Public Health Emergency Workforce (PHEW) plays a significant role in the detection and rapid response to emerging diseases, thus helping countries manage global threats. In line with the International Health Regulations' call for strengthening national capacities, field epidemiology training programs (FETPs) and rapid response teams (RRTs) have been developed to enhance countries' preparedness and response capacities. This scoping review synthesizes the evidence on available FETPs and RRTs and on their effectiveness as well as the challenges they face. A scoping review was conducted using EMBASE, Ovid Medline and Scopus databases in addition to the grey literature for studies published after year 2000, in the English language. Studies were selected by two independent reviewers and data were extracted into an excel sheet. Included manuscripts were analyzed through a narrative synthesis. Four thousand one hundred ten studies were identified from the three peer-reviewed databases and six articles from the grey literature. Finally, 67 studies were included in the review comprising 47 identified through our search and 20 sourced from the references. The studies on PHEW training included FETPs encompassing those with laboratory and veterinary focus, and training on rapid response. Enhancement in learning acquired, course satisfaction, application of skills in workplace and engagements in key emergency response activities were found. However, lack of funding and a standardized curriculum were still among the most common challenges facing FETPs and RRTs. While PHEW training including FETPs and RRTs are essential for building resilience against health threats, financial challenges, lack of standardized curricula and operating procedures hinders their effectiveness. Integrating One Health and laboratory skills into FETPs are vital, as seen during the COVID-19 pandemic response. Governments should work towards increasing funding and incentivizing graduate retention. They should also collaborate with organizations such as the International Association of National Public Health Institutes (IANPHI) and the Global Field Epidemiology Partnership (GFEP) to establish standardized curricula for FETP and RRT.
Mental health conditions account for 18% of years lived with disability worldwide. 1-in-6 adults are affected in England, with most mental health conditions beginning in childhood and adolescence. Mental distress and ill health are unequally distributed in the UK, with strong associations with wider determinants of health, and higher prevalence among systemically disadvantaged groups. Currently, there is a lack of evidence to inform effective and timely policymaking for primary prevention in the UK. In recognition of these challenges, a national Population Mental Health (PMH) Consortium was established, as part of Population Health Improvement UK (PHIUK). PHIUK is a national research network which works to transform health and reduce inequalities through change at the population level. Our aim is to establish an interdisciplinary PMH Consortium, focussing on upstream determinants and the prevention of risks and onset of mental health conditions through interdisciplinary stakeholder engagement, to create new opportunities for population-based improvement of mental health in the UK.The PMH Consortium brings together leading interdisciplinary representation in population mental health, spanning from sciences to the arts, across the UK. Membership includes six academic institutions, third sector organisations, lived experience expertise, and strong links with national bodies to ensure integrated cross-national and regional policy impact. The PMH Consortium comprises four cross-cutting platforms (Partners in policy, implementation, and lived experience; Data, linkages, and causal inference; Narrowing inequalities; Training and capacity building) and three challenge areas (Children and young people's mental health; Prevention of suicide and self-harm; Multiple long-term conditions) which are highly integrated and interdependent. The work will be underpinned by a Theory of Change across an initial four-year life cycle. This paper describes the aim, objectives, and approach of the PMH Consortium, as well as anticipated challenges and strengths. The goal of the PMH Consortium is to develop a model for population mental health research and policy translation that is both scalable and sustainable. It is critical to ensure continued impact and viability beyond the initial four years, contributing to the prevention of mental health conditions in the UK, with personal, economic, social, and health benefits.
The prevalence of dental and oral diseases is increasing globally, yet the utilization of dental services has not shown a corresponding rise. Cost remains a major barrier, as dental care ranks among the four most expensive health services globally. These costs are shaped by each country's health payment system, which plays a critical role in determining access to healthcare. This scoping review aims to map the existing evidence on oral health payment systems and examine how these systems influence access, utilization, equity, and financial protection in different settings. A scoping review was conducted of articles published between 2018 and 2025 that examined payment systems for oral health services. Literature searches were performed using PubMed, Google Scholar, and ScienceDirect. Eleven eligible articles revealed two main types of payment systems: insurance-based and non-insurance-based systems. Insurance models included capitation, global budgets, and reimbursement schemes, whereas non-insurance models relied on out-of-pocket or fee-for-service (FFS) payments. The FFS approach, commonly used in countries such as Saudi Arabia, the Netherlands, and Cameroon, imposed significant financial strain on patients. Insurance systems combining public and private schemes were implemented in multiple countries, including the United States, Saudi Arabia, Denmark, the United Kingdom, Hungary, Ireland, Italy, the Netherlands, Scotland, Spain, France, Germany, Romania, and Indonesia. Service coverage varied by country; for instance, government insurance in the Netherlands excluded dental care. Capitation for preventive services has been implemented in Sweden, Australia, and Indonesia. Cameroon did not have a national health insurance system (NHI). Moreover, the Netherlands and Spain had NHIs that did not cover dental health services. No single dental health financing model is universally applicable, as its effectiveness depends on government policies and local contexts. Payment systems should be designed to increase access and alleviate the financial burdens of low-income populations.
Modelling approaches that consider system-wide delivery platforms rather than single diseases can be instrumental in economic evaluation and forward-looking policy formulation. This study develops a costing approach tailored to the Thanzi La Onse (TLO) model of Malawi's healthcare system, with general applicability to other health system models. We developed a mixed-method costing approach to estimate the total cost of healthcare delivery (excluding high-level administrative costs) in Malawi using the TLO model, from a healthcare provider perspective. Through iterative adjustments of key parameters, we aligned model-based estimates as closely as possible with real-world expenditure and budget data. Costs were projected for 2023-2030 under alternative scenarios of health system capacity. A comparison with expenditure and budget data suggests our costing method is broadly reliable for the conditions captured by the model, though some mismatches remain owing to data limitations and definitional inconsistencies. Under current system capacity, total healthcare delivery costs for 2023-2030 were estimated at 2.83 billion US dollars [95% uncertainty interval (UI), $2.80-$2.87 billion], excluding non-medical infrastructure and administrative costs, averaging $390.98 million [$385.92-$396.71 million] annually or $16.89 [$16.75-$17.08] per capita. Scenario analysis highlighted strong interdependencies within the health system. Improving consumable availability alone increased consumables costs by 4.63%, while expanding human resources for health (HRH) alone increased them by 1.43%. When both HRH and consumable availability were expanded together, consumable costs rose by 5.93%, a combined effect larger than either change alone, illustrating how bottlenecks in one component constrain the impact of improvements in another. Mixed-method costing using health system models is a feasible and robust method to estimate and forecast healthcare delivery costs. Clarifying assumptions and limitations can improve their utility for economic analyses and evidence-based planning in the health sector.
Malnutrition during pregnancy is a public health concern. Interventions implemented through the health sector can prevent maternal malnutrition. Our aim is to identify implementation strategies for delivering nutritional interventions through primary health care to prevent malnutrition in all its forms during pregnancy. We followed the Cochrane Handbook for Systematic Reviews and PRISMA guidelines. A search strategy was developed for five databases. The information was systematized using the Template for Intervention Description and Replication. Meta-analyses were performed using a random-effects model. We used the Risk of Bias and the Non-randomized Studies of Interventions tools, and the certainty of the evidence followed the GRADE guidelines. We included 51 studies conducted across high-, middle-, and low-income countries. Multiple micronutrient supplementation (MMS) was more effective than iron-folic acid (IFA) supplementation alone in improving hemoglobin levels and other anemia-related indicators, when initiated during the first or second trimester of pregnancy and delivered with in-person, individualized counseling and follow-up. Our meta-analysis confirmed that MMS improved maternal anemia compared to IFA with a moderate certainty of the evidence. Healthy eating counseling, physical activity, and weight gain monitoring, when combined, were effective in achieving weight gain when the interventions were guided by prenatal care protocols and included materials and resources to support. Our meta-analysis showed a non-significant reduction in excessive weight gain with very low certainty, no meaningful effect on low weight gain with low certainty, and a potentially meaningful increase in the likelihood of gaining weight within the recommended range with very low certainty. A coordinated package of health system-delivered interventions, including MMS, behavioral counseling, and monitoring of maternal weight gain, should be implemented within primary health care, beginning in the first or second trimester, to prevent all forms of malnutrition during pregnancy. Effective implementation strategies to provide these interventions can be adapted to local contexts. The protocol for this review was registered in PROSPERO with the ID CRD4202460299.
Maternal mortality ratio (MMR) and neonatal mortality rate (NMR) are key indicators of population health and health system performance. Yet longitudinal cross-country evidence on how macroeconomic conditions-such as income growth, inflation, and unemployment-relate to maternal and neonatal mortality remains limited. We assembled a balanced country-level panel of 152 countries for 1991-2023 using World Health Organization mortality series and World Bank World Development Indicators. Outcomes (MMR, NMR) were modelled in natural logarithms; GDP per capita was log-transformed, inflation was expressed as ln(1 + IR/100), and unemployment as the first difference of log unemployment. Cross-sectional dependence was assessed using Pesaran's CD test, and-given dependence-stationarity was evaluated with Pesaran's second-generation CIPS test. Associations were estimated using two-way fixed-effects panel regressions (country and year effects) with Driscoll-Kraay standard errors (lag = 2), with sensitivity analyses using lagged GDP per capita (t - 1, t - 2) and continent-stratified models. In the global two-way Driscoll-Kraay fixed-effects models (country and year fixed effects; Driscoll-Kraay standard errors, maximum lag = 2), GDP per capita was inversely associated with both ln(MMR) (B = - 0.233, p < 0.001) and ln(NMR) (B = - 0.139, p < 0.001), while inflation (LINF) was positively associated with both outcomes (lnMMR: B = 0.055, p < 0.001; lnNMR: B = 0.042, p < 0.001). Changes in unemployment (dLUR) were positively associated with ln(NMR) in the global model (B = 0.102, p < 0.05) and in Asia (B = 0.063, p < 0.05), but were not significant for ln(MMR) in continent-specific models under the contemporaneous income specification (Table 6). This pattern may partly reflect measurement limitations of official unemployment rates in settings with large informal sectors and weaker labour-market registration; however, in the lagged-income specification (GDP per capita t - 1), dLUR was positive and statistically significant in Europe (Supplementary Table S2), suggesting that unemployment effects on maternal mortality may be specification- and context-dependent and should be interpreted cautiously. Macroeconomic conditions were associated with maternal and neonatal survival. Globally, higher GDP per capita was associated with lower maternal and neonatal mortality, and this inverse association remained in sensitivity analyses using lagged GDP per capita (t - 1, t - 2). Although the strength of income-mortality associations varied across continents and some region-outcome models were imprecisely estimated, particularly in Oceania (small number of countries), the overall pattern suggests that macroeconomic conditions may be relevant correlates of RMNCH outcomes. Inflation was related to worse outcomes in some settings, underscoring the importance of growth that preserves purchasing power and protects health-system inputs, but the inflation-mortality relationship was heterogeneous across regions. Unemployment effects appeared context-specific, with evidence most clearly observed for neonatal mortality in Asia, suggesting that labour-market and social-protection responses may be most relevant where vulnerability and out-of-pocket financing are high. These findings should be interpreted as adjusted associations rather than causal effects. Aligning macroeconomic management with RMNCH financing and access policies may help support progress in preventable maternal and neonatal deaths. Not applicable.
Research using the multidimensional sleep health (MDSH) framework has increased globally, often relying on self-report measures. The Ru-SATED scale and Sleep Health Index (SHI) are common self-report measures of MDSH, but comparative data on their measurement properties and contextual characteristics remain limited. Seven electronic databases were searched for measurement properties and uses of the two scales over the past twelve years. This review identified 19 psychometric validation studies concerning two original and 17 cross-cultural, and summarized contextual comparison of MDSH measures and frameworks. Measurement properties of both measures were assessed with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, and contextual comparisons were conducted narratively. Both measures exhibited acceptable psychometric properties across diverse cultural settings, with the SHI findings showing greater consistency than those of the Ru-SATED scale. Aggregating the Ru-SATED and SHI frameworks fully covered the sleep characteristics assessed by five instruments grounded in the World Sleep Society initiative, encompassing regularity, satisfaction, alertness, timing, efficiency, duration, and disorder. Notably, the SHI framework incorporates targeted sleep disorder assessment while the Ru-SATED framework specifically excludes such assessment, highlighting the distinct focus and scope of each tool. Instrument selection depends primarily on research purpose, study sample, and intended use. We recommend characterizing both sleep health and sleep disorders to fully capture the complex relationships between sleep and health outcomes.
Pregnancy rates among adolescents and young people in South Africa remain high despite the widespread availability of sexual and reproductive health information and contraception being free of charge. Knowledge gaps, misconceptions, and insufficient attention to youth voices are critical barriers to informed decision-making. Support for adolescents and young people is often negatively framed, focusing on sexual abstinence before marriage. This paper explores youth perspectives on sexual and reproductive health information and support. It also examines gaps in contraceptive knowledge, providing insights for public health programmes and interventions. Findings highlight significant gaps in contraceptive knowledge, which contribute to low uptake. The quality and nature of relationships between young people and adults also shapes the support and information provided. For adolescents and young people, trust and feeling understood impact whether adults are perceived as valuable sources of information. Suitable interventions include the creation of safe support spaces for adolescents and young people to develop sexual and reproductive health knowledge and communication skills, access accurate information, and address socioeconomic constraints.
The evolving global disease landscape, in conjunction with the significant impact of an aging population, has led to mental‒physical multimorbidity, imposing unprecedented pressures on healthcare systems and economies. This study aimed to investigate the interrelationships among multimorbidity, depression, and catastrophic health expenditure (CHE) and to test whether the intensity of CHE mediates these links. The analysis employed data from the China Health and Retirement Longitudinal Study (CHARLS), which conducted a longitudinal survey from 2011 to 2018, tracking 5,274 participants aged 45 years and older over a seven-year timeframe. Multimorbidity was ascertained through self-reported data from participants, whereas depression was evaluated via the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The intensity of CHE was calculated as the ratio of out-of-pocket (OOP) payments to the capacity to pay (CTP), adjusted for a catastrophic threshold of 40%. The relationships among the three variables were analysed via an extension of the random intercept cross-lagged panel model (RI-CLPM), which includes covariates to predict the observed variables. Mediation via the intensity of CHE was tested using 5,000 bootstrap resamples. At the between-person level, multimorbidity and depression were positively correlated (Model 1 r = 0.349; Model 2 r = 0.246; both p < 0.001), whereas the intensity of CHE showed negligible between-person associations with either variable. At the within-person level, all variables showed significant autoregressive stability, with multimorbidity demonstrating the strongest persistence (β = 0.808 in Model 1 and 0.936 in Model 2). Cross-lagged associations were clearly asymmetric, with prior multimorbidity exerting the largest prospective effects on the intensity of CHE (β = 3.028) and subsequent depression (β = 0.646 in Model 1 and β = 0.789 in Model 2), whereas prior depression and prior intensity of CHE had much smaller effects on later multimorbidity. Mediation analyses indicated that the intensity of CHE (T) partially mediated the association from multimorbidity (T‑1) to depression (T + 1) (indirect effect = 0.063, 95% CI [0.042, 0.084]), but showed negligible mediation for the reverse pathway from depression (T‑1) to multimorbidity (T + 1) (indirect effect = 0.001, 95% CI [0.000, 0.001]). The study identified asymmetric bidirectional relationships among multimorbidity, depression, and the intensity of CHE in Chinese middle-aged and older adults, with effects predominantly running from multimorbidity to increased intensity of CHE and later depression; the intensity of CHE explained only a small portion of the multimorbidity→depression effect and virtually none of the depression→multimorbidity pathway. Policies that integrate multimorbidity management with routine depression screening could help reduce the combined physical, psychological, and financial burdens among middle-aged and older adults.
Malnutrition is a critical global health issue impacting children's growth, with nearly 45% of child deaths associated with undernourishment. The 2019 Ethiopia Mini Demographic and Health Survey reported a stunting prevalence of about 37% among children under 5, positioning Ethiopia among the countries with the highest stunting prevalence. This study aimed to identify risk factors for stunting among children under 5 in Ethiopia. A cross-sectional study was conducted from March 21 to June 28, 2019, enrolling 5126 children aged 0 to 59 mo through a stratified two-stage cluster sampling method. Binary logistic regression was used to identify factors associated with stunting, including variables with P values less than 0.2 from bivariate analysis in the multivariable analysis. Variables with P values less than 0.05 indicated significance. The prevalence of stunting among children under 5 in Ethiopia was 36.9%. Tigray had the highest prevalence of stunting (49%), whereas Addis Ababa had the lowest (9.6%). Multivariable logistic regression revealed several risk factors: rich households (adjusted odds ratio [AOR], 0.451, 95% confidence interval [CI], 0.123-0.931), middle-income households (AOR, 0.625, 95% CI, 0.345-0.725), mothers with secondary and higher education (AOR, 0.336, 95% CI, 0.252-0.937), primary education (AOR, 0.781, 95% CI, 0.231-0.872), child still breastfeeding (AOR, 0.261, 95% CI, 0.165-0.742), rural residence (AOR, 2.105, 95% CI, 1.415-3.471), and vitamin A supplementation (AOR, 0.841, 95% CI, 0.126-0.963). Other significant factors included child age, number of children under 5, vaccination status, water source, birth interval, and region. Stunting remains a significant issue in Ethiopia, influenced by factors such as household wealth, maternal education, place of residence, and health practices. Policymakers must address these determinants to enhance nutritional outcomes in Ethiopia.
Empathy is central to humanised nursing but vulnerable to erosion in demanding academic and clinical settings. Positive mental health (PMH) encompassing emotional, psychological, and social well-being, may regulate how self-compassion is statistically linked to empathic engagement. However, evidence in nursing students remains limited. To examine the statistical association of positive mental health in the relationship between self-compassion and empathy among undergraduate nursing students within a structural equation modelling (SEM) framework. Observational, analytical, cross-sectional study. A total of 402 nursing students from a public university completed validated measures of self-compassion, empathy, and PMH. SEM with latent variables was conducted using diagonally weighted least squares (DWLS) to account for ordinal and non-normal data. Model fit was assessed using multiple indices, acknowledging the complexity of the latent structure. Self-compassion was positively associated with PMH (β = 0.772, p < 0.001), which related positively to empathy (β = 0.689, p < 0.001). The indirect effect via PMH was positive (β = 0.532, p < 0.001), while the direct effect of self-compassion on empathy was negative when controlling for PMH (β = -0.553, p < 0.001), indicating an inconsistent mediation pattern. The model explained 59.6% of the variance in positive mental health and 19.3% in empathy. PMH appears to be a key correlate in the association between self-compassion and empathy. Findings suggest that emotional well-being may be an important foundation for relational competence, although the study's cross-sectional nature precludes causal inferences and the marginal model fit warrants a cautious interpretation. Fostering empathy may require more than interpersonal skills training. Nursing curricula could benefit from integrating positive mental health promotion, including training in self-compassion and emotional regulation, to support empathic and humanised nursing practice across educational and clinical contexts.
Aims Links between food insecurity and poor oral health are increasingly well evidenced. However, research on addressing the associated challenges in dental settings is scarce, and little is known about the priorities of members of the public. The aim of this research was to investigate the experiences and priorities of people with lived experience of food insecurity in relation to their oral health to: a) understand whether dental professionals are addressing their needs related to food insecurity; and b) to identify priorities for future research.Methods Key stakeholders and people with lived experience of food insecurity were invited to speak with the project team via face-to-face consultations, virtual meetings, telephone calls and emails. This process established their key dental care priorities.Results Thirty-five people from community food networks and spaces identified the following priorities for dental care: 1) improving access to dental care; 2) improving the dental team's understanding of living in poverty and its impact on oral health; 3) patient education; and 4) signposting.Conclusions People with lived experience of food insecurity highlighted the importance of improving the dental profession's understanding of and response to food insecurity, providing valuable insight for future research directions.
Maternal mortality continues to be a major global health concern that disproportionately affects low- and middle-income countries (LMICs), with the World Health Organisation (WHO) estimating a maternal death occurring every two minutes. The data-sparse LMICs employ a multitude of estimation approaches to gauge maternal mortality ratios (MMR); however, their classification of deaths and reproducibility of estimates remain open to discussion. Despite a considerable reduction of MMR levels since 2000, more recently, the MMR levels in countries including the US have resurged due to the sociomedical crises brought about by the COVID-19 pandemic. The United Nations' Sustainable Development Goal (SDG) 3.1 aims to achieve global maternal mortality ratios of less than 70 per 100,000 live births and below 140 per 100,000 live births at the national level by 2030. However, recent projections indicate it will remain unmet by a margin of a million maternal deaths. Many LMICs apply the three-delays framework of maternal deaths that requires verbal autopsy to be used in tandem with the identification of maternal deaths. The three-delays model devised in the mid-1990s allows LMICs to gear their resources towards specific intervention points. A significant portion of the existing literature has focused on the description of the magnitude of the issue and the factors precipitating maternal deaths. Innovative solutions have recently been implemented, such as repurposing military helicopters to reduce the delays in managing obstetric complications. Similarly, prospective studies are required to devise ways to address the sociomedical mechanisms underlying maternal deaths.
Australian Aboriginal people have evolved advanced relational knowledge systems for raising children and young people over thousands of years. Documentation of this knowledge within peer-reviewed literature is dispersed across a broad set of disciplines and sources that are mostly contextualised within Eurocentric frameworks. In this scoping review, we describe the literature on Australian Aboriginal Early Relational Knowledge Systems. Our aim is to describe how Australian Aboriginal approaches to relational wellbeing uniquely promote health and human development from pre-conception, to childhood, to adolescence and into parenting next generation offspring. We privilege Australian Indigenous authors as the holders of knowledge and limit our review to data sources led by Australian Indigenous people. A systematic search for relevant studies was conducted across four databases: MEDLINE, PsycINFO, Embase and CINAHL. This yielded 5,141 articles, of which 26 met criteria. A further 5 articles were identified through citation searching resulting in 31 included articles. We describe how Aboriginal children and young people develop relational security through engagement with multiple complex social systems within family and community, through interaction with Country, and across human and non-human elements, many features of which are missed in Western theories and Western interpretation of Aboriginal relational knowledge. Culturally valid and reliable assessment measures are urgently needed to accurately represent and monitor population relational health in Aboriginal children and young people.
Pediatric sepsis is a leading cause of global morbidity and mortality, yet high-resolution, granular subnational assessments remain scarce. Chile and Mexico are the only countries in Latin America that possess robust vital registration systems and open access databases with marginal levels of missing cases. This offers a unique opportunity to quantify the subnational burden of pediatric sepsis, identify healthcare system constrictions, and guide targeted public health interventions. This retrospective longitudinal study analyzed official hospital discharge and non-fetal death records of pediatrics (< 10 years old) from Chile and Mexico between 2014 and 2024. Age-standardized incidence (ASIR) and mortality (ASMR) rates, standardized ratios, and the mortality-to-incidence ratio (MIR), were calculated to assess mortality relative to subnational hospital output. A novel dynamic risk stratification matrix was developed to classify ICD-10 sepsis-related causes into four risk/severity quadrants based on year-specific ASIR and MIR indicators. A total of 656,234 discharges and 2,035 deaths in Chile, and 964,452 discharges and 77,252 deaths in Mexico were analyzed. Subnational trends were highly heterogeneous. Chile exhibited a predominantly low pediatric MIR (median < 1%) with isolated hotspots with significant structural deviations to the North. High-severity sepsis causes in Chile were relatively rare. Conversely, Mexico displayed an alarmingly high MIR (median 7.2%), with systemic persistency in States such as Chiapas and Nuevo León. Strikingly, high-severity causes in Mexico (e.g., unspecified septicaemia, bacterial meningitis) were highly frequent, accounting for 88-97% of pediatric sepsis deaths. Furthermore, systemic instances of code-specific MIR > 1.0 in Mexico suggest significant health system fragmentation and decoupling of hospital discharge from vital statistic registries. Pediatric sepsis in Latin America encompasses distinct realities, ranging from localized critical care gaps to high-lethality persistency. One-size-fits-all national policies may be inadequate. These findings advocate for precision public health, urging the deployment of decentralized, data-driven interventions and specialized resource allocation based on high-risk subnational hotspot identification.
The increasing prevalence of allergic diseases in China necessitates a comprehensive understanding of allergen sensitization patterns to inform effective public health strategies and clinical management. This nationwide cross-sectional study aimed to identify allergen sensitization profiles, demographic variations, and regional disparities among Chinese patients. Data from 33,308 initial outpatient visits between 2021 and 2024 were analyzed. Sensitization to 25 common allergens was assessed using the ImmunoCAP system. Demographic and geographic factors, including age, gender, and regional distributions, were evaluated for their impact on allergen sensitization. Dermatophagoides pteronyssinus (D. pteronyssinus) and Dermatophagoides farinae (D. farinae) were the predominant aeroallergens, sensitizing 48% of patients. Significant regional variation was observed, with South China showing the highest sensitization rates to D. farinae (63.51%) compared to the Northwest (36.95%). Among food allergens, shrimp (17.22%) and crab (11.85%) were most common, especially in adolescents aged 13-18 years. Polysensitization was prevalent in patients with atopic dermatitis (63.79%). Gender differences revealed higher sensitization rates among males. Regional disparities underscored the need for geographically customized health interventions. This study provides critical insights into allergen sensitization patterns across China, emphasizing the importance of tailored public health strategies and personalized immunotherapy to improve allergic disease management. Findings contribute to the global understanding of allergic disease epidemiology and foster advancements in prevention, diagnosis, and treatment strategies.
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Periodontitis is a highly prevalent, chronic inflammatory disease that progressively destroys tooth-supporting structures, significantly impacting systemic health and patient quality of life. Given its global public health implications, a current, evidence-based understanding of periodontitis management is essential, particularly as therapeutic strategies have evolved rapidly. This paper critically traces the evolution of periodontitis management from historical paradigms to modern, evidence-based practices, highlighting how shifting conceptual frameworks have reshaped clinical decision-making and patient care. A structured narrative literature review was conducted, analysing recent clinical studies, systematic reviews, updated classification systems, and internationally recognised treatment guidelines. This review highlights emerging paradigm shifts in the aetiopathogenesis, risk factors, and treatment of periodontitis. Advances in diagnostic tools and classification systems now enable refined, risk-informed, and personalised care pathways. Despite these improvements, the global prevalence of periodontitis remains high. Given that periodontitis is largely preventable, this work aims to re-engineer current therapeutic strategies to prioritise robust preventive measures. This approach is combined with updated, validated clinical protocols for curative treatment, aiming to drastically reduce the global burden of disease and its systemic impact. Current evidence-based guidelines underscore a shift toward personalised periodontal care, emphasising tailored, patient-specific management over 'one-size-fits-all' protocols. Future research must prioritise refining diagnostic precision and validating innovative, preventive strategies to bridge the gap between scientific advancements and everyday clinical practice.
Antimicrobial resistance (AMR) is a major global public health threat, undermining the efficacy of commonly used antibiotics. Resistance patterns differ across bacterial taxa, including Enterobacteriaceae, non-fermenting Gram-negative bacilli, and Gram-positive cocci. This study aimed to provide a comparative analysis of antimicrobial susceptibility among reference strains with defined susceptible and resistant phenotypes, alongside selected clinical isolates, to evaluate the preservation of phenotypic traits and the impact of antibiotic use. Reference susceptibility strains exhibited high susceptibility across most antibiotics, whereas resistant reference strains demonstrated multidrug resistance. Among Enterobacteriaceae, reference strains harboring ESBL and AmpC mechanisms displayed resistance to penicillins, cephalosporins, and carbapenems. Non-fermenters, including Pseudomonas aeruginosa and Acinetobacter baumannii, showed both intrinsic and acquired resistance to multiple classes, particularly carbapenems and fluoroquinolones. Gram-positive cocci largely retained susceptibility to glycopeptides and linezolid, while MRSA, high-level aminoglycoside-resistant enterococci, and penicillin-resistant Streptococcus pneumoniae posed significant therapeutic challenges. Comparative analysis revealed that antimicrobial susceptibility is influenced not only by bacterial taxonomy but also by patterns of uncontrolled or inappropriate antibiotic use. Clinical strains of Klebsiella pneumoniae and Streptococcus pneumoniae displayed reduced and more variable susceptibility compared to the predictable profiles of reference strains. These findings highlight the importance of continuous surveillance, strict adherence to antimicrobial stewardship, and the use of standardized reference strains to ensure reliable susceptibility testing. Early detection of emerging resistance patterns is essential to guide effective therapy and mitigate the public health impact of multidrug-resistant pathogens.
Loneliness is linked to higher mortality and poorer health worldwide. As the global population of individuals who are unpartnered and childless grows, public health concerns about social isolation have risen. Sociological theories distinguish between having fewer ties, being socially isolated, and being lonely while gerontological theories emphasize how aging adults prioritize smaller, high-quality relationships. Yet, norms about family, friendship, and loneliness also differ by country contexts such as culture and development. Therefore, while close non-family ties (e.g., friendship) might reduce loneliness, particularly among those who lack partners or children, these processes likely differ across country contexts. Consequently, it remains unclear 1) whether lacking partners or children is associated with various dimensions of loneliness, 2) whether friendship buffers risk of loneliness, and 3) if and how these processes differ across societies. This study examines being unpartnered or childless, friend contact, and loneliness among those aged 45+ (N = 19,289) across 25 countries using data from the International Social Survey Programme (2017) and country-level indicators from the World Health Organization and World Values Survey. Being unpartnered is particularly associated with loneliness-especially lacking companionship. Yet, frequent friend contact likely buffers loneliness across all outcomes-especially for the unpartnered. Those in countries that place a high value on family and especially friendship are at lower risk of loneliness. These findings are discussed considering changing family structures, the potential role of friendship in compensating for limited family ties, and differential risks of loneliness by country context.