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Agricultural systems are major sources of methane emissions, contributing to climate change with potential downstream effects on population health. West Africa faces a growing burden of non-communicable diseases (NCDs) alongside agricultural intensification, yet the relationship between agricultural emissions and NCD mortality remains unexplored. We examined whether changes in agricultural methane emissions were associated with NCD mortality trends across West African countries. We conducted an ecological panel study of 11 West African countries from 2015 to 2020 using World Bank World Development Indicators data. The exposure was agricultural methane emissions, measured in carbon dioxide equivalents (Mt CO&#x2082;e). The primary outcome was the probability (%) of dying from NCDs between exact ages 30 and 70 for both sexes combined; sex-stratified outcomes for women and men were examined as secondary analyses. We classified countries by emission trajectory: decreasing (>&#x2009;5% reduction), stable, or increasing (>&#x2009;10% increase). For each outcome we estimated associations using pooled ordinary least squares, within-country fixed effects, mixed effects models with random intercepts, and a descriptive group-by-period comparison of NCD mortality trajectories between The Gambia (largest emission reduction: -28.3%) and other countries. Sensitivity analyses assessed robustness to influential observations, functional form, and temporal specification. For both sexes combined, pooled analysis suggested an inverse cross-sectional association between agricultural methane and NCD mortality (&#x3b2;&#x2009;=&#x2009;-0.085; 95% CI: -0.126 to -0.043; p&#x2009;<&#x2009;0.001). However, within-country fixed effects models showed no association (&#x3b2;&#x2009;=&#x2009;0.027; 95% CI: -0.081 to 0.134; p&#x2009;=&#x2009;0.62), indicating confounding by time-invariant country characteristics. The intraclass correlation coefficient was 0.984, indicating 98.4% of variance occurred between countries. A descriptive group-by-period comparison found no differential change for The Gambia versus other countries (0.62 percentage points; 95% CI: -0.78 to 2.03; p&#x2009;=&#x2009;0.39). Sex-stratified analyses were consistent: the pooled inverse association was present for both women (&#x3b2;&#x2009;=&#x2009;-0.077; p&#x2009;=&#x2009;0.001) and men (&#x3b2;&#x2009;=&#x2009;-0.096; p&#x2009;=&#x2009;0.004) but was eliminated under fixed effects (women p&#x2009;=&#x2009;0.27; men p&#x2009;=&#x2009;0.88), and excluding Nigeria reversed the pooled association (both sexes &#x3b2;&#x2009;=&#x2009;&#x2009;+&#x2009;0.091, p&#x2009;=&#x2009;0.014), confirming it was driven by a single influential country. Agricultural methane emission reductions were not associated with short-term changes in NCD mortality in West Africa. The high between-country clustering suggests that stable country-level factors including health system capacity, socioeconomic development, and baseline disease burden are more strongly associated with NCD mortality patterns. Longer follow-up periods and individual-level studies are needed to evaluate potential health co-benefits of agricultural emission reductions.

HIV case management supports people living with HIV to be linked to and retained in care. HIV case management becomes virtual case management (VCM) when some or all these services are provided via virtual tools or platforms including mobile phones, chat messenger apps, other mobile or web apps, and/or electronic case management systems. The COVID-19 pandemic accelerated the use and expansion of virtual services, including health services, across the globe. These case studies document how HIV programs in Indonesia and Nepal transitioned from in-person case management to VCM during the COVID-19 pandemic in 2020. As part of this transition, the program in Nepal implemented VCM in 37 districts that were providing services to 12,820 people living with HIV (PLHIV), and in Indonesia the program supported 18,244 PLHIV in 5 districts. Data on the transition from in-person support to VCM were collected on client clinical outcomes, costs of the virtual services, and case manager feedback. These case studies indicate that VCM is a feasible and affordable approach to implement in low- and middle-income country contexts. Between March and September 2020, 10,995 (82.1%) and 3,801 (51.5%) PLHIV in Nepal and Indonesia, respectively, were supported by VCM. Continuity of care remained high in both countries with only 1%-2% interruptions in treatment. Viral load suppression also remained high in both countries (91%-92% in Indonesia and 94%-95% in Nepal). Viral load coverage, however, was low, but this was influenced by clinic and laboratory closures. Startup costs were low (<US$2,500), and the monthly cost per person to provide VCM was $2.34 in Nepal and $4.67 in Indonesia. Case manager feedback was focused on compensation, expanded reach of virtual services, gaps in client mobile phone ownership or digital literacy, efficiency of services, and confidentiality and privacy. VCM has transformative potential to expand the reach of health services and provide differentiated options, meeting clients' preferences and needs. The experiences and lessons learned from these two case studies can guide the implementation of future VCM programs in other countries.

Despite national and international commitments to food systems transformation and an increasing adoption of common indicators, no comprehensive targets have been established against which progress can be measured. Here, building on the Food Systems Countdown Initiative framework, we identify existing targets-based on internationally agreed commitments and normative goals-and establish benchmarks-based on empirically derived peer performance reference values at the global, regional and income group levels-for 44 Food Systems Countdown Initiative indicators. We also assess countries' historical progress and the rate of change required to achieve targets and benchmarks over two different timescales. We show that current progress is insufficient to meet 2030 targets and benchmarks at global level. Comparing countries' status to regional and income benchmarks, which are generally less ambitious, yields better performance across indicators and regions, although gaps remain. Achieving most targets and benchmarks by 2050 is possible if countries correct course and accelerate progress, but certain indicators will require considerable investment and intervention.

Pediatric cardiomyopathy is the leading indication for cardiac transplantation in children. However, data on its prevalence and outcomes mainly comes from developed countries, with only a scarce amount of information about its status in low- and middle-income countries. This study aimed to characterize the clinical presentation, echocardiographic features, and outcomes of pediatric cardiomyopathy at a tertiary care center in a developing country. We conducted a retrospective review of children diagnosed with cardiomyopathy before 18 years of age at a single tertiary cardiac center over a 20-year period. Mortality at 5 years following diagnosis was assessed as a binary outcome. Univariable and multivariable logistic regression analyses were performed to identify factors associated with mortality. A total of 244 children were included (mean age at diagnosis 5.9 &#xb1; 5.7 years; 57% male). Dilated cardiomyopathy was the most common phenotype, identified in 153 patients (62.7%), followed by hypertrophic cardiomyopathy in 74 (30.3%), restrictive cardiomyopathy in 10 (4.1%), and left ventricular non-compaction cardiomyopathy in 7 (2.9%). No cases of arrhythmogenic right ventricular cardiomyopathy were identified. Half of the cohort was asymptomatic at presentation and diagnosed incidentally. Presumptive myocarditis/inflammatory etiologies predominated overall and in the DCM subgroup, whereas familial/genetic etiologies predominated among patients with HCM. The 5-year mortality rate was 13.1%, with the majority of deaths occurring in children with dilated cardiomyopathy. In the overall cohort multivariable model, severely reduced left ventricular systolic function at diagnosis (adjusted OR 3.06, 95% CI 1.36-6.85) and pulmonary hypertension at diagnosis (adjusted OR 2.64, 95% CI 1.45-4.80) were the only independent predictors of mortality. Cardiomyopathy subtype, age at diagnosis, sex, and arrhythmias were not independently associated with outcome. In the In the DCM subgroup, pulmonary hypertension remained independently associated with mortality (adjusted OR 2.77, 95% CI 1.42-5.40), while severe systolic dysfunction showed a borderline association (adjusted OR 2.54, 95% CI 1.00-6.44). In this cohort, pediatric cardiomyopathy was characterized by a high prevalence of incidental diagnoses and a predominance of dilated phenotypes. Severe systolic dysfunction and pulmonary hypertension were the principal determinants of medium-term mortality, outweighing demographic and phenotypic factors.

Despite resulting in significant mortality and long-term disability, research on the burden of intracerebral hemorrhage (ICH) remains insufficient. Therefore, this study estimated the global burden of ICH and projected changes in the disease burden through 2050 under scenarios of improved risk factor profiles. The burden of ICH was estimated using data from the Global Burden of Disease Study 2021, based on incidence, mortality, and disability-adjusted life years (DALYs), and was stratified by region, age, year, sex, and Socio-demographic Index (SDI) level. In addition, we conducted an attribution analysis of the ICH burden, focusing on behavioral (including dietary risks and tobacco) and metabolic risk factors, and developed scenario-based projections through 2050 to estimate the potential impact of improved risk management. In 2021, a total of 3,444.34 thousand incident cases (95% uncertainty interval [UI], 3,053.01-3,812.04) of ICH were reported worldwide, along with 3,308.37 thousand deaths (3,021.08-3,594.72) attributable to ICH. Males exhibited a higher disease burden, with an age-standardized incidence rate (ASIR) per 100,000 population of 48.71 (95% UI, 43.07-54.27), compared to 33.61 (29.47-37.22) in females. The burden progressively increased with age, with notably higher mortality observed among individuals aged &#x2265; 65 years. There were substantial disparities in the ASIR by SDI level, with high SDI countries showing the lowest rates at 16.30 per 100,000 population (95% UI, 14.51-18.02), compared to 57.83 (51.95-63.27) in low SDI countries. Among behavioral and metabolic risk factors, high systolic blood pressure and smoking were identified as the leading modifiable risk factors for ICH. Forecasts based on the improved behavioral and metabolic risk scenario project a reduction in the age-standardized DALY rate to 166.13 per 100,000 population (95% UI, 132.31-209.64) by 2050, compared to 599.04 (482.89-744.16) projected under the baseline scenario. Although the global burden of ICH has declined, it remains a major concern in several regions. Projections through 2050 suggest that improvements in the behavioral and metabolic risk profiles could substantially reduce the future burden of ICH, emphasizing the importance of targeted strategies to support evidence-based public health policy.

To synthesize barriers associated with delays in the diagnosis and initiation of treatment of oral cancer across high-income countries (HICs) and low- and middle-income countries (LMICs) contexts, aligned with the Aarhus diagnostic-therapeutic intervals. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, and ProQuest. Observational, qualitative, and mixed-methods studies reporting patient-reported perceptions or system-level barriers affecting the diagnostic-therapeutic pathway and associated with diagnostic or treatment delays in adult oral cancer were included. Data were narratively synthesized, and identified barriers were semantically standardized and mapped to the Aarhus intervals. Sixteen studies were included. Barriers were categorized into psychosocial, symptom appraisal, health literacy, structural, professional-related, and organizational domains. Studies focusing on the patient interval most frequently reported psychosocial and appraisal-related barriers. Studies examining diagnostic, composite, or total intervals more commonly identified professional-related and organizational barriers. Studies from LMICs more frequently addressed extended segments of the care pathway and reported nonbiomedical management strategies, health literacy-related barriers, and professional or structural barriers beyond the patient interval. Delays in oral cancer care reflect an interconnected, trajectory-based process shaped by interacting individual, professional, and system-level factors, supporting the need for integrated interventions across the care continuum.

This study investigated the association of maternal nationality with stillbirth and infant mortality in Japan. The Vital Statistics data in Japan from 2010 to 2023 were used, and singleton births born from 2010 to 2022 were used in the analysis of stillbirth and infant mortality. The maternal nationality consisted of Japan, Korea, China, the Philippines, Thailand, the United States (US), Brazil, Peru, and other countries in the analysis. Stillbirth and infant mortality rates were calculated by maternal nationalities. In addition, modified Poisson regression models were used to investigate the associations between the outcomes and maternal nationality, and residential area, parity, maternal age, marital status, and year of birth were adjusted. Data on 12,287,030 live births and 33,968 stillbirths were analyzed. As a result, the stillbirth rate for American mothers was the highest, and that of "other countries" was the second highest. In addition, the infant mortality rate of American mothers was also the highest. The multivariate regression analysis revealed that mothers from the US and "other countries" had a significantly higher risk of stillbirth than Japanese mothers and mothers from the US had a significantly higher risk of infant mortality than Japanese mothers. It was suggested that support before and after childbirth is particularly necessary for American mothers in Japan.

Growing evidence supports a close association between childhood obesity and precocious puberty (PP). However, there remains a lack of bibliometric research specifically examining the factors and trends within this intersecting field. A systematic bibliometric analysis would provide a comprehensive understanding of the current research landscape, identify key contributors and emerging trends. On June 2, 2026, relevant studies published between 2005 and 2025 were retrieved from the Web of Science Core Collection (WoSCC), Scopus and PubMed databases. Using the bibliometrix R 4.5.1, CiteSpace 6.4.R1, and VOSviewer 1.6.20, we conducted a visual analysis of dimensions such as publication volume, countries, institutions, authors, journals, and keywords. We employed the Latent Dirichlet Allocation (LDA) method to reveal the underlying thematic structure and track its temporal evolution. A total of 2506 publications were included, involving 9,843 authors and spanning 664 academic journals. The annual publication volume increased steadily, with the United States and China as the major contributing countries. Harvard University led institutional output, followed by the University of California System and Leipzig University. Chen Y was the most prolific author with 42 publications. Journal of Pediatric Endocrinology & Metabolism was the most productive journal in this field. "Obesity" (1,179) and "puberty" (1,031) were identified as the core research keywords. LDA analysis yielded 15 topics, which were grouped into four clusters. These clusters respectively cover adrenal endocrine function and pubertal physiology, obesity-related metabolic complications and multisystem damage in children, the link between childhood obesity and pubertal timing, and relevant upstream etiological factors. This study applies bibliometric analysis and LDA topic modeling to trace the development of research on the association between childhood obesity and PP over the past two decades. It systematically reviews research progress in this field, clarifies publication trends, the global research landscape, and patterns of thematic evolution, thereby providing an important academic reference for clinicians and scholars in the field of pediatrics to identify research hotspots and cutting-edge directions.

Parents frequently consult health care professionals because of infant regurgitation, crying and stool consistency. The Cow's Milk-related Symptom Score (CoMiSSTM) is an awareness tool for cow's milk allergy. We aimed to characterize the distribution of CoMiSS items in presumed healthy infants and developed centiles with these data. Data from 2500 infants (median age 5.3 months [Q1-Q3: 2.6-8.8]) across 10 countries were analyzed by pooling individual-level data. Age distribution differed between countries (p&#x2009;<&#x2009;0.001). Median (Q1; Q3) and mean (SD) total CoMiSS were 4 (2; 6) and 4 (2.6), respectively. Overall CoMiSS <10 was observed in 99%. Crying >3&#x2009;hours/day occurred in 6.1% at 1-2 months, 4% between birth and 4 months, and <1.5% thereafter. Regurgitating > 5x/day occurred in 7-11% during the first 7 months (peak at 1-4 months: 16-17%) and decreased to <2-4% thereafter. Stool consistency accounted for 93.9% of the score. Atopic dermatitis and respiratory symptom scores are very low. CoMiSS is stable across age, with transiently higher crying and regurgitation scores below 4 months. CoMiSS &#x2265;10 is uncommon in healthy infants. Age-specific CoMiSS centile charts provide a framework for interpreting common infant symptoms and identifying values warranting further evaluation. These data report on the prevalence of common manifestations in healthy infants and inform about normality according to age and different regions. Crying or distress and regurgitation scores are transiently more frequent during the first 4 months of life. Eczema and respiratory symptoms are seldom reported in presumed healthy infants. While caregivers and health care professionals consider regurgitation and crying or distress up to a certain limit as normal, atopic dermatitis and respiratory symptoms are not. These age-specific centile charts provide information on common infant symptoms and identify conditions that may warrant further evaluation.

Vitamin A deficiency is a public health problem in developing countries including Ethiopia. Thus, its prevalence and associated factors in each locality is essential for tackling the problem since the cause differs across geographical areas and community to community. The aim of this study was to assess the prevalence of clinical vitamin A deficiency and associated factors among preschool children aged 24-59 months in Finote Selam Town, Northwest Ethiopia, 2022. A Community-based cross-sectional study design was conducted from April 1 to April 30/2022. A total of 607 preschool children aged 24-59 months were enrolled through a simple random sampling technique. Data on clinical signs of vitamin A deficiency (xerophthalmia) were collected via detailed clinical histories and physical eye examinations conducted by trained ophthalmic personnel. No biochemical testing of serum retinol was performed. Data was collected through an interviewer-administered structured and pre-tested questionnaire. Bivariate (p-Value&#x2009;<&#x2009;0.25) and multivariable (p-Value&#x2009;<&#x2009;0.05) binary logistic regression analysis was carried out using SPSS version 22. An adjusted odds ratio (AOR) with the 95% confidence interval was used to measure the association between the outcome and independent variables. The Multicollinearity test was checked using VIF&#x2009;<&#x2009;10. The Hosmer and Lemeshow test was fitted (p&#x2009;=&#x2009;0.79). Five hundred and ninety-one children aged 24-59 months were included in the study, giving a response rate of 97.4%. The overall prevalence of clinical vitamin A deficiency among children aged 24-59 months was 3.7% [95%CI; (2.3-5.6], comprising night blindness (2.2%), Bitot's spots (1.35%), and superficial corneal ulceration (0.15%), while conjunctival xerosis, corneal xerosis, and corneal scars exhibited zero prevalence. The odds of vitamin A deficiency were 4.89 [95% CI: 1.63-14.71] times higher among children whose mothers did not have postnatal care visits. Children aged 48-59 months were 5.43 (95% CI: 1.40, 21.0) times more likely to develop vitamin A deficiency compared with those children aged 24-35 months. Children who had been ill in the past 2 weeks were 5.85 [95%CI: 1.84, 18.59] times more likely to develop clinical vitamin A deficiency. The prevalence of clinical vitamin A deficiency was relatively high as compared to the national figures, indicating a moderate public health problem according to World Health Organization criteria. Targeted, practical preventative interventions to minimize clinical vitamin A deficiency should be designed, and future large-scale biochemical studies evaluating serum retinol levels are recommended.

The incidence of colorectal cancer (CRC) has risen in recent decades, with a disproportionate increase observed among younger individuals in Japan and other countries. The etiological contribution of the gut microbiota to CRC pathogenesis is recognized, yet the mechanisms involved remain to be fully clarified. Here we integrated whole-genome sequencing (WGS) and transcriptome profiling of CRC with whole-genome metagenomic sequencing of fecal samples to interrogate host-microbiome interactions at high resolution. Application of interpretable artificial intelligence enabled the stratification of CRC into four distinct microbiome-informed subtypes. WGS analysis identified mutational signatures SBS88 and ID18, linked to colibactin exposure, as early clonal events detected in 44.8% of non-hypermutated patients. Notably, these signatures were significantly more frequent among patients born after the 1960s. Microbiome-based subclassification revealed subtype-specific clinical and molecular features. Collectively, our findings indicate that colibactin exposure constitutes a prevalent and potentially modifiable risk factor for CRC in the Japanese population.

Retraction serves as a critical mechanism for correcting flawed publications and preserving the integrity of the scientific literature. Systematic analysis focused on retractions in Central Nervous System (CNS) tumor research is still lacking. This study characterized retracted CNS tumor publications regarding temporal trends, geographic distribution, retraction reasons, citation patterns, and retraction lag. Retraction data were downloaded from the Crossref/Retraction Watch Database on December 31, 2025. CNS tumor&#x2011;related retractions were identified using tumor terms derived from the 2021 WHO Classification of Tumors of the Central Nervous System. Eligible records were screened manually, and tumor type, article type, retraction reason, first-author country, author count and time to retraction were extracted. Citation data were retrieved from Web of Science, and journal impact factor (JIF) and quartile were obtained from the 2024 Journal Citation Reports. Descriptive statistics, the Mann-Kendall test and Kruskal&#x2011;Wallis test were used. 582 CNS tumor articles were included. CNS tumor retractions increased over time and peaked in 2023. "Gliomas, glioneuronal tumors, and neuronal tumors" accounted for 74.57% (434/582). 80.58% (469/582) were retracted due to misconduct. In terms of absolute numbers, China was the leading first&#x2011;author country, followed by USA and India. Basic research accounted for 75.26% (438/582). The median time to retraction was 805.5&#xa0;days (IQR: 423.25-1,711&#xa0;days). A total of 515 articles received at least one citation (total citations 12,151), and 89.71% (462/515) had citation after retraction. The median pre&#x2011;retraction, post&#x2011;retraction, and total citations were 5 (IQR: 1-17), 3 (IQR: 1-7), and 10 (IQR: 3-24), respectively. Significant differences were observed in normalized citation counts and retraction lag across most retraction reason categories, JIF and quartiles, article types, author counts, and first&#x2011;author countries. CNS tumor retractions have increased markedly as the primary driver. The persistent post-retraction citation of flawed research highlights a critical gap threatening evidence-based neuro-oncology.

In Sub-Saharan Africa (SSA), women of reproductive age face significant barriers to accessing healthcare, undermining progress towards Universal Health Coverage. Understanding the complex determinants of this multifaceted problem requires advanced analytical approaches. This study aimed to identify and rank the key predictors of perceived healthcare access barriers among women in SSA using a multi-country dataset and an interpretable machine learning (ML) framework. We analyzed recent Demographic and Health Survey data from 28 SSA countries (n=467,965 women). A composite measure of healthcare access barriers was used as the outcome. After preprocessing and feature selection, eight ML models were trained and evaluated. The best-performing model was interpreted using SHapley Additive exPlanations (SHAP). The pooled prevalence of perceived healthcare access barriers ranges from 17.8% (95% CI, 17.0-18.6%) in South Africa to 72.1% (95% CI, 71.6-72.7%) in Malawi. The Light Gradient Boosting Machine (LightGBM) was the top-performing model (Accuracy:65.2%, F1-score: 72.8%, ROC-AUC:68.2%, and PR-AUC: 72.9%). SHAP analysis identified the wealth index as the most powerful predictor, followed by use of internet, media exposure, mobile phone ownership, and educational level. Lower socioeconomic status and limited access to information and communication technologies were strongly associated with greater access barriers. The findings underscore that socioeconomic and digital inclusion factors are paramount in determining healthcare access. This highlights the need for integrated strategies that go beyond health-sector solutions to address underlying social and economic determinants. This study provides an evidence-based, actionable ranking of the determinants of perceived healthcare access problems. The results can inform targeted policies on poverty alleviation, digital inclusion, and education to reduce disparities and advance equitable healthcare access for women in SSA.

In an era of rapidly evolving healthcare systems and escalating demands for value demonstration, pharmaceutical companies face unprecedented pressure to generate robust, relevant evidence for a diverse array of stakeholders. Traditional, siloed approaches to evidence generation are no longer sufficient. The development and use of integrated evidence generation plans (IEGPs) have emerged as strategic imperatives-reshaping how organisations align scientific, regulatory and patient-centred objectives across the product life cycle. The IEGPs bring together evidence-generation activities across functions and geographies, to ensure that robust evidence is delivered throughout the product life cycle. In this article, we present IEGP development as a collaborative and strategic process, which enables pharmaceutical companies to demonstrate the holistic value of a new therapy to a broader range of healthcare decision makers. We argue that Medical Affairs professionals are well positioned to lead this initiative, given their in-depth understanding of the evidence generation needs and priorities of patients and healthcare professionals; however, a close and strategic partnership with other key functions, including Market Access&#xa0;and&#xa0;Clinical Development, regions and countries, is vital to the holistic understanding of all key evidence needs and to establish the strategic differentiation required to bring new medicines to patients. Our companion article in this edition of Pharmaceutical Medicine expands on the role of specific subfunctions of Medical Affairs in the development of an IEGP; it also considers how the impact of Medical Affairs' role can be measured. Please note that in both articles we prefer to use the term 'IEGP', but the reader may also see the similar term 'IEP' (Integrated Evidence Plan) used in the literature-these terms are used interchangeably in the field.

Transboundary animal and emerging infectious diseases (TADs, EIDs) threaten livestock health and production, food security, and the livelihoods of smallholder farmers in Southeast Asia (SEA). Outbreaks of TADs, including foot-and-mouth disease (FMD), classical swine fever (CSF), African swine fever (ASF), and lumpy skin disease (LSD), highlight ongoing risks associated with informal animal movement and cross-border trade. We reviewed four decades of research from Thailand, Lao PDR, and Cambodia in the Greater Mekong Subregion (GMS) to track the evolution of diagnostics, surveillance, and policies for these diseases. Incremental investments in laboratory diagnostics, epidemiology, abattoir surveillance, and field health measures were integrated into disease control strategies by adaptation to resource-limited, endemic settings and shaped by regional collaboration, notably through the SEA, China and Mongolia FMD (SEACFMD) campaign. Key achievements include establishing disease prevalence baselines, improving understanding of virus dynamics, identifying local disease risk factors, identifying veterinary service gaps, and rapidly increasing diagnostic and response capacity during outbreaks. Evidence from the studies reviewed suggests that integrating diagnostics with field surveillance, socioeconomic information, and regional coordination can provide actionable insights for disease control, although implementation and effectiveness have varied between diseases, countries, and time periods. This narrative review suggests that sustainable control requires long-term adaptive development of diagnostics, surveillance, and policy translation while recognising persistent heterogeneity in veterinary capacity, surveillance coverage, and biosecurity across the region. This review is based on a narrative synthesis of published literature, institutional reports, and programme experience.

<b>Background and Objective:</b> The rapid development and deployment of COVID-19 vaccines constituted a critical global public health response; however, vaccine hesitancy posed a substantial challenge, particularly in low- and middle-income countries such as Iraq. Mistrust, misinformation and sociopolitical factors were reported to influence vaccine uptake. This study aimed to assess public perception, acceptance and hesitancy toward COVID-19 vaccines in Iraq during the pandemic and to identify key sociodemographic and informational determinants influencing vaccination behavior. <b>Materials and Methods:</b> A cross-sectional survey was conducted among 1,747 participants across Iraq. Vaccine acceptance was defined as receipt of at least one vaccine dose, while hesitancy included delayed or refused vaccination due to concerns regarding safety, efficacy, or other factors. Public perception reflected attitudes and beliefs toward vaccination irrespective of vaccination status. Data were analyzed using descriptive statistics and inferential tests to examine associations between sociodemographic variables, exposure to misinformation and vaccine acceptance, with statistical significance set at p<0.05. <b>Results:</b> Among the participants, 42.7% were vaccinated and 57.3% were unvaccinated. Vaccine acceptance was significantly higher among men, older individuals and participants with higher educational attainment (p<0.001). The most commonly reported reasons for vaccine hesitancy were concerns about long-term side effects (72.4%) and distrust in vaccine manufacturers (41.9%). Exposure to misinformation via social media platforms showed a significant association with increased vaccine hesitancy (p = 0.03). <b>Conclusion:</b> The findings identify critical sociodemographic and informational factors influencing COVID-19 vaccine acceptance in Iraq. Targeted public health interventions focusing on women, younger populations and individuals with lower educational levels are warranted. Strengthening evidence-based communication strategies to counter misinformation and rebuild public trust may improve vaccine uptake. Future studies should explore longitudinal trends and intervention effectiveness to address persistent vaccine hesitancy.

This study presents three artificial intelligence-based models - XGBoost, Random Forest (RF), and Deep Artificial Neural Network (DANN) - with 2-day lead time for forecasting broad-scale oyster norovirus outbreaks. Among them, the XGBoost model performs best and is characterized by unique features: (1) the model was constructed and tested with epidemiological and environmental data collected from three distinct coastal countries representing broad trends in oyster norovirus outbreaks; (2) model input variables include five important environmental predictors (along with their time-lags ranging from 2-30&#x2009;days), identified by using Pearson correlation and Gini index, including solar radiation, water temperature, gage height, precipitation, and salinity plus GPS coordinates, which affect various processes governing the sources and sinks of oyster norovirus; and (3) the model output performance is characterized by a high accuracy, demonstrating the strongest overall prediction performance. This study identifies solar radiation and water temperature as the two most important predictors of oyster norovirus outbreaks. Another major finding is the strong long-range dependence of outbreaks on antecedent marine environmental conditions up to 30&#x2009;days before. These novel features of the XGBoost model provide an effective early-warning framework that can support proactive management of oyster norovirus outbreaks.