The consequences of climate change have detrimental effects on human health. The establishment of functional governance structures is considered crucial for addressing health challenges, as such structures provide the foundation for coordinated and coherent action. At present, no standardised and internationally applicable approach exists for assessing and benchmarking governance structures for climate and health at national level. Therefore, the objective of this study was to develop the PHONIC framework, a tool designed to assess governance structures for climate-resilient and sustainable health systems. We followed a four-step approach: First, we selected a methodology, originally designed for assessing food environment policies, and assessed its applicability to governance structures for health and climate change. This methodology comprises five key stages, as well as a set of indicators and a catalogue of good practice examples. Second, we identified and adapted existing indicators, through online consultations with international experts, and collated good practice examples for the assessment of governance structures for climate-resilient and sustainable health systems. Third, we piloted the framework with national expert groups in two countries, Germany and Kenya. Finally, we evaluated the PHONIC framework's application and revised the methodology based on the findings from the pilot phase. The final PHONIC framework includes a set of ten indicators across three thematic areas: three indicators focused on governance, four on policy development, and three on cross-sectoral collaboration. In addition, we compiled a catalogue of good practice examples for climate-resilient and sustainable health systems, currently comprising 47 examples from 32 countries. The piloting revealed opportunities, such as the participatory process, but also challenges regarding the narrow focus on health systems. The PHONIC framework, with its participatory and adaptable approach, enables the benchmarking and comprehensive analysis of the strengths and weaknesses of governance structures for climate-resilient and sustainable health systems at country level. The potential of the framework could be expanded by including international experts from a broader geographic scope and systematic searches for good practice examples. Decision makers in the health sector can use the outcomes of the PHONIC framework to identify the most relevant areas and actions for improvement of their climate change and health governance.
Cystic fibrosis (CF) is a multisystemic disease increasingly affecting adults due to improved survival rates. However, the functional outcomes, participation in daily life, and influence of environmental factors in adults with CF remain underexplored. This study aimed to evaluate the impairments and multidimensional functioning of adults with CF within the International Classification of Functioning, Disability and Health (ICF) framework, based on the perspectives of both patients and healthcare professionals. A qualitative multicenter study was conducted with 101 participants, including 30 adults with CF (≥18 years) and 71 healthcare professionals (27 physicians, 40 physiotherapists, and 4 nurses). Adults with CF participated in in-depth interviews, while healthcare professionals completed an online questionnaire containing six open-ended ICF-based questions. Eighty-three ICF categories were identified: body structures (20.5%), body functions (28.9%), activities and participation (20.5%), and environmental factors (30.1%). Both groups most frequently referred to lungs (s4301), sensations associated with cardiovascular and respiratory functions (b460), socializing (d9205), and immediate family (e310). Adults with CF emphasized environmental influences-such as e310-immediate family (76.67%), e1101-drugs (83.33%), and d9205-socializing (%73)-more than healthcare professionals, who focused primarily on physiological and e580-health services, systems and policies (67.61%). The most prominent ICF categories identified in both groups reflect the physical, psychosocial, and environmental dimensions of CF. Adults with CF placed greater emphasis on environmental and social factors, whereas healthcare professionals focused more on physiological aspects. These findings highlight the importance of the ICF framework, which supports a biopsychosocial, patient-centered, and multidisciplinary approach in the assessment of adults with CF. NCT06128499.
Coal combustion contributes greatly to the level of CO2 emissions, air pollution, and health burdens. International trade classifies coal extraction, coal combustion, and the consumption of goods and services separately. A lack of comprehensive analyses of trade-embodied CO2 emissions and health damages limits our understanding of the regional responsibilities of these impacts across the chain of coal supply and use. Here we developed an integrated framework combining global coal trade matrices, a multiregional input-output model, GEOS-Chem simulations, and exposure-response modeling to trace coal-related impacts embodied in trade. We show that international coal trade accounted for 45.4 Gt of cumulative CO2 emissions and an annual average of 74,700 deaths attributable to fine particle exposure during 1992-2020, while international goods and services trade contributed more, at 60.6 Gt and 166,600 annual cases, respectively. Major exporters of coal (Australia and South and Southeast Asia) and importers of associated goods and services (the United States and Western Europe) are responsible for substantial impacts outside their territories. Although imported emissions and associated mortality have peaked in developed regions and China, they keep growing in emerging economies. Expanding South-South trade may further intensify these risks. The findings support equitable international cooperation on phasing out coal to achieve climate and environmental health objectives.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
To identify and synthesise the International Classification of Functioning, Disability and Health (ICF) categories most used to describe child functioning across health conditions, informing inclusive, context-sensitive assessments and policy frameworks. Systematic review. PubMed, Scopus, Web of Science and CINAHL were searched from inception to September 2024 following Cochrane guidelines. Peer-reviewed studies using ICF categories to assess functioning in children (0-18 years), regardless of health condition, were included. Eligible designs comprised randomised controlled trials, observational and qualitative studies reporting ICF Core Set (CS). Two reviewers independently conducted screening, data extraction and risk of bias assessment using the Mixed Methods Appraisal Tool (MMAT, 2018). ICF codes were categorised by domain and synthesised narratively. Eight studies met inclusion criteria, comprising 29 ICF CS (1665 instances; 194 unique ICF categories after deduplication). Most instances related to activities and participation (40.7%) and environmental factors (30.6%), followed by body functions (27.3%) and body structures (1.4%). Key chapters included learning and applying knowledge, interpersonal interactions, support and relationships and services and policies. Findings highlight a shift towards a biopsychosocial model of child functioning, emphasising participation and environmental context. Results support use of the ICF framework in multidisciplinary assessment and policy development and inform development of a Portuguese National Functioning Table for Children. CRD42024588533.
Southeast Asia has had substantial land use and land cover changes (LULCCs) in recent decades, affecting air quality, human health, and economic development through biogeophysical and biogeochemical cycles. However, little research has examined the combined effects of different LULCC types and impact pathways comprehensively. We aimed to provide a holistic understanding of how LULCCs across southeast Asia in the 21st century have led to changes in air quality and the consequential effects on human health and the economy. In this modelling study, we used a regional meteorology-air quality coupled model (WRF-CMAQ) to assess LULCC effects from 2001 to 2018 on the concentrations of surface PM2·5 and O3 through biogeophysical and biogeochemical pathways. The model was configured at a 30 × 30 km grid size throughout southeast Asia. We used a series of concentration-response models to estimate excess deaths associated with the changes in air pollution concentration caused by LULCCs. The economic implications of these health effects were quantified with age-specific value-of-statistical-life and cost-of-illness approaches. LULCCs in southeast Asia were associated with 13 000 excess deaths (95% CI 11 000-14 000) in 2018 alone, resulting in US$7·79 billion losses (6·24-9·69). Forest degradation and deforestation was the primary driver, accounting for 29·7% of the burden. Furthermore, more than 60·0% of effects occurred through the biogeophysical pathway. LULCCs in southeast Asia are degrading air quality, causing thousands of excess deaths and billions of dollars in economic losses, with forest degradation and deforestation being the primary driver. The findings emphasise the need for strategic land management to improve environmental conditions and public health, and support sustainable economic development in the area, particularly in the countries most affected, such as Indonesia, Viet Nam, and Thailand. Ministry of Education Singapore and Tsao Family Foundation.
Cockroaches are significant mechanical vectors for bacterial pathogens, posing considerable public health risks in human-inhabited environments, such as hospitals, homes, and food-handling establishments. This systematic review and meta-analysis aimed to determine the global prevalence of Salmonella contamination in cockroaches. A comprehensive search of PubMed, Scopus, Web of Science and Google Scholar were conducted to identify relevant papers published between January 2000 and December 2025. The searching process identified 31 eligible studies comprising 8,021 samples from 12 countries. The overall pooled prevalence of Salmonella was 15.2% (95% CI: 8.3-23.6%), with substantial heterogeneity across studies (I2 = 98%). Higher prevalence was observed in lower-middle-income countries (18.0%), in regions with tropical or humid subtropical climates, and in the species Blattella germanica (10.5%). Non-typhoidal Salmonella was more frequently detected (10.9%) than typhoidal strains (3.9%). Internal body parts of cockroaches showed higher contamination levels, emphasizing their role as active reservoirs. These findings underscore the importance of cockroaches as persistent reservoirs of Salmonella and highlight the need for improved sanitation, targeted pest management, and climate-responsive public health strategies in high-risk settings.
Children with special healthcare needs (CSHCN) live with long-term physical, developmental, behavioural, or mental conditions that affect everyday functioning and require specialized care. According to the International Classification of Functioning, Disability and Health (ICF), such conditions may cause impairments in body functions and structures, limitations in activities, and restrictions in participation, shaped by environmental factors. Evidence on social participation and its correlates in CSHCN remains limited. Therefore, we aimed to identify which correlates are associated with social participation across different conditions and indications in a multi-site sample of CSHCN in Social Paediatric Centres (SPCs) in Germany. This study analysed parent-reported data of CSHCN (3-18 years) from the baseline of the PART-CHILD cohort collected in routine care in 15 SPCs in Germany (2019-2020). Social participation (outcome) in home, community, school, and living activity domains was assessed using the German Child and Adolescent Scale of Participation (CASP). In the regression analysis, independent variables included environmental factors (parental educational attainment, German native language) and health-related factors (impairment type and complexity reported as reason for referral to the SPCs, health-related quality of life (HRQoL)), as well as age (operationalised in groups [3-6; 7-10; 11-18 years]) and sex as covariates. Linear complete case regression models were performed, and β-coefficients and 95% confidence intervals were reported. Five hundred fifty-one families of CSHCN (68.24% female; 44.46% aged three to six and 34.66% from seven to ten years old) were available for analysis (10.99% missing outcome). CASP total mean score was 75.99 (± 20.03; range: 25-100), the lowest in living activities subscale (68.07 ± 24.81), including household activities, shopping, transportation. In the complete case regression analysis (n = 350), older child age and higher HRQoL were associated with higher social participation score across all domains. Children with both physical and cognitive impairments had lower CASP scores in the total, home, and school models, with a trend to association in the community model. Lower parental educational attainment was significantly associated with reduced social participation in the living activities subscale. In this study, we confirmed previous findings on factors determining social participation in CSHCN, such as age and higher HRQoL. Impairment complexity (combined physical and cognitive impairments) decreased participation in home and school. The lower participation in daily living activities for lower educated parents confirms, that social environment significantly influences social participation. This highlights that to improve social participation, strategies are needed that address family-level and broader environmental barriers to lessen social and functional disadvantages in particularly vulnerable subgroups. PART-CHILD cohort, German Clinical Trials Register - Deutsches Register Klinischer Studien (DRKS), DRKS00015054, registered on 16 November 2018.
The COVID-19 pandemic has severely affected health and well-being worldwide. While most countries have reported excess mortality associated with COVID-19, little is known about individual and social factors associated with COVID-19 and non-COVID-19 mortality in Bangladesh. This study addresses that gap by investigating the mortality rates from COVID-19 and other causes during the pandemic years (2020-2021), as well as their associated socio-demographic determinants using longitudinal population data. From 2020 to 2021, data were collected on 573,433 individuals residing in three HDSS areas in Bangladesh: Matlab (rural), Chakaria (coastal), and the slums of Dhaka (urban). Probable causes of death were determined by medical personnel using the WHO 2016 verbal autopsy (VA) tool supplemented with a COVID-19 module. Deaths were classified as COVID-19 or non-COVID-19 using the International Classification of Diseases and Related Health Problems, tenth revision (ICD-10). Factors associated with COVID-19 and non-COVID-19 mortality were examined using Cox proportional hazards models. Between January 1, 2020, and December 31, 2021, a total of 6,616 deaths were recorded across the three HDSS sites, of which 5.2% were attributed to COVID-19. The COVID-19 mortality rate was highest in Matlab (58 deaths per 100,000 person-years), followed by Chakaria (15 deaths per 100,000 person-years) and the urban slums in Dhaka (11 deaths per 100,000 person-years). Household socio-economic status was significantly associated with COVID-19 mortality in the Matlab HDSS. Individuals from the lowest wealth tertile had 40% lower mortality compared to individuals from the highest wealth tertile (adjusted mortality rate ratio (aMRR): 0.60; 95% CI: 0.43-0.83). In contrast, no significant differences were observed for non-COVID-19 mortality across wealth tertiles. Age, sex, and marital status were significantly associated with both COVID-19 and non-COVID-19 deaths. Our data revealed that COVID-19 mortality was highest in the Matlab HDSS. Age, sex, and marital status were key determinants of both COVID-19 and non-COVID-19 mortality in Matlab. Notably, individuals from households in the lowest wealth tertile in Matlab had significantly lower COVID-19 mortality compared to those from households in the highest wealth tertile, while no wealth-related differences were observed for non-COVID-19 mortality.
To assess progress, challenges, and enabling factors for building climate-resilient and low-carbon health systems across Latin America and the Caribbean, a region facing accelerating climate-sensitive health burdens amidst persistent health system fragilities. We conducted an explanatory, sequential, mixed-methods study integrating quantitative analysis of the Pan American Health Organisation Climate Change and Health surveys from 2021/2022 (n = 24 countries) and 2023/2024 (n = 27 countries) with semi-structured interviews involving four countries demonstrating progress (Argentina, Chile, Jamaica, Peru). Quantitative data were analysed descriptively across three sub-regions (Caribbean, Central America, South America). Qualitative data underwent two-stage coding (deductive and inductive) with three-researcher consensus to identify barriers, enablers, and lessons learned. By 2023/2024, 93% of countries had designated climate-health focal points (71% in 2021/2022). However, implementation gaps persist: less than 50% of countries had integrated climate change into national health reports; 22%-40% developed national climate-health strategies; and vulnerability assessments rarely informed policy. Access to international climate finance remained inequitable. Whilst 60%-74% developed disaster preparedness plans, only 30%-44% implemented public health communication campaigns. Training focused on environmental health personnel, with doctors, nurses, and planning staff minimally engaged. Qualitative analysis revealed interconnected barriers: climate change perceived as distant rather than urgent, competing priorities overwhelming decision-makers, institutional silos, and misalignment between available training and local needs. Key enablers included linking climate action to established health priorities, institutionalising responsibilities through formal mechanisms, multi-stakeholder engagement, and committed individuals with diplomatic skills navigating cross-sectoral dynamics. Latin America and the Caribbean countries are establishing foundations for climate-resilient and low-carbon health systems, but translating governance progress into sustained implementation requires addressing systemic barriers through institutionalisation beyond political cycles, tailored capacity building, and innovative financing mechanisms. These findings inform guidance for health systems strengthening amidst accelerating climate change.
To report patterns of asthma control, medications and healthcare utilisation in Australian adults with asthma in 2021, and assess changes since a similar survey in 2012. Cross-sectional web-based survey (February-March 2021; n = 5427), compared with a similar 2012 survey (n = 2686). Adults (≥ 18 years) with asthma, recruited from large web-based panels, with enrolment stratified by age group, gender and state/territory. Asthma control test (ACT), healthcare utilisation and medications. Median age was 46 years; 59% of participants reported female gender. Compared with 2012, fewer participants had well-controlled symptoms (ACT ≥ 20: 2021, 48.0%; 2012, 54.4%; p < 0.001), and more had very poorly controlled symptoms (ACT 5-15: 2021, 26.8%; 2012, 22.9%; p < 0.001). Urgent asthma healthcare had increased (2021, 37.9%; 2012, 28.6%; odds ratio 1.53 [95% confidence interval, 1.37-1.69]; p < 0.001). Inhaled corticosteroid (ICS) use in the previous year was similar (2021, 60.9%; 2012, 60.8%) but adherence was lower (p < 0.001). Fewer participants had good symptom control while taking little/no ICS (2021, 33.4%; 2012, 40.1%), and more had uncontrolled symptoms with little/no ICS (2021, 38.1%; 2012, 25.6%; p < 0.001); among the latter group, urgent healthcare utilisation had increased (2021, 63.5%; 2012, 41.2%; p < 0.001). In 2021, 28.7% reported using oral corticosteroids for asthma in the previous year; only 42.0% of ICS users recalled their inhaler technique having been checked in the past 12 months. Overuse of short-acting beta2-agonists was common: 56.3% adults obtained ≥ 3 inhalers in the previous year, and 10.5% obtained ≥ 12 inhalers. For symptom relief in the previous 4 weeks, only 13.3% adults reported using an anti-inflammatory reliever (ICS-formoterol). Our comparison of these two large nationally stratified sample surveys demonstrates significant worsening of key asthma indicators between 2012 and 2021, including worse symptom control and urgent healthcare use, but also indicates opportunities for improvement. The findings highlight an urgent need for system-wide implementation of the 2025 Australian asthma guidelines to reduce preventable morbidity. ACTRN12620000977976p. The known: The first national survey of asthma control in Australian adults in 2012 found uncontrolled asthma symptoms in 46% of participants; 29% had required urgent medical care in the previous year, and only 34% were taking regular inhaled corticosteroids (ICS). The new: A repeat cross‐sectional survey in 2021 found worse asthma control (uncontrolled symptoms 52%; urgent healthcare 37%). ICS adherence had decreased (29%). Overuse of short‐acting beta2‐agonists was common (56%), and only 13% of participants were using a best‐practice combination ICS–formoterol anti‐inflammatory reliever. The implications: This comparison demonstrates an increasingly high burden of preventable morbidity from asthma in Australia. There are substantial opportunities for improvement with system‐wide implementation of recent major changes in Australian asthma guidelines published in 2025.
The aim of this research is to determine whether ICD-10 codes for exposure to forces of nature (X30-X32, X36-X38) can be used to examine disparities in X-code documentation and associations with in-hospital mortality. Binary logistic regression of 169.5 million discharge records from the 2018-2022 National Inpatient Sample was conducted to examine associations between social determinants of health variables, presence of X-codes, and in-hospital mortality. Only 0.055% (93,860) records included X-codes, increasing 32% from 2018 (0.053%) to 2022 (0.070%). Female patients had 65.5% lower odds of documentation (OR = 0.345). Medicaid beneficiaries had 2.6 higher odds (OR = 2.59). Hispanic and Asian/Pacific Islander patients were systematically undercoded (OR = 0.665 and OR = 0.649, respectively). Native American populations had higher odds of documentation (OR = 2.62). X-codes were independently associated with 60% increased odds of in-hospital mortality (adjusted OR = 1.60, 95% CI: 1.55-1.66). ICD-10 X-codes represent a viable, yet underutilized surveillance infrastructure for climate health outcomes, with mortality associations validating their clinical significance. However, the very low prevalence of X-codes (0.055%) and systematic documentation inequities suggest that climate-related exposures may be underrecognized in administrative data and support the need for enhanced clinician awareness, standardized coding protocols, and explicit equity integration for effective climate health surveillance.
Respectful patient care is a fundamental pillar of quality healthcare and is integral to the well-being and satisfaction of patients. However, there is a growing recognition of the disrespect and abusiveness of patients seeking care. Studies have reported that women's experiences of disrespectful and abusive care during childbirth significantly impacted their utilization of these services. This systematic review aims to provide a comprehensive evaluation of the practices of respectful and dignified maternity care in West Africa. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement checklist and was registered in PROSPERO. Research articles were systematically retrieved from four databases: PubMed, Scopus, EMBASE, and PsycINFO, and through manual searches of reference lists. A two-stage screening process was employed, followed by quality assessment using the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies. The review included 17 studies predominantly from Ghana and Nigeria, with one study spanning multiple countries. Most studies utilized qualitative methods and focused on women of reproductive age, practising midwives, and midwifery students. Findings revealed high levels of mistreatment during childbirth, including physical and verbal abuse, non-consented care, and dignity violations. Midwives showed varying levels of awareness and practice regarding respectful maternity care, with structural barriers within healthcare systems exacerbating mistreatment. Women reported experiencing disrespect and abuse, influenced by factors like age, marital status, and facility type. Midwifery students also identified issues of mistreatment and highlighted discrepancies between understanding the importance of respectful care and actual practice. We, however, did not find any literature addressing interprofessional respectful and dignified maternity care. The review reveals widespread mistreatment and disrespect during childbirth, including physical and verbal abuse, non-consented care, and dignity violations. Systemic barriers like staffing shortages and inadequate supplies exacerbate these issues, underscoring the pressing need for structural reforms in healthcare systems.
This study investigates global and regional trends in the burden of malaria and neglected tropical diseases (NTDs) from 1990 to 2021, focusing on their changing patterns and influencing factors. Using data from the Global Burden of Disease study 2021 (GBD study 2021), we analyzed the incidence, prevalence, mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of malaria and NTDs at both regional and global levels. A vector autoregression (VAR) model was employed to explore the effects of the Socio-Demographic Index (SDI), environmental risks, and behavioral risks and to predict the disease burden over the next 15 years. The study highlights the geographical distribution and variations in risk factors associated with malaria and NTDs, offering public health recommendations for their elimination. This research used data from the GBD study 2021 to examine annual incidence rates (age-standardized incidence rate, ASIR), mortality rates (age-standardized death rate, ASDR), and Disability-Adjusted Life Years (DALYs) for malaria and NTDs by region, age, and sex. Joinpoint software was applied to analyze time trends from 1990 to 2021. A VAR model incorporating factors such as the SDI, unsafe water sources, sanitation, and handwashing practices was employed to identify significant risk factors influencing disease burden and to project future trends. From 1990 to 2021, the global burden of malaria decreased, especially in Sub-Saharan Africa, while the incidence of NTDs increased until 2016 and then decreased. Age-standardized DALYs and ASDR for NTDs showed a steady decline, reflecting the impact of effective interventions. The VAR model showed that the SDI influenced both malaria and NTD burdens, especially in low-SDI regions, with environmental sanitation and unsafe behavioral factors significantly impacting malaria. Strengthening environmental sanitation and international cooperation can reduce the burden of malaria and NTDs. Future public health efforts should focus on enhancing infrastructure, particularly in low-SDI regions, to combat challenges posed by climate change and to support the ongoing elimination of malaria and NTDs.
Occupational risk factors associated with traditional kiln technology are major drivers of respiratory symptoms and illnesses. The current research was designed to evaluate prevalence of selected disease and respiratory symptoms among workers at two types of brick kilns. A proportionate stratified random-sampling-based survey was conducted during 2024-2025; a total of 250 adult men were assessed using a translated version of American Thoracic Society Division of Lung Disease (ATS-DLD) questionnaire. Results of the study show that 60% of Bull's Trench Kiln (BTK) workers had diabetes mellitus, while 40% were suffering from chronic obstructive pulmonary disease and 44% reported chronic cough than Zig-Zag Kiln workers. A significant lower concentration of PM2.5 (23 ± 0.27 µg/m3), PM10 (27 ± 0.31 µg/m3) and Cu (0.025 ± 0.002 mg/kg) was observed in the environment of Zig-Zag Kilns (ZZKs). Adjusted generalized linear models (GLMs) with an identity link function showed that BTK workers in burning section had significantly lower FEV1/FVC (%) (B = -7.8; 95% CI: -8.9, -6.8; p < 0.001) than ZZK workers, reflecting a higher respiratory risk in traditional kilns. In conclusion, mandating ZZK adoption is a critical intervention to mitigate respiratory disease burden and heavy metal exposure among brick kiln workers.
Chagas disease affects multiple dimensions of human functioning, requiring assessments that extend beyond the biomedical model. The International Classification of Functioning, Disability and Health (ICF) offers an integrative framework for capturing these impacts. This qualitative study aimed to identify, from the perspective of adults diagnosed with Chagas disease, the aspects of functioning most relevant to them, as a step toward developing an ICF Core Set for this population. Thirteen focus group discussions were conducted with adults diagnosed with Chagas disease, covering all ICF components. Two independent researchers extracted meaningful concepts from verbatim transcripts and linked them to ICF categories. Thirty-two adults with Chagas disease participated. From the discussions, 248 concepts were identified and linked to 49 second-level ICF categories: 13 related to body functions, 5 to body structures, 18 to activities and participation, and 13 to environmental factors. The most frequently mentioned categories were sleep, pain, emotional functions, and cardiac functions. In the Activities and Participation component, limitations were noted in household tasks, mobility, and social participation, with spirituality emerging as a key coping resource. For Environmental Factors, immediate family support and access to healthcare services were identified as primary facilitators of functioning. Adults with Chagas disease reported impairments across a wide range of body functions and activities, underscoring the significant influence of environmental factors. The identified categories will serve as a foundation of candidate items to support the consensus process for developing an ICF Core Set for adults with Chagas disease.
Although tobacco use is high in Lesotho, research on indoor secondhand smoke (SHS) exposure is limited. We assessed the prevalence and predictors of indoor SHS exposure using Lesotho DHS 2023-24 data of 36,161 household individuals of all ages. Binomial logistic regression was carried out. The prevalence of indoor SHS exposure in Lesotho was 24%. Maseru district (27%) had the highest prevalence. Sex, wealth quintile, household size, and district showed significant associations with indoor SHS. Females, compared to males, were less likely to have indoor SHS exposure (aOR 0.77, 95% CI 0.73-0.81). Compared to the poorest quintile, individuals in all other wealth quintiles had lower odds of indoor SHS. Compared to residents of Butha-Buthe, residents of Berea (aOR 3.28; 95% CI 2.37-4.55) were three times more likely to get indoor SHS exposure. Conclusively, in Lesotho, every fourth household member is exposed to indoor SHS. Male gender, higher household size, and poverty are linked with higher indoor SHS exposure, suggesting targeted interventions creating awareness and advocating for smoke-free homes among these at-risk groups. The findings also highlight crucial socio-demographic determinants that can guide the revision of tobacco control policies and the development of smoke-free homes interventions in Lesotho.
Polycystic ovary syndrome (PCOS) is associated with an increased risk of neurodevelopmental disorders in offspring, yet how maternal PCOS interacts with environmental toxicants to influence fetal brain development remains unclear.We hypothesized that an AMH-programmed PCOS-like background increases neurodevelopmental vulnerability, which is worsened by gestational F-53B exposure through lipid metabolic reprogramming. Our study reveals how endocrine-metabolic dysfunction and environmental toxicants interact to impact fetal brain development. F0 dams were exposed to anti Müllerian hormone in late gestation to generate PCOS like F1 females and simultaneously received F-53B or vehicle, yielding four groups: Con, AMH, F-53B, and AF. F1 females from AMH lineages exhibited reproductive abnormalities characteristic of PCOS, which were most pronounced in the AF group. Bulk RNA sequencing of E14.5 F2 embryonic brains revealed progressive transcriptomic divergence across groups, with AF embryos showing the greatest shift from controls. Genes differentially expressed in both the F-53B vs Con and AF vs AMH comparisons were enriched in lipid metabolism and PPAR-related pathways, accompanied by graded upregulation of Cidec, Plin1, Fabp4, and Pparg and reciprocal downregulation of Aqp7, which was confirmed at the protein level for CIDEC, PLIN1, and AQP7. At the cellular level, AF embryos exhibited the most severe neurodevelopmental defects, including loss of TBR2⁺ positive intermediate progenitors, reduced TBR1⁺ and SATB2⁺ cortical neurons, diminished Neurod1⁺ and Tuj1⁺ expression, and decreased Olig2⁺ positive oligodendroglial cells. We hypothesized that an AMH-programmed PCOS-like background would prime offspring for subtle neurodevelopmental vulnerability, F-53B exposure during pregnancy would induce lipid metabolic reprogramming in the offspring fetal brain, and the combination of AMH-induced PCOS-like programming and F-53B exposure would exert 'two-hit' effects, leading to the greatest disruption of neurogenesis and gliogenesis. By linking an emerging PFAS alternative to mechanistically grounded alterations in fetal brain lipid metabolism and neural lineage development on a PCOS-like background, our work provides an integrated framework for understanding how endocrine-metabolic disorders and environmental contaminants converge to shape neurodevelopmental risk.
The goal of this study was to develop and validate the Functioning Assessment Scale for Mental Health (FAS-MH), a multidimensional instrument grounded in the International Classification of Functioning, Disability, and Health (ICF). The FAS-MH is designed to assess key functioning domains and environmental factors in individuals with mental disorders. The development process involved item generation in both Spanish and English, followed by content validation through a two-round Delphi survey with expert panels (20 and 12 professionals, respectively). The Spanish version was then tested in a sample of 334 adults diagnosed with bipolar disorder, depression, or schizophrenia to examine its dimensional structure, internal consistency, and relationships with other variables. The final 37-item scale covers 34 second-level ICF categories across three domains: Body Functions, Activities and Participation, and Environmental Factors. Confirmatory factor analysis supported a hierarchical model with four first-order factors and one second-order Functioning factor. The FAS-MH showed excellent internal consistency (α = 0.85-0.95; ω = 0.90-0.96) and moderate to strong correlations with established measures of disability, health status, and quality of life. Content validation was based on a small sample, only the Spanish version of the FAS-MH was tested psychometrically, and associations with clinical outcomes, symptom severity, or clinician-rated assessments were not explored. The FAS-MH is the first instrument to comprehensively incorporate all ICF components for assessing functioning in individuals with mental disorders. The Spanish version demonstrated strong psychometric properties, providing a brief and user-friendly tool for clinical and research use.
In this study, estimation of pollution and assessment of health risks related to the agricultural application of mussel shell-derived chitosan as organic amendment were evaluated. Furthermore, considering WHO maximum permissible levels in soil, the application rates of chitosan to agricultural soils were calculated. Geo-accumulation index (Igeo), enrichment factor (EF), contamination factor (CF), pollution load index (PLI), and ecological risk index (ERI) were calculated. Mussel shell-derived chitosan generally did not contribute to soil metal loading when evaluated in terms of those indices. The highest hazard quotient for ingestion (HQing) across male (ML), female (FML), and children (CL) followed the order Cr > Ni > Mn >Pb >Zn >Cu, while maximum HQing among metals was observed in the order CL > FML > ML. For inhalation exposure, highest HQinh for all metals was also found in the order CL > FML > ML, with individual metal contributions following Mn > Ni > Cr >Zn >Pb >Cu. Maximum HQder exhibited the trend ML > FML > CL, and the metal-specific order for HQder was Cr > Pb > Ni >Zn >Mn >Cu. Hazard Index (HI) and Total HI for ingestion, inhalation and dermal exposure were all less than 1. Cancer risk was less than 1 × 10-6. Consequently, there were no pollution and health risks associated with the use of musselshell‑derived chitosan in agriculture as organic amendment.