Robotic-assisted surgery (RAS) has evolved from a procedural innovation into an increasingly integrated component of contemporary digital surgical ecosystems. Nevertheless, most current Health Technology Assessment (HTA) frameworks continue to evaluate robotic systems primarily through comparator-based models focused on isolated perioperative and oncological outcomes. In this EFISDS-TROGSS position paper, we critically examine the methodological limitations of conventional HTA paradigms when applied to robotic surgical platforms, using the recent Italian AGENAS appraisal as a representative case study. While the AGENAS document represents one of the most comprehensive national evaluations of RAS performed to date, its heterogeneous recommendations across procedures highlight unresolved tensions regarding perioperative benefit, real-world implementation, learning curves, organizational impact, and long-term healthcare value. We argue that RAS should increasingly be interpreted not simply as a surgical device, but as a platform technology interacting with simulation-based training, digital infrastructure, surgical data science, artificial intelligence, telecommunication systems, and institutional organization. Rather than a surgical device alone, RAS should be interpreted and regarded as a combination of technological advances and approaches that integrate various degrees of artificial intelligence autonomy, image navigation, telesurgery, and other benefits to empower the surgical team. Conventional HTA models, originally developed for relatively discrete therapeutic interventions, may incompletely capture the multidimensional interaction between robotic technologies and modern healthcare systems. Particular attention is dedicated to real-world evidence, implementation maturity, reimbursement limitations, and the growing mismatch between current Diagnosis-Related Group (DRG) structures and technologically integrated surgical care. Finally, we propose more flexible and multidimensional assessment frameworks integrating procedural outcomes with organizational sustainability, digital interoperability, workforce implications, and longitudinal healthcare value.
We updated WHO estimates of the global, regional, and national foodborne disease burden caused by chemical hazards. We estimated incidence, mortality, and disability-adjusted life-years (DALYs) of aflatoxins B1 and M1, inorganic arsenic, lead, methylmercury, cadmium, dioxin, peanut allergy, and cassava cyanide for 2000-21. We used data from systematic reviews, established dose-response relationships, the Global Burden of Disease Study 2021, and, where applicable, a structured expert judgment study. We used disease-specific models and a hierarchical meta-regression model with geographical clustering and global linear time trend with uncertainty propagation. In 2021, the nine foodborne chemicals caused 6·26 million (95% uncertainty interval [UI] 3·36-10·30) cases, 1·12 million (0·40-2·10) deaths, and 29·8 million (12·9-53·1) DALYs globally. Inorganic arsenic and lead caused the highest burden. Cardiovascular diseases due to inorganic arsenic and lead caused 88·9% of foodborne chemical deaths and 76·5% of foodborne chemical DALYs. The greatest DALY rate was estimated for the South-East Asia region, with 789 DALYs (272-1660) per 100 000 people mostly due to inorganic arsenic and lead (94·2%). The region of the Americas carried the highest foodborne chemical DALY rate in children younger than 5 years, with 749 DALYs (435-1260) per 100 000 children, mainly due to the effect of methylmercury on intellectual disability (91·0%). DALY rates from dioxin showed the steepest decrease from 2000 to 2021. Dietary exposure to chemicals causes a substantial global disease burden. An integrated response with ongoing non-communicable disease prevention efforts is key. Granular assessment including subnational exposure contexts is essential to ensure equity. WHO.
Infectious diseases caused by bacterial and viral pathogens remain major contributors to the global disease burden in children, necessitating comprehensive assessments to inform public health strategies. This study sought to quantify pathogen-attributable burden and characterize its temporal trends in children aged 0-14 years from 1990 to 2021, with projections through 2050. This study used data from the Global Burden of Disease (GBD) 2021 Study covering 204 countries and territories. Data analysis was conducted from October to December 2025, and projections through 2050 were generated using the Bayesian age-period-cohort (BAPC) model. The study assessed burden attributable to 34 major bacterial and viral pathogens among children from 1990 to 2021. Primary outcomes included pathogen-attributable deaths and disability-adjusted life-years (DALYs), stratified by sex, age, and Sociodemographic Index (SDI). In 2021, 34 pathogens accounted for an estimated 1,266,053 deaths (95% UI: 856,833-1,812,077). Diarrheal diseases were the leading infectious syndrome (608,793 deaths; 95% uncertainty interval [UI]: 349,675-983,346), followed by lower respiratory infections (545,061 deaths; 95% UI: 424,541-681,064) and meningitis (112,199 deaths; 95% UI: 78,995-157,539). Streptococcus pneumoniae was the predominant pathogen, accounting for 173,041 deaths (95% UI: 136,353-210,258). It was the leading cause of deaths in 18 of 21 GBD regions, with the highest age-standardized deaths rates observed in Oceania. S. pneumoniae and rotavirus were the leading contributors to pathogen-attributable DALYs, and the burden generally declined with increasing age. A strong inverse correlation was observed between SDI and burden metrics, with low-SDI regions, particularly sub-Saharan Africa, bearing the highest burden. The neonatal period was associated with the highest burden, and boys experienced a greater burden than girls. Rotavirus was the leading cause of diarrheal mortality, whereas S. pneumoniae predominated in lower respiratory infection- and meningitis-related mortality. By 2050, although most pathogen-attributable burdens are projected to decline, lower respiratory infections caused by Mycoplasma pneumoniae, meningitis caused by Neisseria meningitidis, and diarrheal diseases attributable to non-typhoidal Salmonella and norovirus are expected to remain major public health challenges. This study demonstrates a substantial pathogen-attributable infectious disease burden in children, particularly in boys and populations in low-SDI regions. These findings highlight the need for pathogen-specific, equity-oriented interventions and strengthened health systems to reduce persistent disparities in childhood infectious diseases.
Snakebite envenomation remains a critical health challenge across the culturally and ecologically diverse sub-Saharan Africa (SSA). This study examined healthcare providers' (HCPs') knowledge, attitudes, and practices (KAP), and their determinants towards snakebite envenomation. A cross-sectional study was conducted across nine SSA countries using the validated Knowledge, Attitudes, and Practices of Snake Envenomation - Healthcare Providers Questionnaire (KAPSE-HCPQ). The fractional logistic regression was conducted to identify the factors associated with KAP. A total of 3,544 HCPs were enrolled through professional and digital networks. General practitioners represented approximately half of the participants (50.1%), whereas toxicologists were 3.2%. Considerable variations were reported across sub-Saharan countries. Uganda and Sierra Leone attained perfect median knowledge scores (100%, range: 93-100, 73-100, respectively) yet both demonstrated marked deficiencies in practice (range: 0-25% and 0-75%, respectively). Attitude scores ranged from the lowest in Ethiopia (79%, range: 75-85%) to the highest in Uganda (91%, range: 87-95%). Higher knowledge was significantly associated with advanced training, antivenom availability, curricular inclusion of toxicology, and self-study. Positive attitudes were significantly associated with prior clinical exposure, faculty-based education, informal information sources, and participants' countries. HCPs demonstrated incorrect practices, such as applying a tourniquet above the bite site, attempting to suck out the venom, incising the bite wound, and asking to run to the nearest health facility, which may accelerate the systemic venom spread. In contrast, pharmacists and HCPs unaware of management guidelines demonstrated poorer practices. The study identifies a substantial gap between theoretical knowledge and clinical practice among HCPs across SSA, with variations by country, profession, training, and resource availability. Urgent interventions training, protocol standardization, and reliable antivenom supply are required to improve snakebite outcomes. Although healthcare providers across sub-Saharan Africa generally have good knowledge and favorable attitudes towards snakebite management, their actual practices remain persistently inadequate, irrespective of their country’s income level.Systemic barriers - limited formal training, absent institutional protocols, unreliable antivenom supply, and weak referral systems- are highly associated with inadequate clinical practice.Urgent standardization of training protocols and reliable antivenom supply are needed to improve snakebite outcomes across the SSA region.
Cardiovascular disease (CVD) continues to be the leading cause of death among women of childbearing age (WCBA) worldwide. An updated, geographically detailed assessment of CVD and its subtype burdens in this population is warranted. This study utilized the data from GBD 2021 to assess the incidence and mortality of CVD among WCBA across 231 countries and regions from 1990 to 2021. Age-standardised rates (ASRs) and estimated annual percentage changes (EAPCs) were used to assess trends in disease burden from 1990 to 2021. Sociodemographic-index (SDI)-associated disparities were explored using smoothed regression and correlation analysis. Predictions to 2050 were performed using Bayesian age-period-cohort (BAPC) modeling to support forward-looking public health planning. From 1990 to 2021, incident cases and deaths of CVD among WCBA increased from 2.77 million and 0.38 million to 4.49 million and 0.42 million, respectively, despite modest declines in ASR of incidence (ASIR, EAPC: -0.08%) and mortality (ASMR, EAPC: -1.59%). In 2021, ischemic heart disease (IHD) has the highest ASIR (67.53 per 100,000) and ASMR (8.64 per 100,000), and showed the fastest increase in ASIR over time. Marked sociodemographic disparities were observed, with low-SDI regions consistently experiencing higher ASIR (276.61 per 100,000) and ASMR (28.59 per 100,000) of CVD in 2021. Decomposition analysis indicated that population growth was the primary driver of the global increase in both CVD cases and mortality, while population ageing played a greater role in higher-SDI regions, with epidemiological changes partially offsetting mortality increases. Predictions suggest that while ASIR will continue to rise, ASMR is expected to further decline. The global burden of CVD among WCBA remains substantial, with rising incidence in key subtypes such as IHD and persistent disparities across SDI regions, underscoring the need for targeted, subtype-specific prevention strategies and strengthened healthcare systems in high-burden settings.
Health technology assessment bodies increasingly emphasise the importance of preference-weighted health-related quality of life (HRQoL) evidence. However, such measures are often absent in clinical trial publications. It is not yet clear how frequently clinical trials have incorporated these measures over the past five decades, how the use of preference-weighted HRQoL instruments has evolved over time, and how trends differ across disease areas, countries and global regions. This study aims to (1) assess changes over time in the proportions of clinical trials using each preference-weighted HRQoL instrument in adults, and (2) model secular trends in the adoption of these instruments across disease areas, countries and regions. The study will provide a comprehensive, systematic assessment of the use of preference-weighted HRQoL instruments in clinical trials since 1976 and develop a scalable approach for large-scale evidence synthesis. We will identify clinical trials involving humans published in English since 1976 through systematic searches of MEDLINE, Embase, Cochrane Library and Web of Science. We will focus on generic preference-weighted HRQoL instruments for adults, including EQ-5D-3L, EQ-5D-5L, Short Form 6 Dimensions, 12-Item Short Form Health Survey (SF-12), Health Utility Index 2, Health Utility Index 3, Assessment of Quality of Life (AQoL) series (AQoL-4D, AQoL-6D, AQoL-7D, AQoL-8D), Quality of Well-Being Scale (QWB), QWB Self-Administered (QWB-SA), 15D and Patient-Reported Outcomes Measurement Information System (PROMIS) with the Preference Scoring System (PROPr). Screening and data extraction will be automated using natural language processing (NLP) pipeline or large language models (LLMs). To determine the most accurate approach, we will benchmark NLP and LLM performance against a manually curated reference dataset of 5000 randomly sampled articles reviewed independently by three reviewers. Model performance will be evaluated using classification metrics including accuracy, recall and F1-score. Annual counts and proportions of trials using each instrument will be calculated, stratified by disease area, country and region. Trends will be modelled using basis-splines (B-splines) with 2 or 3 degrees of freedom and Bayesian spline regression to estimate secular changes in both absolute numbers and proportions of instrument use over time. This study uses only published literature and does not involve human participants or individual-level data. All results will be reported in aggregate form, with no identifiable information. Formal ethics approval is therefore not required. Findings will be disseminated via peer-reviewed publications and conference presentations, and aggregated data and analysis code will be made publicly available to support transparency and reproducibility.
Hypertension (HTN) is a major global health problem and a significant risk factor for cardiovascular disease. Mobile health (mHealth) applications offer an efficient, patient-centered approach to managing chronic conditions like HTN. Given the high prevalence of HTN in Iran, and a recognized lack of approved and scientifically-grounded mHealth applications, this study aimed to address this gap, particularly in Hormozgan Province. This study aimed to design and evaluate a HTN self-care application, named HOPE, to facilitate self-management and enable patients to access health services outside of clinical settings. The research was conducted in four steps: (1) determination of data elements and functional requirements based on a systematic review of guidelines and feedback from 25 cardiologists and 50 patients using a Likert scale questionnaire; (2) content design based on national and international clinical and educational standards; (3) application development using Visual Studio, ASP.NET framework with MVC architecture, and C#; and (4) usability assessment. The final evaluation involved 46 participants with HTN from the Hormoz Clinic, who used the application for one month, followed by an assessment using the Mobile Application Usability Questionnaire (MAUQ). The HOPE application was designed with nine main tabs and 52 sub-tabs, covering key areas such as demographic information, comprehensive education, nutrition tracking, BP recording, medication management, and a dialogue panel for communication with the doctor. The overall usability evaluation for the application yielded an average score of 4.32 (on a 5-point Likert scale), which was categorized as a "very good" level. The highest average score (4.37) was assigned to the "User Interface and Satisfaction" dimension. A significant relationship was determined between satisfaction with the user interface and the participants' level of education (P > 0.05). The HOPE demonstrated very good usability across all evaluated dimensions-ease of use, interface quality, and usefulness. The strong usability performance suggests that the application is well-designed and has high potential to effectively enhance self-care practices and could be a valuable tool in digital health management programs for patients with HTN. Future research should explore the long-term impacts of using HOPE on clinical outcomes and patient adherence, as well as its integration into routine healthcare practice to optimize HTN management.
Taxes on sugar-sweetened beverages can improve public health. We aimed to characterise the extent and types of sugar-sweetened beverage taxes implemented worldwide and the national characteristics predicting implementation, such as sugar-sweetened beverage intake amounts, disease rates, or economic development. This longitudinal analysis aggregated serial global datasets (including the Global Dietary Database, Non-Communicable Diseases Risk Factor Collaboration, Global Burden of Disease study, and World Bank data) from 1990 to 2024 in 183 countries to assess sugar-sweetened beverage tax characteristics and national predictors of policy adoption. Sugar-sweetened beverage taxes for public health purposes were identified and characterised, including amounts, fiscal instruments, structures, and covered beverages. Sugar-sweetened beverage consumption, obesity and diabetes prevalence, gross domestic product (GDP), and sociodemographic index (SDI) were assessed as predictors of tax implementation using Cox proportional hazards models with time-varying covariates. From 1990 to 2024, 64 countries implemented sugar-sweetened beverage taxes, accelerating over time and covering 3·5 billion people globally. South Asia led in adoption (50% of countries; median tax rate 7·5%), followed by southeast and east Asia (47·8%; 5·0%), the Middle East and North Africa (30·0%; 17·0%), and Latin America and the Caribbean (31·3%; 7·0%). Taxes were ad valorem (ie, based on price; 45%), volume-based (44%), sugar-content-based (5%), or mixed (6%), and 13% of countries earmarked revenue for public health. Multivariable-adjusted predictors of tax implementation included diabetes prevalence (hazard ratio [HR]=1·22 [95% CI 1·05-1·43]), obesity prevalence (1·14 [1·00-1·29]), GDP per capita (HR per $10 000: 1·19 [1·06-1·34]), and SDI (0·70 [0·57-0·86]), but not sugar-sweetened beverage intake (0·77 [0·42-1·39]). Global adoption of sugar-sweetened beverage taxes has rapidly accelerated since 1990; however, there is important heterogeneity by region and tax structure, and the taxes are shaped by a country's economic capacity, social development, and health conditions. This work was supported by the National Institutes of Health (R01HL115189).
Hospitals, important in mitigating the health risks of climate change, are themselves increasingly vulnerable, making the enhancement of their climate resilience an urgent necessity. Although high-resolution flood risk and economic loss maps exist, they overlook hospitals. Lack of assessment of future hospital-level climate risks, economic and health impacts, and the optimisation of hospital-specific adaptation measures hinders effective and comprehensive adaptation strategies in policy making, urban planning, and emergency response to enhance hospital climate resilience amid severe urban flooding. The aim of this study is to provide such assessment for China, and to provide the optimisation of hospital-specific adaptation measures. We constructed a database of China's general hospitals and an urban flooding model, integrating high spatial-temporal resolution precipitation data (9 km-15 min) to estimate the maximum water depth hospitals could face. We also quantified the direct economic losses and health impacts of urban flooding on hospitals-both with and without adaptation measures-across approximately 14 000 hospitals in 337 Chinese cities. Under the medium warming scenario, even if all hospitals were to fully adapt to 2020 urban flooding levels, by the 2080s, annual direct economic losses in hospitals would soar to US$9·1 billion (95% CI 8·0-10·1), equivalent to 6·9% of China's 2022 government medical insurance expenditure, with delayed diagnoses affecting 6·8 million people (95% CI 4·5-9·6). In a higher warming scenario, these losses increase by about 50%. A uniform national adaptation strategy would require $51·2-97·4 billion to reduce losses to near zero, whereas cost-effective strategies that are city-specific and hospital-specific could achieve similar results at only $8·2-11·9 billion. Our analysis reveals that climate change poses a severe threat to hospital systems in China, leading to substantial and direct health and economic consequences. The magnitude of the economic effects could place considerable long-term strain on hospitals' ability to safeguard population health. Enhancing climate resilience in hospitals is therefore imperative. Fundamental and Interdisciplinary Disciplines Breakthrough Plan of the Ministry of Education of China, National Natural Science Foundation of China, General Research Fund, the Croucher Foundation, and the Youth Innovation Team of China Meteorological Administration.
Civility and incivility are two multifaceted constructs that can be difficult to assess in a nuanced way. Previous studies have only utilized unidimensional assessments, which may have yielded partially misleading results and conclusions. The aims of the current mixed methods study were to investigate the 4-week prevalence of civility and incivility in a sample in the Swedish retail sector, and to assess if two-dimensional assessments can yield more nuanced interpretations of the civility and incivility constructs. The cross-sectional study included 1,014 employees out of which about 41% responded to the whole questionnaire and 59% answered it almost entirely or partially; approximately 50% responded to the civility and incivility questions presented in the current study. The 4-week prevalence of incivility was approximately 62%, which is lower than in previous studies. Two-dimensional civility and incivility assessments and open-ended questionnaire responses demonstrate that these constructs can be interpreted in a more nuanced way. The notion that civility or incivility, mostly, or on average, is associated with positive or negative experiences does not necessarily mean that it applies for everyone. This insight becomes particularly important when assessments are used as a basis for efforts to systematically ensure good and healthy work environments. Scientifically, the results implicate the importance of using two-dimensional assessments for more accurate and nuanced conclusions. In occupational settings, dialogues need to be conducted to understand the true meaning of assessments to enable adequate actions based on accurate conclusions, rather than preconceived notions.
In branch retinal artery occlusion (BRAO), the regional distribution of epiretinal macrophage-like cells (eMLC) and the objective assessment of ischemic tissue alterations using en face optical coherence tomography (OCT) have not been characterized. This study aimed to quantify eMLC and the optical intensity ratio (OIR) on en face OCT in acute BRAO. This retrospective study included 17 patients with unilateral acute BRAO. En face OCT was acquired using a 3 × 3 mm scan pattern centered on the fovea. Structural en face images from a 3-µm slab above the inner limiting membrane were used to identify and quantify eMLC, while slabs at the retinal nerve fiber layer, superficial capillary plexus (SCP), and deep capillary plexus (DCP) were used to measure optical intensity and calculate OIR. eMLC density and OIR were compared between affected and unaffected regions. eMLC density was significantly higher in BRAO eyes than in contralateral eyes across all regions, including the global macula, the affected region and the unaffected region (all p ≤ 0.001). Further analysis showed that eMLC density was higher in the affected region than in the unaffected region (p = 0.015). Global SCP OIR in BRAO eyes was comparable to contralateral eyes (p = 0.113), but global DCP OIR was lower (p = 0.001). OIR in the affected region was higher than in the unaffected region for both SCP and DCP (both p < 0.001). Compared with contralateral eyes, DCP OIR was higher in the affected region (p = 0.013) but lower in the unaffected region (p < 0.001). En face OCT enables simultaneous assessment of cellular and ischemic changes in acute BRAO, revealing presumed eMLC aggregation in the affected region and a paradoxical OIR pattern. This technique offers a noninvasive platform for evaluating ischemic neuroinflammation, though the OIR findings warrant further investigation.
Aeolian dust is one of the most pervasive natural air pollutants, strongly influencing atmospheric chemistry, visibility, climate feedback, and human health. This review critically evaluates the integration of geochemical fingerprinting techniques and YOLO-based deep learning frameworks for real-time aeolian dust monitoring, with the overarching objective of advancing source attribution, health risk assessment, and evidence-based policy formulation in dust-prone regions. The Middle East, particularly the Qatar Peninsula, experiences recurrent dust storms that transport mineral particles and trace metals, contributing to degraded air quality, reduced solar energy efficiency, and elevated risks of respiratory and cardiovascular diseases. Traditional monitoring approaches including satellite observations, ground-based measurements, and geochemical analyses such as inductively coupled plasma mass spectrometry (ICP-MS), scanning electron microscopy with energy dispersive spectroscopy (SEM-EDS), and X-ray diffraction (XRD) have improved source apportionment and compositional understanding, yet they often lack real-time detection and high-resolution spatiotemporal coverage. Emerging artificial intelligence (AI) tools, particularly the You Only Look Once (YOLO) deep learning framework, offer transformative opportunities for atmospheric dust monitoring by enabling rapid, automated plume detection across multispectral and hyperspectral datasets. This review demonstrates that ICP-MS, SEM-EDS, and XRD, when applied in combination, provide robust multi-dimensional source fingerprinting: ICP-MS isotopic ratios discriminate crystal from anthropogenic contributions, SEM-EDS resolves particle-level morphology and elemental composition, and XRD quantifies mineralogical assemblages that vary systematically with source region and transport pathway. Concurrently, successive YOLO generations (YOLOv5 through YOLOv10) have achieved real-time dust plume detection with mAP values exceeding 88% on satellite and UAV imagery. The proposed multimodal YOLO-geochemical integration framework, in which YOLO-guided plume detection triggers targeted field sampling and geochemical labels iteratively retrain detection models, enables compositionally resolved, real-time exposure mapping that directly supports inhalation risk assessment against WHO PM2.5 and PM10 thresholds and metal-specific reference concentrations. Collectively, these findings establish a scalable, evidence-based monitoring architecture that strengthens early-warning systems, informs air quality regulation, and advances global strategies to mitigate the environmental and public health burdens of dust storms.
Family carers have a key role in supporting malnourished older adults; yet, intervention evidence is lacking in the rehabilitation setting. This study aimed to explore the preliminary effects and acceptability of a family-centred, telehealth-enhanced dietary counselling intervention for treating protein-energy malnutrition (PEM) in rural-living older adults transitioning from rehabilitation to home, compared with usual care, in matched patient-carer dyads. A pragmatic, historically controlled, prospective, two-arm non-randomised controlled trial was conducted as a pilot study. Fifteen malnourished older adults admitted to rural rehabilitation units in New South Wales, Australia, and their family carers, were recruited and matched to 15 historical controls. The Patient-Generated Subjective Global Assessment (PG-SGA) was the primary outcome for nutrition status assessed at rehabilitation admission, discharge, and 3 months post-discharge. Quality of life, physical function, length of stay, discharge location, institutionalisation, mortality, carer burden, and service satisfaction were secondary outcomes. The historical control group received usual care. The intervention group received a telehealth-enhanced dietary counselling intervention developed with co-design principles, which engaged the family carer as a partner in the nutrition care team, delivered during the rehabilitation admission and for 3 months post-discharge. The difference in PG-SGA score from baseline to 3 months post-discharge between the two groups was 3.46 (95%CI: -2.07, 9.01; p = 0.238). The intervention group had a higher proportion of patients who were well-nourished at 3 months post-discharge compared to controls (60% vs 13%). At 3 months post-discharge, the intervention group had lower odds of being rated malnourished or with more severe malnutrition (i.e., moderate vs. well-nourished, severe vs. moderate) on the PG-SGA (OR 0.01, 95%CI: 0.00, 0.27; p = 0.005). There was a trend towards the intervention group having reduced odds of being discharged to a location other than home (OR 0.18, 95%CI: 0.03, 1.07; p = 0.06). The intervention was perceived as acceptable to patients and family carers. There were no differences between groups in other outcomes. Compared with usual care, the family-centred telehealth-enhanced dietary counselling intervention for the treatment of PEM in rural-living older adults transitioning from rehabilitation to home demonstrated preliminary efficacy and was acceptable to both patients and family carers. Future research aiming to improve PEM should meaningfully engage family carers as partners in the nutrition care team.
Urological malignancies are major contributors to the global cancer burden. This study aims to provide a comprehensive, sex-stratified assessment of the 2022 baseline and project trajectories to 2050 for prostate, bladder, and kidney cancers to inform long-term surgical oncology and healthcare planning. Baseline estimates for 185 countries were retrieved from GLOBOCAN 2022, with longitudinal trends from GBD 2021. We employed a dual-modeling framework: demographic forecasting for absolute case volumes and Bayesian Age-Period-Cohort (BAPC) models for age-standardized risk trends (ASIR/ASMR), including 95% uncertainty intervals (UI). In 2022, urological cancers accounted for 2.52 million new cases and 773,968 deaths globally. While prostate cancer dominated male burden, bladder and kidney cancers posed a notable clinical demand in both sexes. Higher HDI correlated with higher ASIR but lower mortality-to-incidence (M:I) ratios. A critical sex-specific divergence was observed: BAPC models predicted risk declines in females, but stable or modestly rising risks in males through 2050, likely driven by escalating metabolic factors. Paradoxically, the absolute global burden is projected to increase by 92.5%, reaching 4.85 million cases and 1.74 million deaths annually by 2050. The sharpest relative increases (>100%) are expected in low-to-medium HDI regions, where mortality growth is projected to outpace incidence. The urological cancer landscape faces a dual challenge of population aging and stagnating male-specific risks. Our findings describe an urgent need to expand urological surgical capacity and infrastructure, particularly in transitioning economies, to accommodate the inevitable surge in operative demand despite favorable risk trends in specific populations.
On April 20, 2026, the U.S. Food and Drug Administration FDA published a 1-year progress report of its initiative to reduce animal testing requirement in drug development. The FDA roadmap, announced on April 10, 2025, represented a pivotal paradigm shift toward human-centric New Approach Methodologies (NAMs), including stem cell-derived organoids, organs-on-chips, in silico modeling, and AI-enabled tools. The aim is to address the longstanding challenges of conventional preclinical safety assessment using animal models, including poor translational predictability, high cost, ethical concerns, and inherent interspecies biological differences, resulting in high clinical attrition and delayed access to effective therapies. In this commentary, we critically evaluate the scientific rationale, first-year implementation progress, and global regulatory impact of the FDA initiative. We highlight landmark advances including the permanent Innovative Science and Technology Approaches for New Drugs (ISTAND) program, human-centric validation principles, streamlined nonclinical frameworks for biologics, and alignment with global agencies and regulators. We also discuss existing, persistent challenges, such as uneven validation across toxicological endpoints, incomplete global data sharing, and cultural inertia, and propose actionable strategies to accelerate the safe, systematic adoption of NAMs in regenerative medicine and drug development.
Ehrlichia canis and canine Babesia spp. are widely distributed tick-borne pathogens of veterinary and One Health relevance. Contemporary nationwide data on canine exposure and associated determinants in Portugal are limited. This study aimed to estimate seropositivity proportions and explore epidemiological determinants of exposure to E. canis and Babesia spp. in clinically suspected dogs from Portugal over an 11-year period (2015-2025). Serum samples from 2960 dogs collected between 2015 and 2025 were analysed using commercial enzyme-linked immunosorbent assay kits to detect immunoglobulin G antibodies to E. canis and Babesia spp. Associations with demographic and geographic variables were assessed using chi-square and Fisher's exact tests. Univariable and multivariable logistic regression were used to identify potential risk factors (P < 0.05), and model performance was evaluated using the Hosmer-Lemeshow test, Nagelkerke's R2, and the area under the receiver operating characteristic curve. Overall seropositivity was 4.0% (116/2,872) for E. canis and 12.0% (337/2,818) for Babesia spp. Borderline results accounted for 3.0% (88/2,960) and 4.8% (142/2,960), respectively. E. canis seropositivity varied significantly by Nomenclature of Territorial Units for Statistics level 2 region (P < 0.001), with highest values in the Algarve (15.3%; odds ratio [OR] = 4.3, P < 0.001) and Setúbal Peninsula (50.0%; OR = 23.9, P = 0.025). Age was associated with E. canis exposure (P = 0.014), with increased odds in dogs aged 6 to < 11 years and ≥ 11 years (both OR = 2.1, P < 0.05). No significant geographical association was observed for Babesia spp. (P = 0.803), and sex and age were not significant predictors. Seropositivity to Babesia spp. was a risk factor for seropositivity to E. canis (OR = 3.6, P < 0.001). Multivariable models retained no independent predictors (Nagelkerke R2 = 0.15; area under the curve = 0.71). This study provides a nationwide, long-term retrospective assessment of serological exposure to E. canis and Babesia spp. among clinically suspect dogs in Portugal. Exposure to E. canis showed marked regional heterogeneity, particularly in southern Portugal, whereas Babesia spp. showed no significant regional association. Co-seropositivity, although uncommon, is consistent with shared tick-borne exposure pathways. These findings support risk-based tick control and continued surveillance within a One Health framework.
Climate change is expanding vector-borne disease ranges, yet Chikungunya virus (CHIKV) risk projections remain limited by single-model uncertainty and lack of vector integration. CHIKV, transmitted by Ae. aegypti and Ae. albopictus, threatens 1.3 billion people globally, necessitating robust spatiotemporal risk assessment. Using hierarchical ensemble modeling in Biomod2, we first projected vector distributions based on 19 bioclimatic variables and elevation, then integrated vector suitability as biological predictors for CHIKV under 16 CMIP6 scenarios (4 SSPs × 4 GCMs, 2021-2100). Eleven algorithms were evaluated and ensembled to minimize uncertainty. Ensemble models achieved excellent performance (Ae. aegypti: AUC = 0.949, TSS = 0.773; Ae. albopictus: AUC = 0.934, TSS = 0.764; CHIKV: AUC = 0.909, TSS = 0.659). Ae. aegypti distribution was constrained by temperature stability (isothermality, temperature seasonality), while Ae. albopictus responded to both temperature and precipitation. CHIKV distribution was primarily vector-driven (84% explanatory power), further modulated mainly by the mean temperature of wettest quarter. Currently, 21.26% of global land area (139 countries) faces CHIKV risk, concentrated in tropical/subtropical zones. Future projections reveal northward expansion into temperate regions (northeastern North America, central Europe, East Asia), but extreme warming (SSP585) may contract tropical habitats via thermal stress. Multi-model projections identify region-specific invasion risks, with previously unaffected temperate areas emerging as high-priority surveillance zones by 2100. These findings provide actionable risk maps for targeted vector control and preparedness strategies in 139 at-risk countries, particularly those lacking population immunity. Model heterogeneity underscores the necessity of ensemble approaches for climate-health policy planning.
Viral hepatitis remains a major global health threat, causing approximately 1.3 million deaths in 2022. Despite substantial advances in vaccination and clinical treatment, it continues to impose a heavy disease burden across China. Existing studies have largely focused on single hepatitis subtypes and national epidemiological trends, with limited evidence on provincial heterogeneity. To fill this research gap, this study aimed to conduct a refined, region-specific epidemiological assessment of viral hepatitis in China. Data were extracted from the Global Burden of Disease Study 2021 (GBD 2021) and the China Public Health Science Data Center to systematically analyze the epidemiological characteristics and spatiotemporal trends of viral hepatitis in China over the past three decades. The overall burden of viral hepatitis in China decreased substantially over the study period, with obvious regional heterogeneity. Acute hepatitis A, B and E, as well as chronic hepatitis B and C, all presented prominent downward trends. The fastest declines in incidence were observed in acute hepatitis B (estimated annual percentage change [EAPC] = -3.03) and chronic hepatitis B (EAPC = -4.74). Notably, males suffered a higher disease burden for nearly all outcomes, except for HCV-related hepatocellular carcinoma, which predominantly affected females. Furthermore, provincial-level analysis indicated marked regional disparities: Xizang maintained a high incidence rate, while Beijing exhibited low incidence accompanied by strikingly high hepatitis-related mortality, suggesting a notable decoupling between infection prevalence and mortality. China has achieved remarkable reductions in the overall burden of viral hepatitis, attributable to comprehensive public health interventions such as universal vaccination, standardized screening and improved sanitation conditions. Nevertheless, residual burdens in vulnerable populations and striking regional inequalities warrant targeted prevention and control strategies to reduce disease disparities nationwide.
Hypertension is the leading global risk factor for mortality, causing over 10 million deaths annually. In sub-Saharan Africa, hypertension prevalence is high, particularly in rural areas, where it is less likely to be diagnosed, treated or controlled effectively. This results in a high burden of complications, including heart failure, stroke and kidney disease. Community-centred approaches using community health workers (CHWs), risk-based approaches and simplified treatment regimens have shown promise in improving hypertension management. However, there is limited evidence on the effectiveness of such approaches in rural sub-Saharan Africa.The primary aim of this study is to assess the feasibility of a community-centred intervention for hypertension management in rural Kenya and The Gambia. The objectives are to evaluate the intervention's adoption, fidelity, reach and dose; understand the mechanisms of action and contextual factors affecting its implementation; assess acceptability from the perspectives of patients, healthcare providers and policymakers; estimate the costs associated with the intervention; and evaluate study procedures to inform the design of a future full-scale trial. We will conduct a mixed-methods, non-randomised, single-arm feasibility study, designed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) framework and checklist for feasibility and pilot studies, including best practice guidance for non-randomised feasibility studies. The study will be conducted in two rural sites: Kilifi, Kenya and Kiang West, The Gambia. The intervention was codesigned with stakeholders and includes community-based hypertension screening by CHWs, risk stratification and hypertension-mediated organ damage assessment at primary healthcare facilities, followed by treatment initiation using single-pill combination (SPC) antihypertensive therapy for eligible individuals. Training will be provided to all healthcare providers involved in the study. We will screen 500 participants aged 30-80 years at their residence (250 from each country), and we expect that about 45% will be referred for additional assessments and of these 25% (or 10% of the total sample) will be prescribed treatment with SPC. Data collection to evaluate the intervention and its implementation will involve quantitative measures of feasibility and clinical outcomes; observations to assess fidelity and costing measures; and qualitative interviews and focus group discussions with patients, healthcare providers and policymakers to understand the acceptability and contextual influences on intervention implementation. Ethics approval was obtained from the Kenyan National Committee for Science, Technology and Innovation (ref: 415561), the Gambia Government/Medical Research Council Joint Ethics Committee (ref: 31372) and the London School of Hygiene and Tropical Medicine Ethics Committee (ref: 31372). Study findings will be disseminated through peer-reviewed publications, conferences, policy briefs, community engagement forums and accessible summaries shared via the Improving Hypertension Control in Rural sub-Saharan Africa and partner newsletters. This study is registered with the ISRCTN- The UK's Clinical Study Registry (ISRCTN81228019), and Pan African Clinical Trials Registry (PACTR202504839027548).
Despite low alcohol consumption across most MENA countries, the burden and management challenges of alcohol-associated liver disease (ALD) remain poorly characterized. This study assessed healthcare providers' perceptions, clinical experiences, and barriers to ALD care in the region. A cross-sectional survey was distributed to clinicians involved in liver disease management in MENA. The survey explored perceived ALD prevalence, diagnosis patterns, clinical practices, access to services, and sociocultural barriers. Selected variables were compared across three subregions (Gulf, North Africa, and Levant & Turkey). A total of 286 providers from 16 MENA countries participated. ALD prevalence was perceived as low or moderate by most respondents, and 52.1% reported an increase in ALD case numbers over the past five years. ALD was commonly diagnosed during routine assessments or at advanced stages. Only 12.9% reported existing national ALD guidelines, and 28.3% had access to specialized clinics. Medical management and nutritional support were widely available, whereas liver transplantation was accessible to 54.5%. Stigma (76.6%) and limited treatment facilities (46.9%) were major barriers. This region-wide assessment highlights major gaps in ALD recognition, clinical pathways, and policy infrastructure. Reducing stigma, strengthening provider training, and developing region-specific guidelines are essential to improve ALD care in culturally sensitive settings.