. CHWs expressed multiple understandings of schistosomiasis transmission. Most described schistosomiasis transmission in biomedical terms, often emphasising skin contact with contaminated water. Others combined biomedical terms with locally circulating ideas about disease transmission, linking infection to drinking unsafe water, stepping on faeces, flies or other diseases such as trachoma or diarrhoeal illnesses. These understandings emerged in relation to a complex disease landscape in which signs, symptoms and perceived transmission routes overlapped. They were also situated within uneven training experiences, including irregular refresher sessions, variable access to schistosomiasis-specific training and training focused mainly on treatment campaign logistics. CHWs' varying understandings of schistosomiasis reflect not only individual knowledge but also the broader disease landscape and training contexts in which they work. Strengthening schistosomiasis communication therefore requires attention to how CHWs interpret, adapt and combine disease-specific information with other sources of knowledge, and to how training can better prepare them to navigate similarities and differences between disease-specific messages in everyday practice.
Health inequalities by sex/gender, migration, education and income persist across Europe, yet intersectionality-informed research on how these social positions jointly shape self-rated health (SRH) remains limited. We conducted a cross-sectional analysis of the German National Cohort (NAKO; n=179 861). Sex/gender, education and income were combined with three migration characteristics (any migration, Turkish and ethnic German resettler backgrounds) into three 16-strata exposure variables. We used Poisson regression with robust SEs to estimate adjusted frequencies and relative risks of poor SRH, adjusting for age, household size and study site. Departures from additivity were assessed using two-, three-, four-way and total relative excess risk due to interaction (RERI). Poor SRH followed a social gradient. Adjusted frequency of poor SRH generally increased with each additional marginalised social position, from 6.3% (95% CI 5.5% to 7.2%) among high education and income migrant men to 22.6% (95% CI 21.3% to 23.8%) among low education and income migrant women. Adjusted frequencies were highest among participants with Turkish background. Joint exposure to female sex/gender, migration and low education and income was associated with risk of poor SRH beyond the sum of individual effects. Total RERIs for four-way intersections were 1.10 (95% CI 0.83 to 1.37) for any migration, 3.09 (95% CI 2.02 to 4.15) for Turkish and 1.62 (95% CI 0.84 to 2.41) for ethnic German resettler backgrounds. SRH in Germany exhibits pronounced intersectional inequalities. Individuals occupying multiple marginalised social positions experienced a disproportionate burden of poor SRH, highlighting the importance of intersectionality in population health monitoring.
Physical activity (PA) is safe and beneficial for children and adolescents diagnosed with cancer, yet most engage in low levels of PA. We developed IMPACT (IMplementation of Physical Activity for Children and adolescents on Treatment), a PA intervention delivered by videoconference to enhance PA among young people during treatment for cancer and blood disorder diagnoses. IMPACT is being evaluated in a type II hybrid effectiveness-implementation trial in Alberta, Canada. While referral rates are high and early visual analyses suggest IMPACT may enhance PA and aspects of quality of life and physical function, participation, retention, and adherence rates are low. Findings signal the positive effect of IMPACT for those who participate and underscore the necessity of implementation adaptations. On the basis of these early findings, a demonstrated desire, and funding for PA at sites across Canada, we must first reimagine IMPACT through active collaboration with research users-those who will refer to and/or use or benefit from the intervention. Over the next 5 years, our larger research program will (1) co-adapt IMPACT and prepare for scaling (phase 1) and (2) implement and evaluate co-adapted IMPACT across additional provinces in Canada (phase 2). Specific aims for phase 1 are detailed herein and include (1) identifying necessary IMPACT modifications, (2) examining site-specific factors influencing IMPACT implementation, and (3) developing an implementation research logic model to guide continued scaling. An integrated knowledge translation and patient-oriented research approach and pragmatic orientation have been adopted. A multiple-perspective mixed methods study is underway. Descriptive surveys and interviews, guided by the Consolidated Framework for Implementation Research 2.0, are being conducted with key research user groups, including children and adolescents diagnosed with cancer and blood disorders (on- and off-treatment), carers, health care providers, and support organization personnel. Data will be analyzed using descriptive statistics and framework analysis. An implementation research logic model will be developed with participants and IMPACT co-adaptation advisory board members and program partners and collaborators. Funding was secured, and initial ethics approval was granted on June 10, 2025. Additional administrative and full approvals were secured subsequently. Recruitment started in July 2025 in British Columbia and is commencing across sites in a staggered manner. Full results (ie, all site-specific modifications and implementation strategies and the final version of the implementation research logic model) are expected to be submitted for publication late 2026. Co-adaptation of IMPACT with research users will enhance the likelihood of relevance, acceptability, and uptake nationally. The resulting data will inform a model to guide continued scaling and a larger trial evaluating the co-adapted IMPACT intervention across British Columbia, Ontario, and the Maritime provinces. This work reimagines IMPACT for broader applicability across varied Canadian contexts.. DERR1-10.2196/92574.
Commercial fishing remains one of the most hazardous occupations globally, with smallscale fleets exhibiting persistent safety challenges. In Türkiye, fishing operations are characterized by low regulatory compliance, insufficient training, and fatigue-related risks. This study assessed occupational health and safety (OHS) compliance levels among Turkish fishing vessel crews and identified key predictors of safety outcomes across vessel size categories. A cross-sectional study was conducted (June-August 2018) across Türkiye's Aegean, Marmara, and Black Sea regions, involving 356 crew members from 180 vessels. Data collection included structured questionnaires, observational checklists, and interviews. Analyses employed descriptive statistics, χ² tests, independent t-tests, and multiple linear regression (SPSS v26). Of all participants, 38.8% reported at least one occupational accident in the past year. The most frequent injuries were cuts (12.9%), falls (9.3%), and equipment-related trauma (5.9%). The main contributing factors were the hasty work pace in the workplace (52.2%), inadequate training (28.9%), and fatigue due to long working hours (19.0%). PPE compliance was low at 18%, and only 27% of participants had received formal safety training. A significant association was found between vessel size and accident occurrence (χ² = 12.45, p = 0.002), with smaller vessels having a significantly higher accident risk than larger vessels. Workers involved in accidents reported longer working hours (M = 14.3, SD = 1.8) than their counterparts (M = 13.1, SD = 2.2; p < 0.001). Regression analysis identified formal training (β = 0.35, p < 0.001), education level (β = 0.21, p < 0.001), and vessel size (β = 0.14, p = 0.01) as significant predictors of OHS compliance (R² = 0.29). Occupational health and safety compliance in Türkiye's fishing sector remains inadequate, particularly for small-scale vessels. Prioritizing training expansion, work-hour regulations, and targeted support for high-risk fleets is essential.
Dear Readers, Welcome to this Special Edition of the IMH Magazine, dedicated to the complex and sometimes unnoticed topic of medical repatriation and maritime Telemedical Assistance Services (TMAS). As you will learn in the pages that follow, in maritime medicine, the decision to send a seafarer home is rarely a simple logistical matter. It is frequently a medical judgment that has been shaped by limited onboard resources, operational realities of the vessel while at sea, and the physician's responsibility to maintain a balance between clinical care and the safety and wellbeing of the individual seafarer. Additionally, the regulatory framework provided by the Maritime Labour Convention (MLC 2006) emphasizes the importance of ensuring appropriate medical care and repatriation when illness or injury occurs far from shore. This issue of the Magazine brings together several perspectives from experienced TMAS practitioners who share insights drawn from their daily clinical work supporting ships around the world. Their contributions highlight the complexity of medical decision-making in maritime environments and the collaborative nature of telemedical assistance. We hope that this special edition will not only be an engaging read but can also serve as a useful reference for maritime health professionals who may one day face the difficult question of when going home becomes, above all, a medical decision. On behalf of the editorial team, thank you for joining us in exploring this important aspect of maritime medicine. Warm regards, James A. Denham, MD Editor, IMH Magazine.
Psychosocial, behavioural, and lifestyle-related barriers can substantially affect the uptake, continued use, and discontinuation of diabetes technology in people with type 1 diabetes (PWT1D). However, structured tools to support healthcare professionals (HCPs) in systematically exploring these barriers in routine care remain limited. To address this gap, a clinically oriented questionnaire was developed by a multidisciplinary panel of diabetes experts. This paper describes the development of the questionnaire and its preliminary evaluation in terms of clarity, comprehensibility, usability, relevance, and perceived acceptability. A panel of 12 diabetes experts from 11 countries across Europe, the Middle East, and Africa (EMEA) reviewed the literature on barriers to diabetes technology use, grouped these barriers into key thematic domains, and developed a structured questionnaire that was translated into multiple languages. The questionnaire then underwent a two-round end-user evaluation involving HCPs and PWT1D to assess clarity, comprehensibility, practicality, relevance, and potential bias. Feedback from the first round informed refinement of the questionnaire before reassessment in a second round. The evaluation was descriptive and focused on end-user feedback; formal psychometric testing and hypothesis-driven validation analyses were not undertaken. The expert panel named the questionnaire LIFESTEPS, reflecting its core thematic domains. The questionnaire covers the following areas of discussion related to barriers to technology: psychological and relational aspects of diabetes, experience with technology and body image, and anticipation and adaptation to new technology. In the first evaluation round, feedback was obtained from 19 HCPs and 37 PWT1D recruited by panel members. Following revision of the questionnaire, a second round involving 5 HCPs and 7 PWT1D was conducted to reassess clarity and usability. Overall, participants reported that the final version of the questionnaire was understandable, perceived as easy to complete, and potentially useful for supporting discussion of barriers to diabetes technology use in clinical practice. LIFESTEPS is a newly developed, multilingual clinical support tool designed to facilitate structured discussion of psychosocial and lifestyle-related barriers to diabetes technology use. The findings provide preliminary support for its clarity, acceptability, and perceived clinical usefulness. Further psychometric and prospective clinical evaluation is needed before broader analytical or predictive applications can be considered. Accordingly, LIFESTEPS should be interpreted as a preliminary conversation-support tool rather than as a validated measurement instrument.
Despite low alcohol consumption across most MENA countries, the burden and management challenges of alcohol-associated liver disease (ALD) remain poorly characterized. This study assessed healthcare providers' perceptions, clinical experiences, and barriers to ALD care in the region. A cross-sectional survey was distributed to clinicians involved in liver disease management in MENA. The survey explored perceived ALD prevalence, diagnosis patterns, clinical practices, access to services, and sociocultural barriers. Selected variables were compared across three subregions (Gulf, North Africa, and Levant & Turkey). A total of 286 providers from 16 MENA countries participated. ALD prevalence was perceived as low or moderate by most respondents, and 52.1% reported an increase in ALD case numbers over the past five years. ALD was commonly diagnosed during routine assessments or at advanced stages. Only 12.9% reported existing national ALD guidelines, and 28.3% had access to specialized clinics. Medical management and nutritional support were widely available, whereas liver transplantation was accessible to 54.5%. Stigma (76.6%) and limited treatment facilities (46.9%) were major barriers. This region-wide assessment highlights major gaps in ALD recognition, clinical pathways, and policy infrastructure. Reducing stigma, strengthening provider training, and developing region-specific guidelines are essential to improve ALD care in culturally sensitive settings.
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.
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The perspective discusses how the suspected Andes virus (ANDV) associated hantavirus cluster on the expedition cruise ship MV Hondius illustrates a critical preparedness gap in managing rare zoonotic infections in mobile, closed, and medically constrained settings. Focusing on the reported multi-country cluster involving severe hantavirus cardiopulmonary syndrome, deaths, and international passenger dispersal, it highlights the associated diagnostic, clinical, and epidemiological challenges. The perspective also explains why ANDV is distinct among hantaviruses, including its documented potential for limited person-to-person transmission during close and prolonged contact, with insights into the virology and pathogenesis of ANDV. Additionally, it highlights ecological exposure hazards in Patagonia, rodent reservoirs, clinical progression, the necessity for laboratory confirmation, candidate severity biomarkers such as IL-6 and intestinal fatty acid-binding protein, and the lack of specific antiviral therapy. Furthermore, it discusses risk factors, including European ethnicity and host genetic susceptibility linked to αVβ3 integrin variation. Overall, this perspective argues that expedition travel, maritime medicine, One Health surveillance and outbreak preparedness must be better integrated in order to detect, investigate and manage rare but high-consequence zoonotic infections before they escalate into international public health events.
BACKGROUND: Neglected tropical diseases (NTDs) remain a major yet unevenly addressed public health challenge in Southeast Asia, where persistent transmission is closely linked to poverty, environmental vulnerability, and health-system constraints. Understanding the evolution of the regional research landscape is essential for informing integrated disease control strategies and strengthening evidence-based policy responses. This study investigated the scientific landscape of NTD research in Southeast Asia, examining temporal trends, thematic trajectories, and patterns of collaboration using a scientometric approach. METHODS: A retrospective scientometric analysis was conducted using Scopus-indexed publications (1906–2024). Eligible records included English-language original research and review articles with at least one Southeast Asian institutional affiliation. Bibliometric performance indicators and science mapping techniques were applied using Bibliometrix (R) and VOSviewer. Analyses included publication trends, citation impact, collaboration networks, keyword co-occurrence, thematic mapping, and conceptual structure modeling. RESULTS: A total of 12,119 publications were identified, demonstrating sustained growth (AGR: 5.48%), with marked acceleration after 2000. Research productivity was concentrated in Thailand, Indonesia, and Malaysia, while several lower-income ASEAN member states exhibited minimal indexed output. International collaboration networks were dense but asymmetrical, with strong linkages to the United States, United Kingdom, Japan, and Australia, and comparatively limited intra-ASEAN integration. Thematic analyses identified dengue as the dominant motor theme, supported by strong vector biology and molecular epidemiology clusters. Helminthic and zoonotic diseases occupied more peripheral positions. Emerging domains included spatial epidemiology, genomic surveillance, and climate-linked modeling, though One Health integration remained structurally underdeveloped. CONCLUSION: Findings delineate a maturing yet structurally bifurcated NTD research ecosystem in Southeast Asia. Strengthening intra-regional scientific networks, diversifying funding architectures, and promoting cross-disciplinary integration will be critical to aligning research production with regional disease burdens and advancing equitable progress toward the WHO 2030 NTD Roadmap. CLINICAL TRIAL REGISTRATION: Not applicable.
Malaria is a leading cause of under-5 mortality in sub-Saharan Africa. In Somalia, Plasmodium falciparum predominates and transmission shows spatial and seasonal variation. This study analyzed subnational inequalities in malaria incidence and mortality among children aged 0-4 years to inform targeted control strategies. This retrospective subnational analysis used modeled annual estimates of Plasmodium falciparum incidence, Plasmodium vivax incidence, and malaria mortality among children aged 0-4 years across Somalia's 18 regions (2010-2019), sourced from the Institute for Health Metrics and Evaluation via the World Health Organization Health Equity Assessment Toolkit. Five inequality measures (Difference, Ratio, Between-Group Variance, Population Attributable Risk, Population Attributable Fraction) were calculated within the Toolkit's online software, following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Plasmodium falciparum incidence rose sharply between 2010 and 2015, peaking at 51.6% in Awdal, and remained elevated in central and southern regions through 2019 (Bay 32.0%; Juba Dhexe 31.1%). Plasmodium vivax stayed low and spatially homogeneous (Difference ≤ 0.3). The between-group variance for Plasmodium falciparum peaked at 64.3 in 2015 and declined to 20.2 by 2019, while the ratio fell from 5.6 to 1.9. Mortality inequalities widened, with the difference rising from 33.9 (2010) to 118.5 (2014), the between-group variance from 100.6 to 1152.7, and the ratio remaining at 4.24 in 2019. Despite narrowing incidence gaps, children in central and southern Somalia were over four times more likely to die than those in least affected regions, reflecting structural healthcare inequalities.
Medical evacuations (MEDEVACs) from offshore installations are both costly and disruptive. Enhancing worker well-being may help reduce evacuations due to illness or injury, thereby maintaining the smooth operation of offshore activities and lowering financial burdens. This scoping review aims to identify whether illness or injury is the predominant cause of MEDEVACs from offshore oil and gas installations and to determine the most common types of illnesses or injuries involved. Additionally, the review outlines a future research agenda focusing on offshore worker health and well-being. A comprehensive structured search was conducted across the Scopus, PubMed, and Web of Science databases, as well as through reference lists and grey literature. Studies were included if they addressedMEDEVACs from offshore oil and gas installations. Eleven articles met the inclusion criteria. Articles indicate that non-occupational illnesses are more frequent causes of MEDEVACs than injuries. Among these, chest pain, cardiovascular issues, and dental problems were disproportionately represented. Contractor personnel were more likely to require evacuation than company employees. Additionally, younger workers were more likely to be evacuated due to injuries. Chronic health conditions were more common reasons for MEDEVACs among older workers. The review highlights the significant role of non-communicable diseases in contributing to MEDEVACs, as opposed to occupational exposures. Investing in preventive health management, targeted research, and workforce education may substantially reduce the prevalence of non-communicable diseases in the offshore environment, lowering MEDEVAC rates, associated costs, and operational disruptions. Further investigation into the underlying causes of ill health among offshore workers is needed to enhance overall workforce well-being.