Large-scale migration of health workers from low-income countries continues to undermine health system capacity, particularly in contexts characterised by fiscal constraint and donor dependence. While retention incentives are widely used to mitigate attrition, their ability to offset international wage differentials remains contested. Zimbabwe provides a salient case, having implemented a long-standing Health Worker Retention Scheme (HWRS), largely financed by external partners, to stabilise critical cadres within the public health sector. This study aimed to quantify PPP-adjusted international salary differentials for selected Zimbabwean health worker cadres and to assess the extent to which donor-financed retention incentives narrow these gaps. This was a cross-country comparison of annual remuneration for three cadres: professional nurses, medical officers, and medical specialists, using a purchasing power parity (PPP) framework. Salaries in Zimbabwe, South Africa, the United Kingdom, and the United States were compiled from official public-sector pay schedules and adjusted using International Comparison Program (ICP) 2021 PPP conversion factors. Zimbabwean salaries were analysed under three scenarios: base salary; base salary plus USD-denominated Government of Zimbabwe (GOZ) allowances; and total remuneration including GOZ allowances and Global Fund-financed HWRS top-ups. PPP-adjusted salary gaps were calculated relative to Zimbabwean health workers' base salary. Combined USD-denominated Government of Zimbabwe allowances and Global Fund-financed HWRS top-ups substantially increased PPP-adjusted salaries across all cadres, more than doubling remuneration for medical officers and specialists and nearly tripling earnings for nurses. Despite these increases, PPP-adjusted salaries in South Africa, the United Kingdom, and the United States remained several multiples higher than those in Zimbabwe. Combined domestic and donor-financed retention incentives meaningfully improve Zimbabwe's relative salary position but do not fundamentally alter the international remuneration gradient that underpins health worker migration. In donor-dependent health systems, such schemes function as stabilising mechanisms rather than long-term solutions. Sustainable retention will require complementary strategies addressing career progression, working conditions, and the global governance of health worker mobility.
Somalia has one of the lowest childhood immunization coverage rates globally, with only 34.8% of children aged 0-59 months having received at least one vaccine and a high burden of zero-dose children. Immunization uptake is influenced by socioeconomic, maternal, healthcare access, and geographic factors. This study examined determinants of childhood immunization coverage in Somalia to inform equity-focused strategies. A cross-sectional analysis was conducted using nationally representative data from the 2020 Somalia Demographic and Health Survey (SDHS), including 7,373 mother-child pairs. bivariate and multivariable logistic regression models assessed associations between sociodemographic, economic, maternal, healthcare access, and geographic characteristics and child vaccination status, accounting for survey design and confounders. Overall vaccination coverage was 34.8%. Health facility delivery was the strongest independent predictor (AOR = 1.93; 95% CI:1.68-2.22; p < 0.001). Children from the highest household wealth quintile had higher odds than the poorest (AOR = 2.45; 95% CI:2.00-3.00; p < 0.001). Maternal primary and secondary education were positively associated with vaccination (AOR = 1.58; 95% CI:1.34-1.87 and AOR = 1.94; 95% CI:1.40-2.67; respectively; p < 0.001). Nomadic residence was associated with higher odds compared with rural residence (AOR = 1.69; 95% CI:1.46-1.96; p < 0.001). Compared with infants aged 0-11 months, children aged 12-23 months (AOR = 1.36; 95% CI:1.10-1.69; p = 0.005) and 24-59 months (AOR = 1.33; 95% CI:1.12-1.59; p = 0.001) were more likely to be vaccinated. Lack of radio exposure was associated with lower vaccination odds (AOR = 0.64; 95% CI:0.50-0.82; p < 0.001). Children living in Gedo region had markedly lower odds of vaccination than those in Awdal region (AOR = 0.26; 95% CI:0.17-0.39; p < 0.001). Childhood immunization coverage in Somalia remains critically low, reflecting socioeconomic, maternal, healthcare access, and geographic inequalities that require strategies targeting disadvantaged populations and regions.
Implementation of integrated care into the training of our health and social care workforce is lacking or inconsistent. This study engaged discipline leads across Australian higher education providers to ascertain whether a validated International Competency Framework for High-Quality Workforce Development in Integrated Care (the Framework) could be used to guide the implementation of integrated care into curriculum. Twelve curriculum leads participated in individual interviews across different disciplines. Interviews focused on participants' understanding of integrated care and the potential utility of the Framework in their work. We used reflexive thematic analysis to identify the key themes across the data set. We identified barriers to implementing the Framework including a lack of understanding of what integrated care is and how the Framework can be used. Three main areas were identified in which the Framework could be implemented. These were: national workforce reform, curriculum transformation and leadership and culture. Our findings show training in integrated care needs to be mandated and incorporated into the training of health and social care professionals. Our Framework serves as a national standard for guiding this training.
This study aimed to describe and compare patient-reported outcome measures (PROMs) and objective clinical outcome measures (CROMs) in the treatment of age-related macular degeneration (AMD), exploring the concordance between these measures within a value-based healthcare (VBH) framework. This prospective, multicenter, observational, real-world study was conducted at three tertiary referral hospitals specializing in the treatment of neovascular AMD. Clinical outcomes (CROMs) and patient-reported outcomes (PROMs) were analyzed using the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) questionnaire as a functional assessment tool. Data were collected at baseline and at three, six, and 12 months following initiation of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Statistical analysis was primarily descriptive. The comparison between baseline and 12 months in the global NEI VFQ-25 score was performed using the Wilcoxon signed-rank test for paired samples. Concordance between CROMs and PROMs was assessed using the intraclass correlation coefficient (ICC). A total of 235 eyes were included, receiving 2338 intravitreal injections. The mean age of participants was 81 years (SD = 8.57), and 55.8% were female. The mean baseline NEI VFQ-25 score was 67.83 (SD = 10.39). The median best-corrected visual acuity was 63 ETDRS letters (interquartile range [P25 - P75]: 41 - 75) at baseline, increasing to 65 letters at three months and remaining stable through 12 months of follow-up. The comparison between baseline and 12 months revealed a statistically significant difference in visual acuity (Wilcoxon signed-rank test, Z = 4.2; p < 0.001). A reduction in the proportion of patients classified as legally blind was observed, together with an increase in the proportion of patients in the reading-vision and driving-vision categories. At 12 months, 58.7% of patients reported stabilization or improvement in visual function on the NEI VFQ-25 questionnaire. Concordance between the variation in visual acuity and the variation in the global NEI VFQ-25 score showed good agreement between CROMs and PROMs (ICC = 0.76; p < 0.001). The integrated analysis of CROMs and PROMs suggests that anti-VEGF treatment for neovascular AMD is associated with stabilization or improvement in visual acuity and patients' perceived visual function. The implementation of the VBH-AMD model proved feasible in a real-world clinical setting, reinforcing the importance of integrating patient-centered measures into the evaluation of therapeutic outcomes. Introdução: O objetivo deste estudo foi descrever e comparar os resultados reportados pelos doentes (patient-reported outcome measures, PROM) e os resultados clínicos objetivos (clinical-reported outcome measures, CROM) no tratamento da degenerescência macular da idade (DMI), explorando a concordância entre estas medidas no contexto de um modelo de cuidados de saúde baseados em valor (value-based healthcare, VBH). Métodos: Conduziu-se um estudo prospetivo, multicêntrico e observacional, da prática clínica, realizado em três hospitais terciários de referência no tratamento da neovascularização macular secundária à DMI. Foram analisados os resultados clínicos e os resultados reportados pelos doentes, utilizando o questionário National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) como instrumento de avaliação funcional. Os dados foram recolhidos no início do tratamento e aos três, seis e 12 meses após o início da terapêutica com injeções intra-vítreas de agentes anti-fator de crescimento endotelial vascular (anti-VEGF). A análise estatística baseou-se em estatística descritiva. A comparação entre o baseline e os 12 meses do score global do NEI VFQ- 25 foi realizada através do teste de Wilcoxon para amostras emparelhadas. A concordância entre os CROM e os PROM foi avaliada através do intraclass correlation coefficient (ICC). Resultados: Foram incluídos 235 olhos, tratados com 2338 injeções intravítreas. Na amostra, a idade média dos participantes foi de 81 anos (DP = 8,57), sendo 55,8% do sexo feminino. Relativamente ao questionário, o score médio na avaliação basal foi de 67,83 (DP = 10,39). A mediana da melhor acuidade visual corrigida foi de 63 letras ETDRS (intervalo interquartil [P25 - P75]: 41 - 75) na baseline, aumentando para 65 letras aos três meses e mantendo-se estável até aos 12 meses de seguimento. A comparação entre a baseline e os 12 meses revelou uma diferença estatisticamente significativa na acuidade visual (Wilcoxon signed-rank test, Z = 4,2; p < 0,001). Observou-se uma redução da proporção de doentes classificados como cegueira legal e um aumento das proporções de doentes nas categorias de visão de leitura e visão de condução. Aos 12 meses, 58,7% dos doentes reportaram estabilização ou melhoria da funcionalidade visual no questionário NEI VFQ-25. A concordância entre a variação da acuidade visual e a variação do score global do NEI VFQ-25 revelou boa concordância entre CROM e PROM (ICC = 0,76; p < 0,001). Conclusão: A análise integrada de CROM e PROM sugere que o tratamento da neovascularização macular secundária à DMI com anti-VEGF se associa a uma estabilização ou melhoria da acuidade visual e da perceção funcional da visão. A implementação do modelo VBH-DMI demonstrou ser aplicável em contexto de prática clínica real, reforçando a importância de integrar medidas centradas no doente na avaliação dos resultados terapêuticos.
Physician associations play a significant role in shaping health policy at national and sub-national levels. However, the influence of such associations in low- and middle-income countries has not been synthesized or assessed. The Indian Medical Association (IMA), one of the largest physician associations in the world, has a long history of policy engagement at national and state levels across multiple issues. This review aims to assess - for the first time - the empirical literature available on the IMA as a political actor. Adopting a scoping review methodology, the paper sought to identify the policy stances, strategies and influence of the IMA over India's health policy. Nine health, social science, and policy research databases were searched for English-language studies published between 1974 and 2024. Reviewing 37 papers, it finds that the IMA has been active in seven main policy domains: violence against doctors; regulation of the private healthcare sector; restriction of traditional medicine; professional authority or autonomy for physicians; publicly funded health insurance; medical ethics; and partnership in public health programs. It has been reactive against new legislation, reform or regulation in all domains except for violence against doctors. Through interrelated interior and exterior strategies, the organization has been successful in influencing, stalling or limiting legislation. While the IMA holds influence through the size of its membership and its embeddedness in health administration and corporate interests, the tactics of the organization often lack coherence and consistency. Situating these findings in the broader landscape of health governance, our review contributes further evidence for the need to develop more inclusive and transparent pathways for participation in decision-making.
Breastfeeding has been shown to provide numerous benefits for mothers and babies in the short and long term. During the COVID-19 pandemic, breastfeeding support, which was traditionally provided offline, shifted to online platforms. Although these remote services were available before the pandemic began, online interventions emerged as an alternative and proved effective in helping mothers breastfeed during that period. We aimed to explore the existing literature on the experiences of mothers and health care professionals with remote one-to-one synchronous breastfeeding support and to identify the unmet support needs of mothers regarding this type of support. We systematically searched seven literature databases: MEDLINE, CINAHL Plus, MIDIRS, Web of Science, ASSIA, WHO Global Index, and Google Search. Articles published before 2010 and in languages other than English and Bahasa were excluded. A thematic approach was used to synthesise the data. Twenty-one studies were included in this review. Three themes generated from the synthesis: (1) mothers' acceptance of one-to-one synchronous telelactation, (2) benefit of one-to-one synchronous telelactation, and (3) challenges faced in one-to-one synchronous telelactation. In conclusion, mothers generally accepted one-to-one synchronous breastfeeding support as an alternative to in-person sessions, although some challenges remain. Further improvements are needed to address accessibility and scheduling issues.
The early phase of psychosis is critical for interventions to modify long-term outcomes. It is unclear what proportion of individuals' exhibit early persistent psychosis and the long-term implications. An epidemiologic sample of individuals with acute psychosis was recruited at first admission and followed for 25 years. Early persistent psychosis was defined as presence of active psychosis for ≥90% of the days of the 4 years after first hospitalization for psychosis. Multivariable regression analyses were conducted, testing the association between baseline predictors and persistent psychosis, and between persistent psychosis and 25-year outcomes. Out of 526 individuals (age = 27.4 ± 9.4 years, males = 56.8%, baseline schizophrenia/schizoaffective disorder = 30.0%), 101 (19.2%) had early persistent psychosis. At baseline, low premorbid cognitive performance (odds ratio (OR) = 2.08, 95% CI, 1.05-4.12), lower Global Assessment of Functioning (OR = 1.59, 95% CI, 1.16-2.13), low role function (OR = 1.49, 95% CI, 1.03-2.16) and worse social function (OR = 1.52, 95% CI, 1.03-2.22) were predictive of persistent psychosis. At 25-year follow-up (n = 307, 58.9%), early persistent psychosis was associated with worse avolition ($\beta$=0.25, 95% CI, 0.14-0.35), more severe reality distortion ($\beta$=0.19, 95% CI, 0.07-0.31), disorganization ($\beta$=0.21, 95% CI, 0.09-0.32), worse social ($\beta$=-0.18, 95% CI, -0.06 to -0.30), role ($\beta$=-0.22, 95% CI, -0.09 to -0.34), and global function ($\beta$=-0.28, 95% CI, -0.17 to -0.38), greater odds of being on public assistance (OR = 2.13, 95% CI, 1.15-3.95), lower odds of living independently (OR = 0.43, 95% CI, 0.23-0.80) or recovery (OR = 0.09, 95% CI, 0.02-0.38). One in 5 individuals with first-episode psychosis had early persistent psychosis without clearly modifiable premorbid factors, and with strong associations with adverse long-term outcomes. Individuals experiencing early persistent psychosis require focused long-term interventions.
While border screening measures were widely adopted by countries during the COVID-19 pandemic, a lack of consensus on the utility of border screening created a gap in best practice for its implementation. As such, countries adopted a diversity of approaches, providing an opportunity to evaluate the configuration and evolution of border screening systems. The article addresses three questions: (i) how did countries configure their border screening systems for COVID-19? (ii) In what contexts did countries rely on public or private providers of these services? (iii) what do policies and narratives reveal about the perceived role of border screening in global public health? The article contributes to long-standing debates over the private sector's role in public health and the perceived value of border screening measures. This article presents results from an international comparative study based on tracking the organisation of border screening in eight countries. Secondary data was collected between July 2021 - June 2022 from official government websites and policy publications, private sector sources where relevant, and trusted media sources in each study country. The countries included are Australia, Canada, Germany, Ireland, South Africa, South Korea, Spain, and the United Kingdom. All study countries used private provision for pre-departure diagnostic testing for international travellers. In contrast, screening of arriving travellers was more diverse. Countries that opted for private sector post-arrival screening saw governance challenges around accreditation and monitoring of providers, while public service provision saw challenges in capacity and high resource costs. Travel was often framed as a 'luxury,' allowing states to shift responsibility for obtaining tests onto individuals; especially in the context of individuals travelling from low income to high income countries. The different approaches countries followed for screening of departing and incoming travellers suggests wealthy countries were more oriented towards defending their populations against disease importation, rather protecting the international community from disease exportation. These findings provide an opportunity to reflect on the purpose and implementation of border screening. We emphasise a need for further discussion on the efficacy of border screening from both perspectives, given the tendency for countries to rely on these measures.
Human trafficking poses a major public health challenge to the international community, with significant health and social consequences for those affected. Forced migrants are particularly vulnerable to becoming victims of human trafficking due to language barriers and migration-related hardships. These include social and economic deprivation. To better understand the lived experiences within this already vulnerable group, it is essential to examine individual cases in relation to risk factors, experiences of exploitation and exit, and resilience. Using a qualitative approach, this study examines social determinants and risk factors of forced migrants who survived human trafficking. It explores their experiences, eventual escape, and sheds light on their resilience. For this purpose, semi-structured interviews regarding the trafficking experiences were conducted with newly arrived forced migrants at a reception and registration centre in Germany. The presence of human trafficking was determined through an initial screening procedure and then confirmed in a personal interview. Additionally, we assessed the refugees' mental health burden with brief screening questionnaires for post-traumatic stress disorder, depression, anxiety, and the overall stress level (PC-PTSD-5, GAD-2, PHQ-2, RHS-15 distress thermometer). A total of 20 interviews were conducted with 14 female and 6 male participants. The participants came from 9 different countries. Most of them experienced sexual exploitation (N = 11), labour exploitation (N = 7). Few were trafficked but not exploited (N = 3). Participants reported that financial hardship was the main benefitting exploitation risk, and in many cases, they had been recruited by individuals they already knew. Spiritual rituals were sometimes used to increase pressure and control. Various forms of violence were inherent to the trafficking situations. In most cases, those affected managed to free themselves. Interpersonal connections and religious beliefs played a crucial role in coping with these experiences, however the screening for common mental disorders among refugees still indicated high levels of psychological distress. The results are discussed in relation to existing literature and implications for support and intervention are presented.
Early cardiopulmonary resuscitation and timely defibrillation are key determinants of out-of-hospital cardiac arrest survival. Community first responder (CFR) networks improve early response, yet adoption varies internationally. This study summarizes current key factors affecting CFR-system implementation through an international expert consensus process. A mixed-methods design explored barriers and facilitators to CFR system development. Data were collected during an expert consensus workshop in April 2024 Hinterzarten, Germany (46 experts, 14 countries) and an online survey. Experts were invited based on previous authorship regarding CFR systems. Thematic content analysis and descriptive statistics identified recurrent themes and areas of agreement. Experts agreed on core needs for effective CFR systems with high consensus regarding locally adapted dispatch algorithms, clear privacy rules for CFR activation, sufficient CFR training, structured debriefing and psychological support. Congruence was weaker regarding funding, legal or governance frameworks, reflecting variation in responsibilities, liability, and automated external defibrillator- (AED-) registry organisation. Findings were structured around a previously developed roadmap outlining four stages of CFR-system maturation. In the exploration phase, unrecognition of delays in Basic Life Support initiation impedes translation of practice gaps into action. Installation is challenged by recruitment, funding, and coordination among stakeholders. Implementation requires outcome evaluation. Moreover, sustainability is threatened by volunteer attrition and reliance on government budgets. Supportive legal frameworks, centralised AED registries, and integration into national health initiatives facilitate both establishment and long-term stability. This exploratory expert consensus process on CFR system implementation highlights the need for stable funding, coherent governance, aligned legal frameworks, comprehensive and exhaustive AED registration, data-driven feedback from practice to system optimisation and targeted training of CFR.
Cutaneous leishmaniasis (CL) is a neglected tropical skin disease. In Ethiopia, CL is a public health concern; about 29 million people are at risk, with an estimated incidence of up to 50,000 new cases annually. In endemic communities, access to diagnosis, treatment, and prevention is crucial but often limited. Understanding the prevalence and access to care, as well as exploring its relationship to agroecological factors, is crucial to inform control strategies. The aim of this work is to estimate the pooled prevalence, access to care service facilities, and spatial distribution and relationship to agroecological factors. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. The metafor and metadata packages from R Studio were used to obtain pooled prevalence and odds ratio using a random-effects model with a double arcsine transformation. The CL endemicity at the woreda level was overlaid with the locations of CL treatment centers and agroecological zones using ArcGIS. The pooled prevalence of CL was 6.75% (95% confidence interval (CI) 3.37-11.17). Sociodemographic factors (male gender, rural living) and environmental factors (muddy walls, outdoor sleeping, proximity to rocky habitats, and hyrax populations) were significantly associated with CL. CL cases were reported from 85 woredas with a broad spatial distribution; a higher proportion of them were from the Weyna Dega, Dega, and Upper Kola agroecological zones. Access to care is generally poor, with service centers for CL often centralized at the zone level. The estimated pooled prevalence likely underrepresents the true burden of CL. The identified risk factors are more related to rural livelihoods and living conditions, and most of the endemic woredas are in the most productive agrarian agroecological zones, which underlines the health and socioeconomic significance of CL in Ethiopia. Thus, decentralizing healthcare services and improving surveillance for CL are crucial steps in breaking the vicious cycle of poverty.
Ongoing global changes are strongly impacting the distribution and incidence of vector-borne diseases (VBD) affecting both humans and animals. Livestock production is a cornerstone of the economy and food security of many countries, notably in Europe, and VBD represent a major constraint on its development. Furthermore, domestic animals can serve as reservoirs for zoonotic agents, highlighting the need for a One Health approach to anticipate and control VBD. However, research on livestock-associated vectors in Europe, particularly mosquitoes and stable flies at farm level, remains limited. Although ticks are recognized as the most important vectors in Europe, comparative studies between countries and host animal species are still scarce. On the basis of vector presence, this study assesses the entomological risk for livestock on seven farms located in two European countries, Spain and Hungary, characterized by contrasting climates and husbandry practices. During spring 2023 and 2024, as well as autumn 2023, three groups of arthropods, mosquitoes, ticks, and stable flies were collected from seven cattle, sheep, and pig farms in Spain and Hungary. Environmental, climatic, and meteorological data, together with information on management practices and animal characteristics, were collected on-site and obtained from local databases. A total of 1432 mosquitoes, 345 ticks, and 1266 stable flies were collected and identified to species level, representing 37 species in total: 30 mosquito species, 6 tick species, and 1 stable fly species. Among these, 16 species are recognized vectors of pathogens. Hungary consistently exhibited higher arthropod abundance across all groups. Mosquito diversity was also greater in Hungary, with 21 species dominated by Aedes vexans and Culex pipiens pipiens, whereas in Spain, 13 species were recorded, mainly Culex theileri and Anopheles atroparvus. Four tick species were identified in Hungary (Ixodes ricinus, Haemaphysalis concinna, Dermacentor marginatus, Dermacentor reticulatus) while two species were collected in Spain (Hyalomma lusitanicum and Rhipicephalus bursa). The stable flies Stomoxys calcitrans was the only species present in Europe and accounted for all specimens collected, 99% of which were found in Hungary. Seasonal patterns showed spring peaks for mosquitoes and stable flies, and summer/autumn peaks for ticks in Hungary. The originality of this study lies in its multi-vector description of three arthropod communities associated with three livestock species (cattle, sheep, pigs) on farms located in two European countries with contrasting environments and climates. The study demonstrated the coexistence of 16 arthropod species of veterinary and public health relevance in the surveyed farms. Their diversity and abundance were influenced by geographical contrasts between Mediterranean and Central European climates, as well as environmental characteristics, livestock species, and management practices. These findings provide updated information on the diversity of arthropod vectors present on livestock farms, regardless of production type, and highlighted the need for enhanced vector surveillance in livestock systems, which accounts for environmental, farming, and anthropogenic factors. Such efforts are essential to anticipate VBD emergence driven by invasive vectors and circulating pathogens, mitigate impacts on animal health and productivity, and address interconnected risks to both human and animal populations.
Erectile dysfunction (ED) is a prevalent condition with important vascular and systemic implications. Although air pollution has been linked to multiple chronic diseases, its association with ED remains insufficiently explored. To investigate the association between long-term exposure to multiple ambient air pollutants and the risk of ED among Taiwanese men. We conducted a retrospective nationwide cohort study using the National Health Insurance Research Database from 2000 to 2013. Ten-year cumulative exposures to 11 pollutants-sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), particulate matter <10 µm (PM10), particulate matter <2.5 µm (PM2.5), nitrogen oxides (NOX), nitrogen monoxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), and methane (CH4)-were estimated by linking residential postal codes. The outcome was incident ED (Ninth Revision of the International Classification of Diseases, Clinical Modification 302.72 or 607.84). Cox regression models adjusted for demographics, comorbidities, medications, ambient temperature, season, and short-term pollutant levels were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During follow-up, 4936 participants (1.16%) developed ED. Each 1-SD increase in SO2, CO, O3, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 was associated with increased ED risk (adjusted HRs 1.45-2.65; p < 0.001 for all). Conversely, O3 exposure was inversely associated with ED (HR 0.45; 95% CI 0.44-0.46). These associations remained consistent across age strata. Our findings suggest that chronic exposure to most ambient air pollutants may contribute to ED, potentially through vascular, endocrine, and inflammatory pathways, while O3 may exhibit paradoxical protective effects. Long-term exposure to multiple air pollutants is associated with an elevated risk of ED among Taiwanese men, highlighting air pollution as a potential modifiable environmental risk factor for men's sexual health.
The COVID-19 pandemic caused 10.5 million children and adolescents worldwide to lose a caregiver, with South Africa facing this crisis alongside the world's largest HIV epidemic. This study examines how overlapping crises shape HIV-related risk behaviours and mental health among affected young people. Using longitudinal data from 389 participants aged 9-18; researchers assessed HIV risk behaviours, mental health symptoms and social risks at two time points. Half the sample (50.4%) experienced COVID-19-associated orphanhood. Overall, HIV risk behaviours were common, reported by 78.9% at baseline and 73.5% at follow-up. However, reductions occurred only among non-orphaned children; those experiencing COVID-19 orphanhood showed a slight increase in risk behaviours over time. Orphanhood, older age, bullying, domestic violence and community violence were associated with higher HIV risk, while female sex and larger households were protective. Mental health symptoms were significantly worse among children living in HIV-affected households who also experienced COVID-19 orphanhood (66.7% at baseline), a pattern that persisted at follow-up. These findings highlight the heightened vulnerability of children facing multiple, overlapping crises. Effective HIV prevention and support strategies must account for the compounded impacts of pandemic-related loss, violence and pre-existing HIV burdens to protect long-term wellbeing.
This study investigates the global, regional, and national cardiovascular disease (CVD) burden caused by household air pollution (HAP) from 1990 to 2021 across regions, time periods, sexes, and age groups. The global CVD mortality and disability-adjusted life years (DALYs) attributable to HAP are analyzed to assess their current status and historical trends. Quantitative methods are used to assess health inequalities. Projections up to the year 2040 are made using the Nordpred method. In 2021, 0.758 million deaths and 18.175 million DALYs were attributed to HAP-related CVD, with age-standardized rates ( ASR) for mortality and DALYs of 8.950 and 210.354 per 100,000 individuals, respectively. The disease burden increased with age and was higher in men. While mortality and DALYs rates have decreased over the past three decades, with more significant reductions in low- and middle-income regions, health inequalities persist despite improvements. Projections indicate a slow increase in the CVD burden attributable to HAP by 2040, even as the per capita rates decline. Although significant reductions in CVD attributable to HAP have occurred globally, particularly in low- and middle-income countries, disparities persist. Health inequalities have improved but remain significant. As the global population grows and ages, total cases will increase, highlighting the need for continued, targeted interventions.
Tobacco use remains one of the greatest public health challenges worldwide. Social short-video platforms have become the primary channel through which the public obtains smoking-cessation information. Grounded in the Health Belief Model and the Theory of Planned Behavior, this study evaluates the information quality of smoking-cessation short videos on Chinese short-video platforms. We analyzed 262 video samples from four major platforms-TikTok, Kwai, Bilibili, and BuzzVideo. Two researchers who received standardized training independently evaluated each video using the Medical Quality Video Evaluation Tool (MQ-VET), the Global Quality Scale (GQS), and the mDISCERN score. Finally, we performed multiple linear regression to identify factors influencing video quality and user interaction. Of the 262 videos included, only 17.6% were produced by medical experts. Overall information quality was low: median MQ-VET was 44 (41-47), median GQS was 2 (2-3), and median mDISCERN was 2 (1-2). In multivariable regression, videos produced by Medical experts (β = 0.586, p < 0.001) and by Public welfare organizations (β = 0.130, p = 0.001) had significantly higher quality than those produced by Individual users. For user engagement, measured by number of likes, information quality (MQ-VET) (β = 0.215, p = 0.009), TikTok as the platform (β = 0.358, p < 0.001), and Bilibili as the platform (β = 0.485, p < 0.001) were significant positive predictors. Quality scores correlated positively with user interaction (ρ = 0.14-0.35, p < 0.005), whereas video duration correlated negatively with interaction (ρ = -0.14 to -0.29, p < 0.01). Content about smoking cessation on mainstream Chinese short-video platforms is predominantly user-generated, and it is often fragmented, scientifically weak, and lacking elements of behavior-change psychology. Despite these shortcomings, high-quality videos still attract substantial user engagement. To harness the broad reach of these platforms, we propose constructing a four-party cooperation framework among government, platforms, experts, and users grounded in the "Healthy China 2030" initiative, establishing a quality-certification system, and incentivizing medical experts to produce rigorous, high-quality content.
Per- and polyfluoroalkyl substances (PFAS) are persistent and mobile contaminants of growing concern in groundwater systems, yet multi-year assessments in large metropolitan areas remain limited. This study investigates PFAS occurrence, spatial distribution, and associated health risks in Miami-Dade County, Florida, using 1600 samples collected from monitoring wells, raw water, and point-of-exit (POE) locations between 2019 and 2023. PFOA and PFOS were detected in over 90% of samples, while 6:2 fluorotelomer sulfonate (6:2 FTS), perfluorohexanoic acid (PFHxA), and perfluoropentanoic acid (PFPeA) exhibited the highest concentrations. Spatial mapping identified contamination hotspots near airports and firefighting training facilities, with elevated 6:2 FTS levels suggesting aqueous film-forming foam (AFFF) as a primary source. PFAS profiles also indicated contributions from wastewater treatment, landfills, and industrial activities. Rainfall events were positively correlated with increased ∑PFAS concentrations, supporting infiltration-driven mobilization. All POE samples exceeded the newly established U.S. National Primary Drinking Water Regulations, frequently due to PFOA and PFOS concentrations, and some samples occasionally surpassed a hazard index of 1. Miami-Dade Water and Sewer Department (MDWASD) has initiated treatment pilot studies to address these exceedances. Cumulative risk assessments revealed elevated exposure levels across all service areas, underscoring the need for improved treatment technologies and regulatory oversight. This study represents a detailed longitudinal PFAS groundwater assessment conducted in a major U.S. urban area. The findings offer critical insights into contamination patterns, exposure risks, and the urgent need for mitigation strategies to protect public health and ensure regulatory compliance.
The integration of sports and exercise medicine curriculum (SEMc) including physical activity promotion and exercise prescription competencies into medical curricula is increasingly recognised within health profession education (HPE), yet evidence of its educational impact remains limited. This study evaluated the effects of a structured SEMc on medical students' knowledge, skills, confidence, and attitudes in exercise prescription. Medical students (n = 10) completed a 4-week SEMc on the basis of international frameworks and China's national guidelines; controls (n = 14) received no training. All participants completed baseline and post-course knowledge tests and a course-developed questionnaire with high internal consistency.The outcomes were analysed via repeated-measures ANOVA and t tests. Participation in the SEMc significantly enhanced medical students' competency in exercise prescription. Students who received training demonstrated substantial gains in knowledge, with scores improving from baseline and exceeding those of controls at post-assessment (95.2 ± 3.3 vs. 66.6 ± 17.1; p < 0.001). Improvements were sustained at the one-month follow-up, despite a slight decline from the immediate post-test (p = 0.041). The questionnaire data supported these findings, showing significant increases in skills (3.43 ± 0.67 to 4.18 ± 0.54; p = 0.030) and confidence (3.52 ± 0.55 to 4.07 ± 0.58; p = 0.046). Motivation remained consistently high (p = 0.290), and self-perceived knowledge did not change significantly (p = 0.170). Students not participating in the SEMc showed no notable changes (p > 0.10). At post-intervention, the SEMc group scored higher than controls in knowledge (p = 0.020), skills (p < 0.001), and confidence (p = 0.002). In this quasi-experimental pilot study, a brief, structured SEMc was associated with improvements in medical students' exercise prescription-related knowledge, skills, and confidence. Embedding SEMc into mainstream curricula may equip future physicians with essential capacities for chronic disease prevention, aligning with the WHO's Global Action Plan on Physical Activity.
Global climate changehas led to frequent extreme hot and humid events. The Humidex, as a comprehensive temperature and humidity indicator, is closely related to infectious diseases. Other infectious diarrhea is an important public health issue, but the expode-response relationship between it and Humidex, especially the seasonal effect modification and lag effect patterns, still lacks systematic research. This study aims to evaluate the impact of Humidex on the incidence of other infectious diarrhea and explore its seasonal heterogeneity and time lag effect. Using daily OID case and meteorological data from Guangdong Province (2014-2023), a Distributed Lag Non-linear Model was applied to assess the cumulative effects of Humidex, adjusting for season, day of the week, and holidays. Analyses included establishing the overall exposure-response relationship, stratifying by warm (May-October) and cold (November-April) seasons to examine effect modification, and conducting sensitivity analyses to verify robustness. At the extreme Humidex exposure level (P95, 42.27), the cumulative relative risk (CRR) for OID was 1.183 (95% CI: 1.057-1.323), indicating a significant 18.3% increase in risk, with an attributable fraction (AF) of 15.4%. Conversely, a protective effect was observed at the low Humidex level (P5, 11.3) (RR = 0.832, 95% CI: 0.748-0.926). Lag analysis at high Humidex levels (e.g., P75, P90) showed that the highest risk occurred within 0-2 days after exposure, indicating a short-term lag effect. Seasonal stratification revealed significant effect modification: during the cold season, extreme Humidex showed a protective effect (RR = 0.523, 95% CI: 0.319-0.856), while the effect was non-significant in the warm season (RR = 0.957, 95% CI: 0.880-1.040), with a seasonal effect ratio of 1.83. Sensitivity analyses confirmed the robustness of the findings to variations in lag periods and degrees of freedom for splines. Humidex is significantly associated with OID incidence, showing a non-linear exposure-response relationship and clear seasonal effect modification. While extreme Humidex generally increases OID risk, anomalously high levels during the cold season exhibit a protective effect. These findings support the development of season-specific early warnings and targeted public health interventions based on the Humidex index.