the use of real-world (RW) data has become an integral part of pharmacoepidemiological research and regulatory assessment. However, access to individual-level data, especially for purposes other than the original ones (secondary use), is often restricted by legal and ethical constraints related to privacy protection. In this context, generating synthetic data, defined as artificially generated data that reproduce the statistical properties and relationships of real data without containing information traceable to real individuals, offers an innovative opportunity to balance privacy protection with the need to generate RW evidence to support regulatory decision-making. to compare two methods of generating tabular synthetic data: synthpop, based on transparent and interpretable inferential methodologies, and Conditional Tabular-Generative Adversarial Networks (CT-GANs), which leverage deep learning approaches to reproduce complex multivariate distributions. The focus is on evaluating the ability of both approaches to preserve the statistical structure of real data and reduce the risk of disclosure/re-identification. comparative study of two synthetic data generation methods. a large anonymized RW dataset including 42,926 patients hospitalized for COVID-19 in Italy during the early phase of the pandemic. The dataset was obtained through record linkage of administrative databases and the COVID-19 registry using the TheShinISS tool. synthetic versions of the original dataset were generated using both synthpop and CT-GAN methods. Real and synthetic data were compared using three type of measures: 1. general utility measures (univariate, bivariate, and global), including comparison of variable distributions using plots, descriptive statistics, standardized mean differences (SMD), and Propensity Score Mean Squared Error; 2. specific utility measures, assessing the similarity of associations estimates from univariate and multivariable Cox models by evaluating the overlap of 95% confidence intervals (CI) of hazard ratios (HR), and comparison of Kaplan-Meier curves using the log-rank test; 3. disclosure (re-identification) measures, estimating the risk of identity and attribute disclosure using dedicated metrics (Unique in Original - UiO, replicated Uniques - repU, Disclosive in Original - Dorig, Disclosive in Synthetic Correct Original - DiSCO). in terms of general utility, results confirmed the superiority of synthpop over CT-GAN, with more than half of the variables exceeding the acceptable SMD threshold. Moreover, synthpop showed higher specific utility than CT-GAN, with a median overlap of 95%CI of HR of 75% (interquartile range, IQR: 66%-95%) compared with 0% (IQR: 0%-6%) for CT-GAN. Concerning disclosure measures, although the original dataset already presented a negligible risk of identity disclosure (UiO=0.23%), making synthesis largely redundant, both methods further reduced this risk (synthpop: repU=0.06%; GAN: repU=0.05%). in this study, considering the three evaluated aspects, synthpop performed better in balancing statistical accuracy and privacy protection. It also offered greater methodological transparency based on explicit statistical models and required lower computational time. These findings contribute to the ongoing debate on the potential use of synthetic data in research and regulatory assessments supporting their integration into RW data analysis workflows. The disclosure measures adopted may serve as a practical starting point, however, the definition of shared standards for these measures, as well as acceptable disclosure risk thresholds, would be desirable and should be developed collaboratively by the scientific community and data protection authorities. Future studies should focus on generating synthetic data where non-explicit relationships exist in real data (i.e., relationships that are not directly attributable to additive or multiplicative structures).
The United States continues to see significant issues with gun violence, resulting in significant public health concerns. Behavioral medicine is often involved in addressing the psychological aftermath of gun violence, as survivors experience higher rates of post-traumatic stress disorder, depression, and suicidal ideation. Black and Latino communities are disproportionately affected by gun violence due to structural inequities, with gun violence furthering the structural and health inequities experienced in these communities. While the Bipartisan Safer Communities Act of 2022 helped to improve gun control laws, federal policies are still needed to help close loopholes. The STOP School Violence Act of 2018 focuses on violence prevention education in schools but lacks information on behavioral health services and early psychological risk identification. To address future gun violence, we urge members of Congress to co-sponsor the Break the Cycle of Violence Act, which focuses on community building, including counseling services, financial, legal, and housing support for those at high risk for exposure to violence, and job training and digital literacy education for youth. Additionally, we ask them to support stronger measures to ensure safe transfer and responsible handling of firearms, including supporting legislation to close the "Charleston loophole" by requiring completion of background checks before transfers and the Protecting Extreme Risk Protection Orders, allowing courts to temporarily remove firearms from individuals showing warning signs of violence and connect them with crisis and behavioral health support. Gun violence continues to be an important public and behavioral health issue in the United States. In addition to the fatalities resulting from gun violence, survivors and their communities often experience post-traumatic stress disorder and depression. Gun violence also disproportionately affects communities of color, intensifying the structural inequities they face. While there has been legislation passed to help strengthen gun control laws, there are still gaps that need to be addressed. In order to address gun violence, we ask members of Congress to support gun violence legislation focusing on community building, complete background checks before transfers, and temporary removal of firearms from owners showing warning signs of violence.
Extreme Risk Protection Order (ERPO) laws allow civil courts to authorize orders to temporarily prevent a person from purchasing or possessing firearms upon finding that they pose a significant risk of harm to themselves or others. In Louisiana, a state with one of the highest rates of firearm homicide of women in the nation, multiple attempts to pass ERPO legislation have failed despite evidence of their effectiveness. We sought to identify places of common ground on the matter of domestic violence against women in Louisiana and to understand how perspectives on politics and policy solutions - including ERPOs - diverged from there. We interviewed 16 key informants purposefully recruited to ensure diversity in political ideology, professional roles, and regions of Louisiana. All held active roles in gun rights or gun regulation advocacy and lobbying; law enforcement and judicial systems; public health and domestic violence prevention; and state policymaking. Verbatim transcripts were analyzed via thematic analysis with deductive coding following the Multiple Streams Framework. Among key informants, there was nearly universal agreement on the matter of domestic violence as a problem. However, there was ambiguity around the role of firearms in domestic violence and the utility of targeting their removal for the prevention of fatal violence against women. Concerns specific to ERPO law as one such approach included anticipated misuse of the law, uncertainty about its relationship to existing firearm transfer laws, undue burdens on gun owners, and due process. Aspects of the political and cultural context were identified as barriers to the passage of ERPO, including concentrated political polarity, entrenched patriarchy, and lack of connectedness with growing distrust and dehumanization of politicians and of each other. Suggested strategies for overcoming barriers to an ERPO law in Louisiana included broader education about the law and provisions, long-term relationship building outside of legislative sessions, and aisle-bridging collaboration on the drafting of legislation. Understanding the factors that have constrained ERPO legislation in Louisiana can inform research and advocacy efforts to promote evidence-based policy decisions that promote the health and safety of all people.
Child marriage remains a pressing social and public health issue globally, with significant implications for the rights, well-being and development of affected individuals. In Iran, legal frameworks that permit marriage from as young as 9 lunar years for girls-despite countervailing influences such as rising education levels and social reforms-have failed to curb the persistence of early marriage, which continues to be driven by entrenched cultural, socioeconomic and legal factors. Understanding the multifaceted nature of child marriage within this context is crucial for developing effective interventions and policies. Existing research predominantly focuses on quantitative assessments, leaving qualitative insights underexplored. The aim of this protocol is to address the existing gap by undertaking a scoping review and meta-synthesis of qualitative evidence concerning child marriage in Iran. This study seeks to provide an in-depth understanding of the underlying determinants, lived experiences and associated consequences of child marriage with the aim of informing future research endeavours and guiding policy development. This scoping review protocol will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and the methodological framework proposed by Arksey and O'Malley, incorporating recent methodological advancements. Selection criteria will be established through the Population, Concept and Context framework, targeting qualitative studies addressing child marriage within Iran. To ensure comprehensive coverage, an inclusive search will be conducted across diverse databases, including PubMed, Scopus, Web of Science, Scientific Information Database (SID), MagIran and the Barakat Knowledge Network System (BKNS), without any restriction on publication date, extending up to the search date. Both Persian and English language sources will be reviewed. Two independent reviewers will undertake the screening of titles, abstracts and full texts, resolving conflicting decisions through consensus or third-party arbitration. The methodological integrity of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Data will be synthesised through content analysis methods. Confidence in the integrated findings will be evaluated employing the GRADE-CERQual approach to enhance the trustworthiness and applicability of the review outcomes. The Research Ethics Committee of Tabriz University of edical Sciences approved this proposed scoping review and meta-synthesis, confrming ethical compliance absent patient involvement. Results from this investigation will be shared through peer-reviewed journal articles and presentations at relevant academic conferences locally and internationally. Furthermore, the synthesised insights into the phenomenon of child marriage in Iran are intended to inform scholars, policymakers and practitioners, supporting evidence-based strategies and policies to mitigate the issue and promote social change.
A parametric description of RR-interval spectra was introduced in the study, using a broken power-law model in addition to the parametrization of oscillatory peaks. Then, the model was used to evaluate effects of age, sex and sleep architecture on heart rate variability (HRV) in healthy subjects. From a polysomnography database, 215 whole-night electrocardiograms (ECGs) were extracted. The fractal and oscillatory power-spectral densities (PSDs) were calculated from RR-intervals, then a broken power-law model was fitted using piecewise linear regression to the double-logarithmic PSD, determining a breaking point in the fractal component, and allowing for two independent spectral slopes in the lower and higher frequency domains. The two-slope model provided a more optimal description compared to linear regression, even when penalizing increased model complexity. Peak detection was applied to the oscillatory component in the LF (0.04-0.15 Hz) and HF (0.15-0.4 Hz) bands, extracting the frequency and prominence of the dominant peak from each. The high frequency domain intercept, the breaking point frequency and the LF peak frequency decreased significantly with age. Both slopes were flatter in females, while the high domain intercept and the HF peak prominence were significantly increased. Waking after sleep onset and lightest sleep (N1) were associated with lower intercept values, while REM sleep had an opposite effect. The broken power-law model proved to be appropriate for the description of RR-interval spectra, and captured effects of age, sex and sleep structure that were corroborated by the literature. We would like to highlight that while HRV changes are often assumed to be of oscillatory origin, the fractal component has a major contribution to the total PSD, and thus to all measures derived from it.
The aging population presents both opportunities and challenges. Both global and Malaysian statistics have shown that an increase in longevity is also marked by an increase in the time spent in poor health. A key measure of healthy aging is the ability to lead an independent life. This has implications not only for the individual's quality of life but also for society as a whole; loss of independence with age is associated with increased economic burden and reduced workforce productivity. Understanding and subsequently addressing these age-related declines (slowing or reversing them) is critical in improving the health and societal challenges faced by older adults. However, most studies are focused on Western populations. The scarcity of interventions tailored to multiethnic Asian populations is compounded by the fact that existing measurements rely heavily on Western-designed psychometric instruments, which frequently fail in capturing true cognitive health because of large cultural and educational gaps. We aim to examine whether our long-term intervention packages can, over 4 years, significantly slow down the normal rate of aging-related decline in cognitive function and brain structure and function, as well as assess changes in aging-related salivary biomarkers. We will also measure the economic impact of such interventions in a cost-benefit analysis. We propose 3 ecologically valid intervention packages (cognitive stimulation, physical activity, or both combined) and aim to assess them against a control group. We will target a sample of 400 participants as representative of the population of community-dwelling aging citizens in Malaysia (aged 60 years and older). The 5 projects of this study examined (1) psychology (social interaction and emotional well-being); (2) neuroscience, looking at neural markers of cognition (magnetic resonance imaging and electroencephalogram); (3) decision-making (risk and challenges in decision making); (4) economics (cost-benefits and effectiveness of the study interventions); and (5) biological markers of aging, using salivary samples. The Sunway University Institutional Review Board has reviewed and approved the study (SUREC2020/039). Briefly, primary outcomes will include changes in cognitive scores (Montreal Cognitive Assessment), changes in cognitive behavioral measurements, changes in electroencephalogram and structural magnetic resonance imaging, changes in everyday problem-solving and Iowa gambling task scores, changes in salivary biomarkers (lactoferrin, C-reactive protein, and telomere length), and cost-benefit analysis of the intervention. The study grant was awarded in August 2019, with recruitment starting in May 2022 and concluding in July 2023. In 2023, the intervention phase began and is currently ongoing, with the first publications of outcomes expected in 2026. The effectiveness of these interventions will be examined from the perspective of multiple disciplines, including psychology, neuroscience, biology, and economics. We anticipate that the results of our study will be of interest to both the academic and general community and will hopefully influence policymaking. We hope that this study will provide robust and impactful, evidence-based insights on healthy aging and, thus, contribute to improving the overall quality of life associated with aging. ClinicalTrials.gov NCT06376656; https://clinicaltrials.gov/study/NCT06376656. DERR1-10.2196/88268.
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.
The US Food and Drug Administration (FDA) makes and communicates decisions that directly affect the health choices and well-being of the US public. Behavioral and decision scientists have long supported FDA's pharmaceutical (medical drug) regulatory and public health mission, working alongside clinical and pharmaceutical scientists. This Perspective describes four interrelated cases illustrating these collaborations: a) creating the Benefit-Risk Framework to guide regulatory decisions regarding new drug approvals; b) launching an internal decision support service to facilitate specific regulatory decisions; c) implementing the Patient-Focused Drug Development initiative to strengthen the use of patient input to inform regulatory decision making; and d) developing FDA SOURCE, a dynamic systems simulation model to assess potential strategies to address the US opioid overdose crisis. Key to the success of these efforts has been their behavioral and decision science foundations, strategically implemented by an expert team dedicated to fostering trusted collaborations with internal and external partners. These cases offer a model for other agencies facing complex decisions of public impact.
Road traffic injuries (RTIs) represent one of the most concerning and unaddressed public health burdens in Nepal, which disproportionately contributes to premature mortality and disability in a country undergoing rapid motorization. Globally RTIs are projected to become one of the top five causes of death by 2030 with low and middle-income countries bearing the greatest burden. This narrative review adopts a multidisciplinary perspective to provide a comprehensive overview of RTIs in Nepal and the measures that can be taken to prevent them. Crash determinants are examined in human, vehicular, and environmental domains, with driver behavior that includes reckless driving, alcohol impairment, and mobile phone use identified as the predominant contributing factor. The review integrates evidence from public health, road engineering, behavioral science, and policy domains to examine the complex determinants of road traffic crashes. It highlights the role of traffic laws and enforcement, infrastructure improvements such as traffic lights and pedestrian crossings, and public education and awareness campaigns in reducing RTIs. Furthermore, the review highlights the urgent need for the Nepalese government to pass the Road Safety Bill, which would empower the National Road Safety Council to implement safer road interventions. By situating Nepal within the broader global context of road safety, this review emphasizes the importance of integrated, multidisciplinary strategies to mitigate RTI and improve outcomes in resource-limited settings.
Firearms are the leading cause of death among children in the United States (US). As of 2023, half of US states had enacted laws allowing permitless concealed carry of firearms. Our cross-sectional study evaluated the association between permitless concealed carry laws and child general health using data from the nationwide Environmental influences on Child Health Outcomes (ECHO) Cohort collected between 2003 and 2023. Children aged 1-21 years with caregiver- or self-reported general health status were included. Secondary outcomes included child internalizing and externalizing behaviors and child stress. Regression models estimated the association of exposure to state-level permitless concealed carry laws six months prior to each outcome, adjusted for individual- and area-level covariates. One-fifth (20.9%) of the sample (n = 11,325) lived in states allowing permitless concealed carry of a handgun. Children living in these states were 25% less likely (OR: 0.75, 95% CI: 0.60, 0.95) to report excellent/very good general health and had psychological stress scores 0.21 standard deviations higher (β = 0.21, 95% CI: 0.10, 0.31) than children in other states. There was no statistically significant association with internalizing or externalizing behavior scores. Our study found that children living in states that allow permitless concealed carry of firearms had worse general health and higher stress, suggesting the need for policy changes to address gun violence as a public health and human rights crisis.
Unfair treatment of a person based on specific genetic characteristics is generally called genetic discrimination (GD). GD is a large-scale issue, as it is commonly perceived as such in many different contexts (e.g., work environment, insurance industry, legal system). Many entities that are often not directly connected to healthcare have lawful access to large amounts of genetic information, and the individual right to control access to and use of them or even to request their erasure must be balanced with other public and private interests. Given the complexity of the issue, in this paper we review the main regulatory and medico-legal aspects connected to GD, with specific regard to the main contexts where it is present. Two independent reviewers (SG and AC) conducted a narrative review using PubMed, Google Scholar, and the Genetic Discrimination Observatory (GDO). Boolean search combined "genetic information" AND "genetic discrimination" with ("regulation" OR "law" OR "insurance" OR "right to be forgotten" OR "right to erasure" OR "employment" OR "workplace" OR "justice system" OR "antisocial behavior"). Inclusion criteria comprised: (1) full-text articles available in English; (2) publications between January 1, 2001, and December 31, 2025; (3) studies addressing GD or relevant legal frameworks. Exclusion criteria comprised duplicate records, studies not primarily focused on GD, irrelevant publications, unavailable full texts, and non-English articles. G7 countries were prioritized. the results of our review were divided into different paragraphs, following the main aspects/contexts of GD: national and supranational regulations against GD; right to be forgotten; GD in the insurance industry; GD in the workplace; GD in criminal justice. Our review showed a significant international variability in addressing this issue, with legal approaches that vary from relatively static to highly dynamic. Some hot topics, like right to be forgotten, are inadequately or not addressed in most countries, with individual rights in specific contexts that struggle to be regulated. While in insurance industry variable trade-offs between individual and industry interests have been proposed, concerns about GD in workplaces and legal system (with specific reference to behavioral genetics) require a strict and codified regulation and a sound scientific basis to justify lawful and ethical use of genetic information in these contexts. Indeed, in these contexts, unforeseen negative consequences (different from the intended use) for the person who freely gave access to his/her genetic data represent the main hazard. These consequences tend to mainly concern the same economic/social minorities that are already exposed to a high risk of unequal social/employment/legal treatment.
This article examines the legal device known as the margin of appreciation at the European Court of Human Rights (ECtHR). To critically evaluate its modus operandi, we first explore scholarly literature on its functioning to then analyse the margin's application in abortion-related jurisprudence. By relying on the framework of reproductive justice, we present three objections to the doctrine. First, spurious incrementalism addresses individualised burdens of standardised human rights procedures, which place disproportionate procedural and evidentiary constraints onto applicants and reinforce prevailing injustices. Second, politicised presentism explores the normative prioritisation of state representatives, which entrenches static abortion attitudes, even in the face of evolving societal views or the rights of minority groups. Third, the watershed of injustices interrogates the possibility of justifying restrictive jurisdictions through market logics, which displaces access to human rights across borders, compelling citizens to engage in a form of absurd forum-shopping for reproductive health care.
In recent decades, the exponential growth of the global seafood industry has intensified the exploitation of aquatic invertebrates, particularly decapod crustaceans, whose commercial value continues to rise alongside consumer demand. This expansion has coincided with significant scientific advances recognizing these animals as sentient beings capable of experiencing pain and exhibiting complex behavioral responses to noxious stimuli. Nevertheless, legal systems have been slow integrate such evidence, resulting in a persistent misalignment between scientific knowledge and regulatory practice. This article critically examines the legal status of decapod crustaceans within animal welfare law, underscoring a pronounced disjunction between well-established scientific evidence of their sentience and the limited protections they receive. Despite extensive research supporting their capacity for suffering, the prevailing legal paradigm continues to construe these animals predominantly as commodities. Through a comparative analysis of regulatory regimes across the European Union, Italy, and selected extra-European jurisdictions, including UK, Australia, and New Zealand, the study identifies a significant regulatory lacuna alongside considerable legislative fragmentation. It scrutinizes a spectrum of normative models, ranging from indeterminate, principle-based provisions to more exacting and technically prescriptive standards. The article finally advocates for a harmonized, science-driven regulatory framework to ensure coherent and effective welfare protections for decapod crustaceans within the global food industry.
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.
The integration of ambient artificial intelligence (AI) scribes into the OpenNotes environment presents a profound governance crisis in healthcare. While patient access to medical records was designed as a transparency reform, the introduction of machine-generated text introduces novel vulnerabilities regarding record integrity, liability, and patients' trust. This study investigates how clinicians discursively negotiate the systemic risks and accountability challenges of patient-facing, AI-assisted documentation. Employing a netnographically informed qualitative design, the research conducted a reflexive thematic analysis of 484 relevant comments across 120 threads from eight clinician-oriented subreddits spanning October 2020 to February 2026. The analysis revealed five distinct governance challenges. First, an accountability vacuum exists where the mandatory clinician signature functions merely as a legal shock absorber for institutional AI liability. Second, clinicians frame AI hallucinations as a mathematically inevitable epistemic risk rather than a correctable technical bug. Third, a "dual-audience" problem emerges, as algorithmic optimization compromises both the individual clinical voice needed for peer communication and the empathetic clarity required for patient readers. Fourth, existing privacy frameworks are structurally inadequate to manage commercial data extraction during patient encounters. Finally, institutional productivity demands and AI-driven over-documentation severely threaten the fiscal credibility of the medical record through inadvertent upcoding. The prevailing regulatory assumption-that a physician's digital signature combined with passive patient visibility guarantees documentation accountability-is a fragile fiction. To protect clinical truth, health systems must transition from models of passive disclosure toward contingent transparency. This requires establishing authoritative, enforceable mechanisms for provenance tracking, error contestation, and vendor accountability.
The voltage-gated calcium channel CaV2.2 is predominantly located in neuronal synapses, where it plays a role in pain signaling and neurotransmitter release. Furthermore, CaV2.2 is important during early central nervous system development, as it is subsequently replaced by other calcium channels. A number of mouse lines with disrupted CaV2.2 channels have been developed through the utilization of a gene-targeting vector. The CaV2.2-deficient mice primarily exhibited reduced anxiety-linked behavior and response to pain stimuli. In a previous study, we observed hyperactivity and seizures in CaV2.2-knockout mice. Given the absence of prior descriptions of these characteristics, an in-depth characterization was conducted. This characterization included longitudinal behavioral studies, as well as histological, proteomic, and metabolomic analyses. Irrespective of the frequency with which testing was conducted, a variety of behaviors were observed (e.g., hyperactivity and increased exploratory behavior) in comparison with wild-type mice. The frequency and severity of the performed tests demonstrated a positive correlation with the magnitude of the difference in molecular markers between CaV2.2-knockout and wild-type mice. Seizures were observed but were not common. These results suggest that the CaV2.2-knockout mouse lines are susceptible to repeated stress stimuli during experimental studies. The mice are characterized by hyperactivity, explorative behavior, and sometimes experience seizures.
Traditional approaches to designing decision aids have focused on providing completeness of information and quantitative detail. An alternative approach based on psychological research emphasises understanding the essence or 'gist' of the decision. Few gist-based decision aids exist. The objective of this study was to develop novel gist-based decision aids for prostate and breast cancer screening and evaluate their acceptability. Men aged 40-60 years and women aged 40-49 years eligible for prostate or breast cancer screening were recruited from ResearchMatch (National Institutes of Health) and a public hospital located in New York City. Three rounds of semistructured interviews were performed to determine self-reported comprehensibility and acceptability, with iterative modifications after each phase, including: Phase 1: initial feedback; Phase 2, Round 1: evaluating our modifications; and Phase 2, Round 2: confirming final content. A total of 80 participants were involved in the two-phase qualitative interview process; Phase 1 and Phase 2 included 32 and 48 participants, respectively. Racial distribution was 50% white, 30% black and 10% Asian; 9% of participants were Hispanic or Latino. Most participants were highly educated. Interview themes established content validity of the final decision aids. In a quantitative analysis of the final decision aids using a questionnaire with fixed response options, acceptability was high, with two-thirds finding the length and amount of information of the decision aid to be optimal. The majority found the decision aid visually appealing, easy to read and easy to get through, and indicated that it held their interest and did not require much mental effort to read. One-quarter said the tool made them feel somewhat nervous, and three-quarters not at all. Most participants could understand and relate to the images, graphs and patient stories in the decision aid. After Phase 2, 45 of the 48 participants (94%) said they would find the decision aid helpful when making a decision. This study describes the iterative development and pilot testing of a novel gist-based decision aid for cancer screening, demonstrating high acceptability. Our findings provide a foundation for randomised trials comparing gist-based and traditional tools.
The October 7, 2023, terrorist attack in Israel and the ensuing prolonged war represent an unprecedented context of ongoing collective trauma. While early studies documented substantial acute psychiatric burden, the long-term trajectories of distress and posttraumatic growth (PTG) across the general population remain less understood. This study traced these trajectories over 27 months, utilizing a rare pre-war baseline to distinguish war-related outcomes from preexisting distress. In this prospective six-wave national cohort study, the analytical sample consisted of 680 Israeli adults (mean age 41.13 years [SD = 13.75]; 343 [50.4%] women; 544 [80.0%] Jewish and 136 [20.0%] Arab) analyzed via a Generalized Estimating Equations (GEE) framework. Participants were assessed approximately one month before the attack (T1) and followed up at 1 (T2), 6 (T3), 12 (T4), 18 (T5), and 27 (T6) months post-attack. The analytical sample included 29 (4.3%) participants who reported direct exposure to the attack, 129 (18.9%) who reported the loss of loved one, and 102 (15.0%) reported reserve military service during the war. Distress followed a parabolic trajectory characterized by a sharp acute rise followed by gradual attenuation toward baseline levels. Probable PTSD rose from 16.1% (T1) to 29.8% at T2 and declined to 19.7% (T6). Probable depression rose from 30.5% at T1 to 43.1% at T2 and significantly declined to 23.3% (T6). Anxiety rose from 22.1% (T1) to 40.1% at T2 and reached 21.0% (T6). Conversely, PTG increased progressively from T1 (M = 2.48, SD = 1.57) to T6 (M = 6.10, SD = 1.91; p < 0.001). Probable PTSD trajectory was significantly predicted by Arab ethnicity (OR = 4.07), and direct exposure (OR = 6.31). Probable depression trajectory was predicted by female sex (OR = 1.82), Arab ethnicity (OR = 3.62), and reserve service (OR = 4.38). Probable anxiety trajectory was predicted by Arab ethnicity (OR = 2.20) and reserve service (OR = 2.93), while higher PTG was uniquely predicted by female sex and the loss of a loved one (p = 0.007). Long-term adaptation to ongoing national trauma is characterized by the co-occurrence of symptom stabilization and progressive posttraumatic growth. However, the differential vulnerability identified among Arab citizens, women, and highly exposed groups underscores the necessity for sustained, stratified mental health monitoring while reinforcing the relational and meaning-making resources essential for resilience during prolonged conflict. Not applicable.
Smart Hospitals integrated within 6G edge networks aim to enhance hospital connectivity and operational efficiency by enabling intelligent and personalized e-health services and applications while optimizing resource utilization and maintaining a high degree of autonomy. Nevertheless, the interconnectivity and 6G integration, which comprise core components of Smart Hospitals, are susceptible to a wide range of security threats, posing significant risks to the confidentiality, integrity, and availability of hospital data and operations. Given that security is a critical concern for Smart Hospitals, there is an urgent need to develop novel security mechanisms to safeguard these environments within 6G edge networks. In particular, this work highlights how defining 6G characteristics, such as Ultra-Reliable Low-Latency Communications, massive IoMT connectivity, distributed edge intelligence, and AI-native network operation, not only enable next-generation hospital services but also reshape the security and privacy threat landscape and the requirements of mitigation mechanisms. In this context, the first essential step is to comprehensively understand both existing and emerging threats targeting Smart Hospitals in the 6G edge network ecosystem. Therefore, this article provides a categorization of security and privacy attacks based on their primary targets. Moreover, it presents a survey of mitigation techniques derived from recent literature, specifically designed to counter threats facing Smart Hospitals in 6G edge networks. The intent is to establish a foundation that supports ongoing research towards the development of effective, 6G-aware security countermeasures capable of protecting Smart Hospitals under the stringent latency, scalability, and reliability requirements of future healthcare environments.
Digital health tools are increasingly used in mental health care to passively collect patient data and analyze health status outside of clinical settings. While technologies such as digital phenotyping, affective computing, and computational behavioral analysis offer new insights into symptom manifestation in daily life, they generate large volumes of potentially sensitive data that raise significant data privacy concerns, requiring high levels of patient awareness and consent. Empirical research is lacking on stakeholder understandings toward the sensitivity of these data and expectations for data stewardship, perspectives that are critical for developing robust informed consent and data protection policies for digital health data use. This study aimed to explore key stakeholder perspectives on the sensitivity of computer perception (CP) data, trust in existing data protections, willingness to share CP data externally, and desire for transparency of CP data transactions outside of the clinical space. As part of a larger, multisite study, we conducted qualitative interviews (n=40) via Zoom (Zoom Communications, Inc) with 20 adolescents (aged 12-17 years) familiar with CP tools and their caregivers (n=20). Interviews consisted of a series of open-ended questions regarding stakeholders' perspectives on privacy, data security, and the use and exchange of CP data. We developed a qualitative codebook to identify and label thematic patterns in responses to questions addressing the topics above, using thematic content analysis to identify themes inductively. Each interview was coded by merging work from at least two separate coders, and several team members contributed to qualitative analysis. Most adolescents and caregivers viewed CP data as highly sensitive and expressed a reluctance to share these data beyond their clinical teams. While many participants expressed trust in existing data protections to protect CP data, they often misunderstood or overestimated the extent of protections to safeguard CP data. Our findings underscore the critical need for clear and effective patient communication and education about the risks, benefits, and protections associated with CP data through informed consent protocols. To promote greater transparency, understanding, and trust, we recommend 5 strategies: educating patients about data protection; studying secondary data exchange and reidentification risks; strengthening transparency regulations; improving data traceability mechanisms, such as distributed ledger technologies, to enhance data traceability and auditability; and adopting dynamic consent models.