搜索结果：Management, Monitoring, Policy and Law

In low- and middle-income countries, breaking the intergenerational cycle of malnutrition requires the promotion of healthy nutrition practices and behaviours during pregnancy and early motherhood. This study aimed to explore nutrition practices and behaviours among pregnant women and mothers of children under 2 years who were exposed to the Cash-Plus intervention in tribal districts of Rajasthan, India. Data was collected in December 2024 through in-depth interviews with 46 women which included parity-2 pregnant women and mothers of young children (below 2 years of age), 36 husbands and 34 other family members; plus 7 focus group discussions with 23 frontline workers of four intervention districts. A framework analysis approach was used to identify emerging concepts around practices and behaviours. Participants were positive about the intervention, potentially reflecting the study design. They reported improved practices related to antenatal care, pregnancy weight monitoring and gain, dietary diversity, early and exclusive breastfeeding, and child feeding. These were influenced by the combined effect of consistent interpersonal counselling from trained frontline workers and conditional cash transfers. Counselling improved knowledge and motivation, while cash transfers enabled adoption of resource-dependent practices. Involvement of husbands and mothers-in-law supported the uptake and sustenance of practice and behaviours, alongside emerging peer and community influences. The Cash-Plus intervention supported improvements in maternal and child nutrition practices and behaviours through interacting behavioural, economic and social pathways. Findings highlight the importance of integrated, family-centred approaches that address knowledge and structural barriers, alongside ensuring inclusive intervention design in vulnerable settings. Main findings: Cash-Plus interventions influenced maternal and child nutrition behaviours through interacting pathways, including improved knowledge, financial enablement, intra-household support, and emerging normative change.Added knowledge: This study provides insight into how counselling and cash transfers operate through distinct but complementary mechanisms, with counselling initiating behaviour change and cash transfers enabling and reinforcing resource-dependent practices in vulnerable settings.Global health impact for policy and action: Findings support the design of integrated, family-centred Cash-Plus interventions that address both behavioural and structural barriers, while highlighting the need for inclusive and flexible delivery mechanisms to reach vulnerable populations.

The global opioid crisis has highlighted substantial differences in prescribing, monitoring, and regulatory practices across health systems. In Costa Rica, comprehensive national data on opioid use have been limited. This study aimed to describe temporal trends in legally prescribed opioid consumption between 2017 and 2024 using nationwide administrative data. A nationwide, retrospective, population-based analysis was conducted using data from the Costa Rican Ministry of Health's narcotics registry. Dispensation records for morphine, methadone, fentanyl, oxycodone, and tapentadol were included. Opioid consumption was standardized to Morphine Milligram Equivalents (MME) using NIH HEAL conversion factors. Temporal trends were assessed using descriptive statistics and simple linear regression. A total of 31.9 million opioid dispensations were recorded during the study period. National opioid consumption peaked in 2018 (395.1 million MME), followed by an approximate 70% decline through 2023 and a modest increase in 2024. Consumption of morphine and methadone declined substantially (-72.2% and -82.4%, respectively), while oxycodone and tapentadol showed moderate increases over time. These findings indicate a marked reduction in overall opioid consumption alongside changes in the distribution of use across opioid agents. Between 2017 and 2024, Costa Rica experienced a sustained decline in total opioid dispensing and a redistribution of opioid use across substances. These trends occurred in the context of strengthened regulatory oversight and expanded digital monitoring of controlled substances. While causal relationships cannot be established, the findings provide relevant population-level evidence to support opioid stewardship and inform regulatory and public health strategies in middle-income health systems. This study examined how patterns of legally prescribed opioid use in Costa Rica changed between 2017 and 2024 using official national data from the Ministry of Health. Opioids are medications used to treat moderate to severe pain, but they require careful monitoring because they are associated with risks such as dependence and overdose. To describe national trends, we analyzed pharmacy dispensation records for several commonly used opioids and converted all doses into morphine milligram equivalents (MME), a standard measure that allows comparisons across different drugs. We found that opioid consumption in Costa Rica reached its highest level in 2018 and then declined by more than 70% through 2023, with a modest increase in 2024. The largest reductions were observed for morphine, methadone, and fentanyl, while oxycodone and tapentadol showed moderate increases over time. Together, these findings describe a redistribution of opioid use across different agents alongside an overall decline in total consumption. These trends occurred during a period of strengthened regulatory oversight, including the implementation of a national Digital Prescription System for controlled substances. Although this study was not designed to determine causal effects, the results provide important population‐level evidence on how opioid dispensing patterns have evolved in Costa Rica. Understanding these changes can help inform future strategies to balance access to effective pain management with patient safety and public health protection.

In 2016, the US Department of Veterans Affairs (VA) implemented a national initiative to distribute video-enabled tablets and peripheral devices, such as blood pressure monitors and weighing scales, to patients facing geographic, clinical, or socioeconomic challenges. Such patients could potentially benefit from health monitoring in conjunction with video-based care, as peripheral devices offer opportunities to enrich care received during a video visit and support tracking of health-related data collected outside of clinical care, or patient-generated health data. However, little is known about experiences with the devices and how they could support improved access to care. We explored patients' experiences with VA-issued peripheral devices and their impact on video-based care and health monitoring outside of clinical visits. We conducted in-depth semistructured interviews among patients who received VA-issued tablets and peripheral devices between 2023 and 2024. Purposive sampling was used to gather views based on gender, age, race or ethnicity, and rurality. Interviews were transcribed and analyzed using rapid qualitative analysis, guided by the Unified Theory of Acceptance and Use of Technology. Among 25 patients, most received a blood pressure monitor (21/25, 84%), a weight scale (14/25, 56%), and/or a pulse oximetry device (12/25, 48%). The majority reported using their peripheral devices (23/25, 92%) and tablets (19/25, 76%) to monitor their vital signs and attend video visits. Qualitative analysis yielded ten themes reflecting experiences and impacts of the devices, organized by the Unified Theory of Acceptance and Use of Technology constructs: "effort expectancy" consisted of (1) familiar and easy to use devices and (2) challenges of Bluetooth pairing and measurement; "performance expectancy" consisted of (3) integration with video visits, (4) health monitoring for peace of mind, (5) perceptions of improved vital signs and lifestyle behaviors, (6) removing obstacles to in-person care, and (7) desiring an overall picture of health; "social influence" consisted of (8) fostering care team connections and (9) promoting awareness of tablets and peripheral devices; and "facilitating conditions" consisted of (10) supportive help desk infrastructure. Overall, patients described using peripheral devices during virtual visits by syncing data to the tablet for real-time access by their care team. They also reported manually tracking and sharing patient-generated health data with their care team. Despite some challenges with Bluetooth pairing, patients found the devices easy to use and contributed to improved health and motivation. Devices also reduced logistical burdens of in-person visits, especially for those with limited mobility, visual impairments, mental health needs, or transportation barriers. Patients perceive that peripheral devices can enhance video-based care and support health care access and chronic disease management. Patients reported benefits to health, behavior, and communication with care teams. To maximize the impact, program enhancements should prioritize device interoperability, accessible training, and expanded outreach.

Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04-10·3) incident cases of all-form TB, 1·22 million (0·98-1·49) deaths, and 54·6 million (43·8-65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000-879 000) incident cases and 210 000 (142 000-279 000) deaths, contributing 11·0 million (7·56-14·3) DALYs. MDR-TB accounted for 466 000 (198 000-1 080 000) incident cases, 102 000 (31 700-238 000) deaths, and 3·96 million (1·31-9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8-20·5) and deaths declined by 22·6% (4·7-35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000-970 000) and DALYs to 34·9 million (27·8-43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400-183 000) and DALYs to 3·12 million (1·03-7·29). Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. Gates Foundation.

How should the number of offspring per gamete donor be regulated at an international level? The European Society of Human Reproduction and Embryology (ESHRE) recommends introducing a European Union (EU)-wide limit on the number of families per gamete donor, starting at 50 families and gradually reducing it to a maximum of 15 families or lower, supported by an EU-wide donor registry to monitor compliance. Most European countries impose national limits on the number of offspring or families per donor, but these limits vary widely and are not always enforced. Cross-border movement of patients and the export of donor gametes between countries mean that large donor sibling groups can still emerge despite these restrictions. What matters to donor-conceived people is the total number of donor siblings, regardless of which country they are in, making a transnational limit the only relevant mechanism that can address this issue. This position paper sets out principles relevant to international donor offspring limits and the position and policy recommendations of ESHRE, focusing on the EU level. This ESHRE position paper was developed by a multidisciplinary expert working group. Recommendations are supported by data from the literature, where available. The first version was published for stakeholder review in November 2025, with 45 completed review forms received from organizations representing donor-conceived people, families built through donor conception and infertility patients, national fertility societies, researchers, professionals from different disciplines, and gamete banks. The paper was then revised on the basis of the stakeholder review. ESHRE considers that the wellbeing of donor-conceived people should have the highest priority when determining limits, while also balancing the wellbeing of prospective parents. Limits should be set for the number of families rather than individual children. ESHRE proposes a phased introduction starting at 50 families per donor, being reduced to a maximum of 15 families or lower, alongside a 20-year cap on distributing gametes to new families after the first donation. National limits should still be upheld where they are lower, and donors should be able to set their own lower personal limit. Compliance should be monitored through an EU-wide donor registry or, failing that, national registries, with gamete banks (including non-EU banks exporting into the EU) obliged to enforce the limit, donors required to declare all previous donations, and families counted as potential live births unless confirmed otherwise. The evidence base on the psychosocial impact of large donor sibling groups is small and developing, and definitive evidence of harm is limited. Research on the preferences of donor-conceived people, donors, and recipients regarding offspring limits is scarce and inconclusive. These recommendations therefore take a precautionary approach, and the proposed 15-family limit should be reviewed in light of developing knowledge during the transition period. An EU-wide limit would represent a feasible first step towards an international limit. An EU-wide donor registry could potentially serve secondary purposes such as supporting tracing in case of the diagnosis of a serious genetic condition and giving access to information to donors and donor-conceived people. Support for the working group was provided by ESHRE. L.F. and C.C.-J. report travel support from ESHRE. D.P.B. reports speakers' fees from Merck, Ferring, Gedeon Richter and MSD, travel support from ESHRE, and a position as the president of the Croatian Society for Gynaecological Endocrinology and Human Reproduction. A.A. reports speakers' fees from Merck Healthcare KGaA and Ferring, travel support from ESHRE, passive shareholder interest in Inception Midco 1. S.à r.l., membership in a subgroup of the European Medical Devices Coordination Group, and a position as vice chair of the EXPAMED panel on obstetrics, gynaecology and reproductive medicine. G.N. reports speakers' fees from Gedeon-Richter and Organon, travel support from ESHRE, and a position as past chairman and member of the Executive Committee of the Bulgarian Association for Human Reproductive Embryology. P.T. reports speakers' fees and travel support from Ferring and Gedeon Richter and a position as a board member on the Arbeitskreis donogene Insemination. J.K.-B. reports speakers' fees from Ferring, IBSA, Merck and CooperSurgical, travel support from Merck and ESHRE, an associate editor position for the journal Andrology, and a position as chair of the scientific advisory committee of the Association for Reproductive and Clinical Scientists (ARCS). The remaining authors (J.T. and N.V.) have nothing to declare. n/a.

Extreme heat, amplified by climate change, has become a predictable and escalating occupational hazard in Türkiye, increasing the burden of heat-related illnesses, traumatic workplace injuries, and productivity losses among both outdoor and indoor workers, particularly in labor-intensive sectors and among vulnerable populations. This Turkish Thoracic Society workshop report synthesizes interdisciplinary expert input and available evidence to propose a practical, prevention-focused framework for regulating working conditions in extreme temperatures. The recommendations were systematically developed through four thematic interdisciplinary working groups and finalized by plenary consensus. Key recommendations include explicitly defining employers' duties to assess, prevent, and manage extreme weather-related risks within Occupational Health and Safety Law No. 6331; establishing secondary regulations that operationalize temperature/Wet-Bulb Globe Temperature (WBGT)-triggered work-rest schedules, hydration and cooling requirements, and acclimatization protocols; and standardizing objective heat-stress monitoring using the WBGT index (aligned with ISO 7243). The report prioritizes engineering and administrative controls (shading, ventilation/cooling, shift adjustments, rest areas, and "buddy systems") over reliance on personal protective equipment, and calls for strengthened labor inspection capacity "through the lens of climate change." Additional policy actions include integrating heat-related outcomes into occupational disease and injury surveillance systems, enhancing inter-institutional coordination for rapid reporting and work-stoppage mechanisms during extreme heat events, and implementing multilingual, sector-specific training and emergency preparedness pathways. Protecting informal and migrant workers, seasonal agricultural laborers, and individuals with chronic cardiopulmonary disease is highlighted as a core priority for equity and climate justice.

Police force recruits have a high musculoskeletal injury burden, which results in a substantial economic burden and can lead to attrition. The objective of this study was to identify and prioritise the strategies perceived as important and feasible to reduce the prevalence, incidence, and burden of injury in police force recruits. Mixed-methods concept mapping study. Forty-eight participants were recruited from four broad groups: police force recruits/officers; police force staff; health professionals; and research experts. Participants brainstormed statements in response to a prompt ("To prevent injury and/or reduce the impact of injury on law enforcement recruit training, I think it's important to….") before sorting and rating the statements/strategies for importance and feasibility. Descriptive statistics, multi-dimensional scaling, hierarchical cluster analysis, pattern matching and Welch's t-tests were applied. Ninety-six unique prevention strategies were identified (42 were above the grand mean for both importance and feasibility). Eight clusters appropriately represented all statements. From highest to lowest mean cluster importance these were: i) clearly communicate physical training program expectations and requirements; ii) prepare for, monitor and manage physical training load; iii) provide best practice injury identification, prevention and management; iv) educate recruits, staff and other stakeholders involved in academy training delivery; v) provide a supportive training environment that promotes health, wellbeing and injury reporting; vi) have experienced staff deliver training and use appropriate equipment; vii) deliver a comprehensive and holistic physical training program; and viii) have appropriate physical entry standards and requirements. We identified 42 strategies above the grand means for both importance and feasibility to reduce the burden of injury in police force recruits. These strategies can be implemented by recruits, staff delivering the training program, and/ or staff managing or governing the training program. Future research should refine how these strategies can be implemented in practice and policy.

Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021-30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). In 2023, there were 50·9 million (95% UI 46·1-56·1) road injury incident cases, 1·34 million (1·04-1·58) deaths, and 75·3 million (59·8-89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10-39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9-39·7) and mortality decreased by 32·3% (6·1-49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7-56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1-7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9-947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Gates Foundation.

In 2018, the Egyptian government enacted a universal health coverage law mandating provision of high-quality, effective and equitable health care. Achieving this mandate would require expanding availability and use of evidence-based national clinical practice and public health guidelines. In 2022, Egypt's Ministry of Health and Population requested support from the World Health Organization (WHO) to establish a national guideline development and adaptation programme. To inform the process, WHO conducted a situation analysis. The findings led to a collaboration between WHO and national stakeholders including the newly established Egyptian Health Council. In partnership they delivered capacity-building, developed a roadmap and implemented the programme. Egypt is a lower-middle income country of 117 million people. Health services are provided by agencies in public (governmental and semi-governmental) and private sectors (providers and professional syndicates). No national guideline programme existed before 2022. In total, 225 individuals attended the capacity-building workshops. After the council ratified the roadmap, the ministry, WHO and the council formally launched the national guideline programme in July 2024. Implementation of the programme led to clearer delineation of responsibilities, eliminated role overlaps and harmonized processes across different professional societies, teaching hospitals, nurses and allied health professionals. Consistent, informed political support and stakeholder commitment contributed to successful implementation. WHO's approach to contextualizing global guidelines added value. Challenges included reliance on international experts, constrained resources and insufficient institutional capacity. Moving forward, sustained institutional development, coaching, monitoring and evaluation, funding and stakeholder engagement are needed. En 2018, le gouvernement égyptien a promulgué une loi sur la couverture sanitaire universelle, imposant la fourniture de soins de santé efficaces, équitables et de haute qualité. Pour mener à bien cette mission, il y a lieu d’élargir la disponibilité et l’utilisation de lignes directrices nationales fondées sur des données probantes en matière de pratique clinique et de santé publique. En 2022, le ministère égyptien de la Santé et de la Population a sollicité l’aide de l’Organisation mondiale de la Santé (OMS) pour mettre en place un programme national d’élaboration et d’adaptation de ces lignes directrices. Afin d’éclairer ce processus, l’OMS a procédé à une analyse de la situation. Ses conclusions ont donné lieu à une collaboration entre l’OMS et les parties prenantes à l’échelle nationale, notamment le Conseil égyptien de la santé nouvellement créé. Elles ont mis en place un partenariat pour assurer le renforcement des capacités, élaborer une feuille de route et mettre en œuvre le programme. L’Égypte est un pays à revenu intermédiaire inférieur comptant 117 millions d’habitants. Les services de santé y sont fournis par des organismes des secteurs public (gouvernementaux et semi-gouvernementaux) et privé (prestataires et syndicats professionnels). Il n’existait aucun programme national de lignes directrices avant 2022. En tout, 225 personnes ont participé aux ateliers de renforcement des capacités. Après la ratification de la feuille de route par le Conseil, ce dernier, le ministère et l’OMS ont officiellement lancé le programme national de lignes directrices en juillet 2024. La mise en œuvre du programme a permis de mieux délimiter les responsabilités, d’éliminer les chevauchements des postes et d’harmoniser les processus entre les différentes associations professionnelles, les hôpitaux universitaires, le personnel infirmier et les professionnels de santé dans le domaine paramédical. Un soutien politique cohérent et éclairé ainsi que l’engagement des parties prenantes ont contribué à la réussite de la mise en œuvre du programme. L’approche de l’OMS visant à contextualiser les lignes directrices mondiales y a apporté une valeur ajoutée. Parmi les défis figuraient la dépendance vis-à-vis d’experts internationaux, des ressources limitées et une capacité institutionnelle insuffisante. Par la suite, un développement institutionnel soutenu, un accompagnement, un suivi et une évaluation, un financement et la participation des parties prenantes seront nécessaires. En 2018, el Gobierno de Egipto promulgó una ley de cobertura sanitaria universal que exige la provisión de una asistencia sanitaria de alta calidad, eficaz y equitativa. El cumplimiento de este mandato requiere ampliar la disponibilidad y el uso de guías nacionales de práctica clínica y de salud pública basadas en la evidencia. En 2022, el Ministerio de Salud y Población de Egipto solicitó apoyo a la Organización Mundial de la Salud (OMS) para establecer un programa nacional de desarrollo y adaptación de guías. Para fundamentar el proceso, la OMS realizó un análisis de situación. Los resultados dieron lugar a una colaboración entre la OMS y las partes interesadas nacionales, incluido el Consejo de Salud Egipcio recientemente establecido. En colaboración, se llevaron a cabo actividades de fortalecimiento de capacidades, se elaboró una hoja de ruta y se implementó el programa. Egipto es un país de ingreso mediano bajo con una población de 117 millones de personas. Los servicios sanitarios son prestados por entidades de los sectores público (gubernamental y semigubernamental) y privado (proveedores y colegios profesionales). Antes de 2022 no existía un programa nacional de guías. En total, 225 personas participaron en los talleres de fortalecimiento de capacidades. Tras la ratificación de la hoja de ruta por el consejo, el ministerio, la OMS y el propio consejo lanzaron formalmente el programa nacional de guías en julio de 2024. La implementación del programa permitió una delimitación más clara de responsabilidades, eliminó la superposición de funciones y armonizó los procesos entre distintas sociedades profesionales, hospitales docentes, personal de enfermería y otros profesionales sanitarios. El apoyo político sostenido e informado, así como el compromiso de las partes interesadas, contribuyeron a una implementación satisfactoria. El enfoque de la OMS para contextualizar las guías globales aportó valor añadido. Entre los desafíos se incluyeron la dependencia de expertos internacionales, la limitación de recursos y la insuficiente capacidad institucional. De cara al futuro, se requieren el desarrollo institucional sostenido, el acompañamiento técnico, el seguimiento y la evaluación, la financiación y la implicación de las partes interesadas. في عام 2018، قامت الحكومة المصرية بسن قانون للتغطية الصحية الشاملة يشترط توفير رعاية صحية عالية الجودة وفعّالة وعادلة. ويتطلب تحقيق هذا الهدف توسيع نطاق توافر واستخدام الممارسات السريرية الوطنية القائمة على الأدلة والمبادئ التوجيهية للصحة العامة. في عام 2022، طلبت وزارة الصحة والسكان المصرية الدعم من منظمة الصحة العالمية (WHO) لوضع برنامج وطني لتطوير وتكييف المبادئ التوجيهية. ولإثراء هذه العملية، أجرت منظمة الصحة العالمية تحليلًا للوضع الراهن. وأدت النتائج إلى تعاون بين منظمة الصحة العالمية والجهات المعنية الوطنية، بما في ذلك المجلس الصحي المصري حديث التأسيس. ومن خلال الشراكة، قدمت هذه الجهات حلولاً لبناء القدرات، ووضعت خارطة طريق، وقامت بتنفيذ البرنامج. مصر دولة ذات دخل متوسط منخفض، ويبلغ عدد سكانها 117 مليون نسمة. يتم تقديم الخدمات الصحية من جانب جهات في القطاعين العام (الحكومي وشبه الحكومي)، والخاص (مقدمي الخدمات والنقابات المهنية). لم يكن هناك برنامج وطني للمبادئ التوجيهية قبل عام 2022. في المجمل، حضر 225 شخصًا ورش عمل لبناء القدرات. بعد مصادقة المجلس على خارطة الطريق، أطلقت الوزارة ومنظمة الصحة العالمية والمجلس رسميًا برنامج المبادئ التوجيهية الوطنية في يوليو/تموز 2024. وقد أدى تنفيذ البرنامج إلى تحديد أوضح للمسؤوليات، والقضاء على التداخل بين الأدوار، وتنسيق العمليات بين مختلف الجمعيات المهنية، والمستشفيات التعليمية، والممرضين والمتخصصين في المهن الصحية المساندة. ساهم الدعم السياسي المتواصل والواعي والتزام أصحاب المصلحة في نجاح التنفيذ. كما أضاف أسلوب منظمة الصحة العالمية قيمة في صياغة المبادئ التوجيهية. وشملت التحديات الاعتماد على الخبراء الدوليين، ومحدودية الموارد، وعدم كفاية القدرات المؤسسية. وللمضي قدمًا، فإن هناك حاجة إلى التطوير المؤسسي المستدام، والتدريب، والرصد والتقييم، والتمويل، وإشراك أصحاب المصلحة. 埃及政府于 2018 年颁布了全民健康覆盖法，旨在强制要求提供优质、有效且公平的医疗保健服务。如要实现该目标，将需扩大循证国家临床实践和公共卫生指南的可获得性和使用范围。. 埃及卫生和人口部于 2022 年请求世卫组织 (WHO) 提供相应支持以构建国家指南制定与改编计划。为了指导流程推进，世卫组织分析了具体情况。根据分析结果，世卫组织和国家利益攸关方（包括新成立的埃及卫生理事会）决定联手合作。在通力合作下，他们开展了能力建设、制定了路线图并实施了该计划。. 埃及是一个拥有 1.17 亿人口的中等偏下收入国家。卫生服务由公共部门（政府部门和半政府部门）和私营部门（提供商和专业行业协会）的相关机构共同提供。在 2022 年之前并未实施任何国家指南计划。. 总计有 225 人参加了能力建设研讨会。卫生理事会批准路线图后，卫生和人口部、世卫组织及卫生理事会于 2024 年 7 月正式推出了国家指南计划。随着计划实施，责任划分变得更加明确，职责重叠现象得以消除，且不同专业协会、教学医院、护士和医务辅助人员之间的工作流程也实现了协调同步。. 持续而明智的政治支持以及利益攸关方的全力投入，保障了该计划的成功实施。世卫组织因地制宜地改编全球指南的方法发挥了增值效应。但是计划实施过程中也存在各种挑战，包括依赖于国际专家、资源有限及机构能力不足。未来还需持续推进机构发展、提供专业指导、进行监督与评估、提供资金支持和确保利益攸关方参与其中。. В 2018 году Правительство Египта приняло закон о всеобщем охвате услугами здравоохранения, которым предусматривается предоставление высококачественной, эффективной и справедливой медицинской помощи. Для достижения этой цели требовалось расширение доступности и использования национальной клинической практики и руководств в области общественного здравоохранения, основанных на доказательных принципах. В 2022 году Министерство здравоохранения и народонаселения Египта обратилось к Всемирной организации здравоохранения (ВОЗ) с просьбой о поддержке в создании программы разработки и адаптации национальных руководств. Для получения необходимой для этого процесса информации ВОЗ провела ситуационный анализ, по результатам которого Всемирная организация здравоохранения начала сотрудничать с национальными заинтересованными сторонами, в том числе с недавно созданным Египетским советом по вопросам здравоохранения. В рамках партнерства были проведены мероприятия по наращиванию потенциала, разработана дорожная карта и реализована программа. Египет – это страна с населением 117 млн человек со средненизким уровнем дохода. Услуги здравоохранения предоставляются учреждениями государственного (правительственного и полуправительственного) и частного секторов (поставщиками услуг и профессиональными ассоциациями). До 2022 года программа национальных руководств отсутствовала. Семинары по наращиванию потенциала посетили в общей сложности 225 человек. После того как совет ратифицировал дорожную карту, Министерство, ВОЗ и совет официально запустили программу национальных руководств в июле 2024 года. Реализация программы привела к более четкому разграничению ответственности, устранению дублирования функций и согласованию процессов между различными профессиональными сообществами, учебными больницами, сестринским персоналом и специалистами смежных медицинских областей. Последовательная и информированная политическая поддержка, а также приверженность заинтересованных сторон способствовали успешной реализации. Дополнительную ценность придал подход ВОЗ к контекстной адаптации глобальных руководств. Среди проблем можно отметить зависимость от международных экспертов, ограниченность ресурсов и недостаточный институциональный потенциал. Для дальнейшего прогресса необходимы: устойчивое институциональное развитие, наставничество, мониторинг и оценивание, а также финансирование и вовлечение заинтересованных сторон.

The Yangtze River Economic Belt supports over 400 million people and contributes nearly half of China's GDP, yet decades of industrialization, urbanization, and agricultural intensification have resulted in severe contamination and pressing environmental challenges. This systematic review synthesizes three decades of peer-reviewed and governmental data to examine the spatiotemporal distribution, sources, and ecological and human health risks of major pollutants, including heavy metals, microplastics, persistent organic pollutants, and excess nutrients. While point-source emission of heavy metals such as cadmium, lead, and mercury have decreased by 35-42% since 2013 following policy interventions like the 10-Point Water Plan and the Yangtze River Protection Law, legacy contaminants in sediments and diffuse agricultural inputs continue to pose significant risks. Cadmium levels in rice still exceed food safety standards, arsenic in groundwater surpasses health guidelines, and microplastic flux into the East China Sea has reached 8.3 × 1012 particles per year. Nutrient surpluses also drive extensive algal blooms, causing substantial economic losses. This review evaluates remediation strategies such as dredging, phytoremediation, wetland restoration, and AI-enhanced monitoring, which show removal efficiencies of 60-90% at reduced costs. However, critical gaps remain in understanding chronic mixture toxicity, the long-term fate of emerging contaminants, and pollutant-climate interactions. We propose an integrated basin-wide roadmap combining zero-liquid-discharge mandates, green infrastructure, and adaptive, performance-based governance to secure the Yangtze's ecological and economic sustainability. This framework offers a transferable model for large-scale watershed management worldwide.

PURPOSE: Biosimilars offer a cost-effective alternative to originator biologics, but their global adoption remains uneven due to differences in regulatory standards, pharmacovigilance capacity, and healthcare infrastructure. This review compares biosimilar regulatory and safety frameworks in developed (United States, European Union, Japan) and developing (India, Brazil, South Africa) markets to identify key gaps and opportunities for alignment. METHODS: A focused narrative review was conducted using peer-reviewed literature from PubMed, Scopus, and Web of Science complemented by official regulatory guidelines, pharmacovigilance reports, and policy documents published by national and international health authorities. RESULTS: Regulatory agencies in developed economies like FDA, EMA, and PMDA maintain rigorous evaluation processes and robust pharmacovigilance systems. In contrast, developing economies exhibit variability: India, while a major biosimilar producer, faces quality and harmonization challenges; Brazil and South Africa struggle with affordability and infrastructure, limiting uptake. CONCLUSION: The successful integration of biosimilars depends on regulatory maturity, strong pharmacovigilance, and stakeholder awareness. Efforts should focus on harmonizing international standards, strengthening safety monitoring, and improving clinician and patient education. Key takeaways include the need for shared international safety data platforms, the elimination of redundant local bridging studies, and the implementation of pharmacy-level substitution to maximize cost-savings. Harmonization is critical to ensuring equitable access to biologics across diverse economic landscapes.

Rural healthcare systems globally face persistent challenges, including inadequate infrastructure, professional healthcare shortages, and limited access to preventive services, affecting over 3.4 billion people worldwide. The integration of telehealth and artificial intelligence (AI) presents transformative opportunities to address these disparities while promoting global health equity. This review examines the integration of telehealth and AI technologies in rural healthcare settings, evaluating the legal frameworks and implementation strategies, and their potential to advance global health equity. A comprehensive narrative review was conducted by examining peer-reviewed literature, policy documents, and case studies from multiple databases. The key themes included telehealth applications, AI innovations, legal and regulatory frameworks, and implementation challenges in rural settings. Telehealth significantly improves healthcare accessibility through remote consultations, patient monitoring, and mobile health solutions, particularly benefiting maternal and child health. AI-powered diagnostic tools, predictive analytics, and precision medicine enhance clinical decision-making in resource-constrained settings. However, its implementation faces substantial barriers, including digital literacy gaps, infrastructure limitations, data privacy concerns, and regulatory inconsistencies. Legal frameworks must evolve to address licensing requirements, data protection standards, and interoperability, while ensuring equitable access. Successful integration requires comprehensive legal frameworks, targeted technological investments, and community-driven capacity-building initiatives. Collaborative efforts among policymakers, healthcare providers, and technology developers are essential to harness the transformative potential of these technologies. Addressing digital divides and establishing robust regulatory frameworks are crucial for achieving sustainable and equitable healthcare delivery in rural communities globally.

This paper critically reviews current initiatives, regulatory measures, and safety standards addressing plastic pollution, highlighting developments in Europe. While numerous policies and standards are in place, their impact is often constrained by fragmented implementation across disciplines, nations, and sectors. The urgent need for focused scientific research is especially evident in the case of nanoplastics, whose distinctive physicochemical properties and interactions with other contaminants present complex challenges for risk assessment and environmental monitoring. We explore pathways toward sustainable solutions, focusing on reducing plastic footprints and embedding Safe and Sustainable by Design (SSbD) principles into innovation and production. Data-driven Operational Research (OR) tools are presented as a means to optimize decision-making, ensuring interventions remain efficient, evidence-based, and responsive to evolving scientific insights. Equally important is the adoption of rigorous quality assurance (QA) and quality control (QC) protocols in hazard and fate studies, which are vital for producing reliable, reproducible data that can inform both science and policy. This policy analysis situates pollutants within a complex, interconnected system and introduces the exposome approach as a framework for evaluating cumulative environmental exposures over time. Embedding exposome science within the One Health paradigm offers a forward-looking strategy that bridges research, governance, and technology. Such integration fosters interdisciplinary collaboration and enables more effective pollution management. Ultimately, progress in addressing global plastic pollution depends less on new legislation and more on overcoming fragmented efforts through coordinated, cross-sector action guided by One Health perspectives.

Southeast Asia continues to be a global hotspot for marine litter pollution, where several countries in this region are repeatedly identified as top contributors of land-based waste leakages into the ocean. Moreover, marine pollution is a transboundary issue where the prevailing winds and currents move litter across regional water bodies. Hence, a transboundary collaboration is needed to produce comparable field data to guide actions and solutions. This study reports an integrated assessment of macro-litter in mangroves and beaches across Indonesia, Philippines, Singapore, and Viet Nam using standardised belt transect surveys and harmonised litter categorisation at 25 study sites between 2021 and 2023. Across all countries, mangroves consistently had higher litter densities than beaches (2.53× [95% CI: 1.47-4.34] and 2.66× [95% CI: 1.45-4.90] in terms of count and mass, respectively). Plastics accounted for 69.6-88.5% of total litter in terms of count densities, with foam fragments, food packaging, and cigarette butts being the most common plastic categories. There were also country-specific plastic patterns, e.g., plastic bags and fishing-related debris were most abundant in Viet Nam and the Philippines, respectively. Other notable observations included the disproportionate litter mass at several Indonesian sites due to heavier cloth-based items and the high densities of drinking straws in Singapore's mangroves. Seasonal variation was observed in Indonesia, where macro-litter densities were higher during wetter Northwest monsoon than the drier Southeast monsoon, but not in Singapore. Overall, this collaborative and harmonised study provides empirical grounding for interpreting regional patterns of macro-litter pollution and supports future modelling efforts and evidence-based policy development.

Leptospirosis is a widespread zoonotic disease causing over one million cases and 60,000 deaths annually. This review aimed to identify and assess policy options for leptospirosis prevention using the One Health approach and One Health Governance Index (OHGI) framework. PubMed, Web of Science, Scopus, and Cochrane Library were searched for full-text academic articles, along with Google Scholar and reference lists from Jan 2008 to Dec 2023. A scoping review was conducted following Arksey and O'Malley's framework and PRISMA-ScR guidelines. Articles were retrieved from major databases using defined keywords. Eligible studies focused on community-based policies for human leptospirosis prevention. Two reviewers independently assessed quality, and data were categorized by One Health domains and analyzed using the OHGI framework. Forty-two studies were included. Common policy strategies involved sanitation education, medical training, surveillance of humans, animals, and environments, legal controls on exposure sources, infrastructure upgrades, and vaccination. Tools like GIS and climate data supported preparedness. Policy options most addressed rule of law, effectiveness, and equity. Preventing leptospirosis epidemics demands coordinated, context-specific One Health policies that address implementation gaps and promote equity across vulnerable settings.

Kenya's Environmental Management and Coordination (Amendment) Act (2015) mandates Environmental Impact Assessments (EIAs) for mineral processing projects, yet evidence from Siaya County's gold leaching sector suggests widespread non-compliance, raising critical questions about whether licensing frameworks translate into improved environmental practices. This study evaluates the effectiveness of Kenya's licensing regime by examining whether licensing status, specifically EIA licenses and mineral dealers (processing) licenses, correlates with operational practices in cyanide handling, cyanidation wastewater treatment, and tailings management. Using purposive sampling based on operational scale, 15 gold leaching plants were assessed using structured key informant interviews with close-ended questions using an assisted questionnaire format, and Spearman's correlation analysis was employed to examine relationships between licensing status and management practices. Results revealed that 86.7% of surveyed plants operated without mandatory EIAs, exploiting agent-based mineral licensing loopholes that allow multiple facilities to circumvent individual environmental obligations. Critically, no significant correlations emerged between licensing status and any measured practice; cyanide, cyanidation wastewater and tailings management practices (p > 0.05 across all parameters), exposing Kenya's regime as symbolic regulation that prioritizes procedural compliance over substantive environmental safeguards. These findings align with global artisanal and small-scale mining (ASM) challenges, where licensing often fails to mitigate hazards. The study identifies three governance failures: (1) regulatory loopholes enabling systemic non-compliance, (2) ceremonial adoption of policies without implementation, and (3) fragmented oversight between environmental and mining agencies. To address these gaps, the study advocates for outcome-based licensing, e.g., tying permits to verified practices, hybrid governance integrating community monitoring, and technology-specific standards such as mandatory closed-loop systems. These reforms offer a transferable model for mineral-dependent economies, emphasizing enforceable compliance over bureaucratic formalities to achieve sustainable mining.

A two-and-a-half-day workshop on regulatory and ethical issues in first-in-human (FIH) clinical trials in India was held at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, on 7-9 November 2024, under the aegis of the Indian Council of Medical Research (ICMR) Phase I Network. The workshop brought together regulators, academic investigators, and industry representatives to examine the evolving regulatory landscape of early phase trials in India and the operational challenges associated with it. Through interactive sessions, including preparation of investigational new drug (IND) application, mock pre-IND/IND and mock subject expert committee (SEC) meetings, on-site monitoring simulations, and structured hands-on exercises, the workshop navigated regulatory submission pathways, trial reporting, documentation standards, safety oversight, and informed consent processes. A panel discussion on the phase lag policy for FIH studies in India was held with expert personnel from regulatory agencies, ICMR headquarters, industry, and academia. The workshop discussions underscored the need for policy harmonization, enhanced site preparedness, and sustained capacity-building to position India as a leader for early phase clinical research. The present article summarizes the proceeding of the workshop and highlights the critical insights for developing a regulatory and ethical framework to support FIH trials in India.

Background: The United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services (MTaPS) program supported partner countries to implement infection prevention and control (IPC)-related programs. We evaluated the extent to which MTaPS-supported IPC programs fostered local ownership, such that members of local or national-level health systems had agency in developing and running programs. Methods: We surveyed three respondent groups involved in MTaPS IPC programs across eight African countries: (1) healthcare facility staff, (2) national-level stakeholders, and (3) MTaPS-contracted country implementers. Multiple-choice survey questions asked respondents to rate the quality of collaboration and capacity-building between their country and MTaPS, and the extent to which MTaPS fosters local ownership. Open-response questions inquired about factors that did or did not foster local ownership. We described the proportion of respondents reporting each multiple-choice response option, and conducted qualitative content analysis of open responses to generate themes about respondent perceptions of MTaPS support and local ownership. Results: We included 85 survey respondents: health facility staff (56%), MTaPS-contracted country implementers (29%) and national-level stakeholders (14%). Nearly all respondents rated the quality of MTaPS collaboration and capacity building "good" or "excellent." Overall, 75%-92% of respondents rated the quality of MTaPS collaboration and capacity strengthening as "mostly" supportive of local ownership and 8%-25% rated it "sometimes," supportive (0% selected "rarely/never"). Qualitatively, respondents described six activities as conducive to local ownership, including training, data collection/monitoring, stakeholder engagement, guideline/protocol standardization, creation/development of local committees, and supervision/mentorship/direct technical assistance. A reported barrier to MTaPS' support of local ownership was the inconsistent implementation of activities. Conclusions: IPC programs should continue to prioritize strategies for fostering local ownership, particularly as the funding landscape shifts. To increase IPC program sustainability in advance of future infectious disease threats, additional resources are needed to scale up activities perceived as conducive to local ownership.

Monitoring changes in disposable e-cigarette attributes is crucial for youth health and market regulations. Online stores are a major purchasing channel for U.S. youth. This study compares trends in product attributes of disposables between 2022 and 2024 using our unique data scraped from online stores. We obtained product-level information by scraping websites of online vape stores from our 2022 study that remained in business in 2024, and we examined changes in product attributes including sales prices and standardized prices, product size (mL volume and puff counts), consumer ratings and reviews, nicotine dimensions (concentration, free-base/nicotine salt, tobacco-derived/synthetic), battery capacity, and flavor mentions in description texts. Unique product listings significantly increased from 1638 in 2022 to 8339 in 2024. Sales price per unit and standardized price (per mL or per puff) declined, while product size in terms of mL volume and puff counts increased dramatically. The proportion of products with nicotine salt or synthetic nicotine claims decreased, and 5% nicotine level remained dominant. Fruits, sweets and menthol were the most prevalent flavor mentions in both years, though the percentage of products declined from 97% to 79%, 69% to 19% and 59% to 15%, respectively. Disposable e-cigarettes available in the online market have become more diverse, more affordable, and larger in size, especially in puff counts. High nicotine concentration (5%) persists, and fruity flavors remain prevalent. These trends raise public health concerns and require effective market regulations.