Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.
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.
The global increase in life expectancy has led to more visual impairment, significantly impacting the quality of life and daily activities of individuals living across the world's continents. This study aims to develop an ICF Core Set Vision Loss for the adult life span, providing a global perspective on the functional challenges faced by individuals with vision impairment. As part of its development, the aim was to understand the impact of vision loss on the lives and functioning of individuals with vision impairment from their own perspectives. A cross-sectional qualitative study was performed, using a thematic analysis of data that was gathered through an online survey across the six World Health Organization regions and in-depth interviews. Meaningful concepts were linked to the ICF categories based on available linking rules. Analyses of the online surveys with 663 participants in 59 countries and 100 in-depth interviews in Nepal and India resulted in 7652 meaningful concepts that could be linked to 148 ICF categories: 9% related to body functions and structures, 49% to activities and participation and 42% to environmental factors. Key findings regarding body functions and structures included a focus on emotional functions, confidence and energy levels. For activities and participation, major concerns were recreation, transportation and employment. Environmental factors highlighted the importance of family and technology. This study underscores the complex challenges faced by individuals with vision loss, encompassing emotional, psychological, environmental and participation-related aspects. These insights highlight the need for tailored assessments, interventions and comprehensive support systems. By comparing these findings with those from other preparatory studies, these results contribute to a deeper understanding of the lived experience of vision loss and provide an essential step in the future development of the ICF Core Set for Vision Loss.
Open defecation is a harmful and unsafe practice that contributes to environmental pollution and disproportionately affects developing nations, particularly those in Sub-Saharan Africa. According to the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) Joint Monitoring Programme (JMP), Sub-Saharan Africa is home to 46% of the global population still practising open defecation. Socio-economic factors, cultural norms, and individual attitudes play crucial roles in shaping sanitation behaviours and influencing open defecation practices. Therefore, this study aims to determine the prevalence, spatial distribution, and geographic inequalities of open defecation in Sub-Saharan Africa. A community-based cross-sectional survey was conducted, including 20,130 clusters and 496,957 households from 34 Sub-Saharan African countries. The Demographic and Health Survey (DHS) data were weighted, cleaned, and analyzed using Microsoft Excel, Stata version 17, ArcGIS version 10.7, and SaTScan™ version 10.1. Spatial analyses were performed using ArcGIS version 10.7 and Kulldorff's SaTScan™ version 10.1, while Geographically Weighted Regression (GWR) analyses were conducted using ArcGIS version 10.7. The prevalence of open defecation among households in Sub-Saharan Africa was 23.24% (95% CI: 23.12-23.35). The practice was clustered across enumeration areas (Global Moran's I = 0.25, Z-score = 366.12, P-value ≤ 0.001). The Getis-Ord Gi* statistic identified hotspots of open defecation primarily in East Africa, Central Africa, and West Africa. Anselin Local Moran's I detected both high and low clusters of open defecation, while SaTScan cluster analysis identified 146 windows containing significant clusters of households practising open defecation across Sub-Saharan Africa. Geographically Weighted Regression (GWR) analysis revealed that several factors were positively associated with open defecation, including lack of educational attainment, unimproved drinking water sources, lack of basic access to water, younger household heads, and extreme poverty. Additionally, household size greater than four, the richest households and urban and rural residency were negatively associated with open defecation practices. This study reveals a high prevalence of open defecation (23.24%) in Sub-Saharan Africa with significant geographic clustering, particularly in East, Central, and West Africa. This estimate is higher than the 18% reported by the 2021 WHO/UNICEF Joint Monitoring Programme (JMP). Novel spatial and GWR analyses uncovered associations with poverty, lack of education, water access, age of household heads, and wealth status. These findings underscore the need for geographically targeted, multi-sectoral sanitation interventions that address underlying socio-demographic disparities. Future research should explore the effectiveness of spatially tailored programs and integrate behavioral insights to accelerate progress toward Sustainable Development Goal 6.
The current employment market faces many challenges, both from the employers' perspective and that of employees. One of the key health challenges is employees' mental health. Poland has over 17.6 million of active workforce, but each year the number of sick leaves due to mental disorders and occupational burnout is rising, and so are the costs. This leads to lower incomes, higher utilization of medical services, higher spending on medications, and higher social transfers, impacting the country's economy and individuals' quality of living. This research aims to present the current market practice, gaps, and limitations in the coverage of mental health services available through employee medical plans, as well as to provide epidemiological characteristics of sick leave due to mental health issues in Poland. This analysis included general terms and conditions of insurance companies providing employee medical plans (group health insurance) available on their websites. Mental health cover and exclusions of liability were analyzed using 6 different criteria. Epidemiological data on sick leaves (absenteeism) were derived from the annual reports published by the Polish Social Insurance Institution. All insurance companies introduce strong limitations on mental health cover. The gaps apply to the number of packages that cover consultations with psychologists and psychiatrists, as well as the number and type of visits. Most insurers cover no more than 4 visits with a psychologist and psychiatrist per year, excluding psychotherapy (with 1 exception). The main exclusions of liability include treatment of mental illnesses or behavioral disorders and treatment of addiction. There is no coverage for the costs of medications. The offer for mental health treatment through employee medical plans is strongly limited and does not cover the actual needs. Employees must seek treatment through the public sector or pay out of pocket for services with limited income during sick leave. Int J Occup Med Environ Health. 2025;38(6):654-63.
Hip osteoarthritis (OA) and rotator cuff lesions (RCL) are major musculoskeletal disorders that cause chronic pain, reduced mobility, and work incapacity. While certain occupational groups have been studied, limited data exist on other physically demanding professions typically performed by women, such as healthcare, childcare, and hairdressing. This study examines the prevalence and occupational risks of hip OA and RCL in Germany. A retrospective analysis was conducted using anonymized, large-scale, nationwide claims data (2016-2020). Individuals aged 18-65 years diagnosed with OA (International Classification of Diseases and Related Health Problems [ICD-10]: M16) or RCL (ICD-10: M75) were identified. Physically demanding occupational groups were classified according to the German Federal Employment Agency and compared to a propensity score-matched control group of office workers. Between 2016 and 2020, the prevalence of hip OA increased from 1.8% to 1.9%, and RCL from 4.4% to 4.6%. Higher prevalence rates for RCL were found in exposed occupations (4.9%). Increased risks were observed in elderly care (OA: odds ratio [OR] = 1.33, RCL: OR = 1.49) and in health and nursing care (OA: OR = 1.33, RCL: OR = 1.27) compared to office workers with lower physical exposure. Restricting the analysis to women yielded similar effect estimates. The findings highlight an elevated occupational risk for hip OA and RCL in physically demanding professions such as nursing. Targeted prevention, ergonomic interventions, and early screening are essential to reducing work disability and improving long-term health outcomes. Int J Occup Med Environ Health. 2026;39(1):68-78.
Chronic kidney disease (CKD) is common and ranks among the leading causes of mortality and morbidity. This analysis aimed to present global CKD estimates using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to inform evidence-based policies for CKD identification and treatment. This analysis focused on adults aged 20 years and older over the period 1990 to 2023, from 204 countries and territories. Data sources used were published literature, vital registration systems, kidney failure treatment registries, and household surveys. Estimates of CKD burden, including deaths, incidence, prevalence, and disability-adjusted life-years (DALYs), were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool. A comparative risk assessment approach estimated the proportion of cardiovascular deaths attributable to impaired kidney function and estimated risk factors for CKD. Globally, in 2023, 788 million (95% uncertainty interval 743-843) people aged 20 years and older were estimated to have CKD, up from 378 million (354-407) in 1990. The global age-standardised prevalence of CKD in adults was 14·2% (13·4-15·2), a relative rise of 3·5% (2·7-4·1) from 1990. The region with the highest age-standardised prevalence was north Africa and the Middle East (18·0%; 16·9-19·4). Most people had stage 1-3 CKD, with a combined prevalence of 13·9% (13·1-15·0). In 2023, CKD was the ninth leading cause of death globally, accounting for 1·48 million (1·30-1·65) deaths, and the 12th leading cause of DALYs, with an age-standardised DALY rate of 769·2 (691·8-857·4) per 100 000. Impaired kidney function as a risk factor accounted for 11·5% (8·4-14·5) of cardiovascular deaths. High fasting plasma glucose, body-mass index, and systolic blood pressure were all leading risk factors for CKD DALYs. CKD is a major global health issue, with rising prevalence and increasing importance as a cause of death and as a risk factor for cardiovascular death. A better understating of aetiology, appropriate screening, and implementation programmes are needed to translate advances in CKD treatment into improved patient outcomes. Gates Foundation, Wellcome, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.
To establish an overall description of people with cerebral palsy (CP) in Brazil, including the epidemiology, clinical features, functioning, and access to rehabilitation and equipment, through the lens of the International Classification of Functioning, Disability and Health (ICF) framework, using preliminary data from the Brazilian Cerebral Palsy Register (BrCPR). Data were extracted from the ongoing BrCPR for individuals with CP aged 0 to 100 years. The information collected included aetiological risk factors and, from the ICF, personal and health-related factors, environmental factors, body functions and structures, activity, and participation. A total of 1098 participants were included (median age 9 years [interquartile range 5-15 years]; 57.6% male). Most brain injuries occurred pre- or perinatally (68.1%), with preterm birth (44.8%) and perinatal asphyxia (51.1%) being common risk factors. Postneonatal CP (>28 days) was often infection-related (23.0%). One-third of all children were diagnosed before 6 months of age. Bilateral spastic CP predominated (59.4%), and 54.9% were classified in Gross Motor Function Classification System levels IV or V. Co-occurring conditions included epilepsy (57.5%), hip dislocation (31.0%), and cognitive impairment (55.3%). Severe activity limitations were reported, for example dressing (58.9%). Considering participation, 10.0% never attended school. Among environmental barriers, 67.7% lacked home adaptations, 14.0% received no rehabilitation, and 44.7% lacked necessary assistive devices. The BrCPR highlights substantial unmet needs among individuals with CP in Brazil.
People face stressful situations in different ways and exhibit different work-related behaviors and experiences that can be assigned to a pattern (Arbeitsbezogenes Verhaltens- und Erlebensmuster - AVEM). The aim of the study was to determine the mental health and work ability of female kindergarten teachers and their relationship to their individual AVEM patterns. In the cross-sectional study, 185 German teachers (D) and 107 Ukrainian teachers (UA) filled out AVEM-questionnaire. Mental health and work ability were recorded using questionnaires. Group comparisons were carried out between the kindergarten teachers in both countries. A total of 126 German and 83 Ukrainian kindergarten teachers could be clearly assigned to 1 of the 4 AVEM patterns: A - effort (18.3% G vs. 38.6% UA), B - burnout (24.6% D vs. 24.1% UA), G - health (17.5% D vs. 25.3% UA) and S - protection (39.7% D vs. 12.0% UA, p < 0.001). German kindergarten teachers rated their work ability (mean [M] ± standard deviation [SD] 7.3±1.7 pts) lower than Ukrainian kindergarten teachers (M±SD 8.0±1.4 pts, p < 0.001). Both groups cope equally well with physical demands, but Ukrainian teachers cope better with mental demands (M±SD 3.7±0.7 pts vs. 3.4±0.8 pts, p = 0.005). Mental health was subjectively impaired in 16.7% of German and 9.6% of Ukrainian kindergarten teachers (p = 0.160). Overall, German teachers rated their mental health worse with M±SD 11.8±5.3 pts (General Health Questionnaire total score) than their Ukrainian colleagues with M±SD 8.9±4.6 pts (p < 0.001). The analysis of individual AVEM patterns can be a helpful basis for identifying health-endangering patterns as well as resources and thus establishing measures to maintain the health of teachers. Int J Occup Med Environ Health. 2025;38(5):495-511.
Most hospital emergency department (ED) medical staff experience violence from patients and visitors every day, but the level of reporting and documenting acts of violence is very low. The aim of the study was to analyze the reporting of violence from patients and visitors by hospital ED medical staff. The study was conducted retrospectively in the ED of a university hospital in Poland. The department admits 48 000 patients/year. The records kept by nurses and paramedics from 7 years (2017-2023) were analyzed for reports of acts of aggression from patients and visitors. The Python programming language was used for statistical analyses. During the 7-year period, 445 cases of violence from patients and visitors were reported, with the number of reports decreasing significantly over the years. The average age of the aggressors was 47 years. Most of them were male (N = 318, 71.5%). Half of the aggressors were under the influence of alcohol (N = 218, 49%). The results suggest that not all incidents of violence are reported by staff and that their documentation may be influenced by various factors, both institutional and external. The descriptions of incidents of aggression are short and not very detailed, which makes it difficult to analyze their circumstances and nature. Effective prevention of aggression requires a thorough assessment of the scale and characteristics of this phenomenon. By reporting all incidents of aggression, staff can contribute to a reliable analysis of the problem and thus lead to increased safety in the workplace. Int J Occup Med Environ Health. 2025;38(6):596-610.
The International Classification of Functioning, Disability and Health (ICF) was developed by the World Health Organization as a standard language to describe biopsychosocial aspects of functioning, health, and health-related states. Different health professionals document functioning data from their professional perspective. The primary objective of this study was to utilize multidisciplinary electronic health records to identify the factors considered significant by different healthcare professional groups in documenting the functioning, disability, and health of individuals with spinal cord injury (SCI). A random sample of 10 patients was selected from a larger cohort (n = 49) for analysis. Free text from electronic health records regarding subacute inpatient rehabilitation and an outpatient visit at the chronic stage was collected. Two researchers annotated the data to ICF codes. The study was a descriptive, longitudinal study using quantitative content analysis. Contextual analysis was used to compare the data between different health professionals and at different time points. In the 10-patient random sample, 447 health records were retrieved. The functioning data consisted of all ICF domains, with 9349 findings. Environmental factors were documented the most. Health professional groups had different patterns in the frequency of documented ICF categories in their documents, reflecting professionals' expertise in the multidisciplinary team. For example, occupational therapists highlighted activities and participation whereas psychologists emphasized body functions. The findings of this study may facilitate the development of rehabilitation for persons with SCI and highlight the importance of multidisciplinary rehabilitation in complex medical conditions.
The aim of this study was to psychometrically validate the Spanish version of the Polish SDM-20 questionnaire (Skala Doświadczania Mobbingu) as a screening instrument for assessing workplace mobbing in occupational health settings. A cross-sectional online survey was conducted among 753 Spanish employees (65.5% women, age: 18-66 years). The factorial structure of the SDM-20 was examined using confirmatory factor analysis (CFA). Internal reliability was assessed using Cronbach's α and McDonald's ω coefficients. Convergent and divergent validity were evaluated through correlations with workplace bullying (Negative Acts Questionnaire - Revised - NAQ-R), burnout (Maslach Burnout Inventory - General Survey - MBI-GS9), and organizational climate measures. Confirmatory factor analysis supported the original 3-factor model, encompassing person-related mobbing, work-related mobbing, and health-related harm, and demonstrated satisfactory model fit. All subscales showed high internal reliability. Strong positive correlations with workplace bullying and burnout measures supported convergent validity, whereas negative associations with organizational climate indicators provided evidence of divergent validity. The results confirm the structural stability and construct validity of the Spanish SDM-20. The Spanish version of the SDM-20 is a reliable and valid instrument for screening workplace mobbing in occupational health contexts. By integrating behavioral exposure with a psychometrically assessed harm component, the instrument enables differentiation between exposure and clinically relevant victimization. Its brevity and robust psychometric properties support its application in occupational health surveillance and early risk detection. Int J Occup Med Environ Health. 2026;39(3).
Acute ischemic stroke stands as a significant contributor to high disability and mortality rates. Patient after stroke require vigilant supervision from general practitioners. Cardiovascular prevention emerges as a critical aspect. Physicians play a vital role in managing post-acute care and preventing secondary complications in patients with stroke after discharge. The aim of the study was to characterize and evaluate the cerebrovascular risk factors for stroke in patients under the care of general practitioners. Data were collected from 277 patients after ischemic brain stroke under general practitioner care. Baseline demographic and clinical characteristics were gathered for all study participants. Data were collected from 277 patients after ischemic brain stroke under general practitioner care. Baseline demographic and clinical characteristics were gathered for all study participants. Results: Gender distribution among the study cohort was 143 females (51.6%) aged mean (M) ± standard deviation (SD) 76.4±11.8 years and 134 males (48.4%), aged 78.5±11.9 years. Hypertension emerged as the most prevalent risk factor, affecting 75.8% of participants. Ischemic heart disease, lipid disorders, and atrial fibrillation, observed in 30.32%, 30.7%, and 29.6% of patients respectively. Diabetes mellitus was present in 23.1% of the cohort. The body weight was M±SD 76.9±16 kg, with BMI 27.6±6.6 kg/m2. The presence of atrial fibrillation and chronic kidney disease showed statistically significant differences between survival and death groups. Statistically significant differences were observed in diastolic blood pressure in women vs. men (p = 0.0383). Regarding stroke severity, women presented with more severe symptoms (National Institutes of Health Stroke Scale score M = 10.5 vs. 8.3, p = 0.0163) and poorer functional outcomes in modified Rankin Scale (M = 3.3 vs. 2.8, p = 0.0062), a higher prevalence of hypertension and atrial fibrillation among women compared to men (35.0% vs. 17.5%, p = 0.0045). The authors' findings highlight the necessity for sex-specific approaches in stroke management, particularly considering the impact of comorbid conditions such as hypertension and atrial fibrillation on stroke outcomes. Despite the availability of general guidelines, it would be valuable to develop specific guidelines for general practitioners on ischemic stroke risk factors. Int J Occup Med Environ Health. 2025;38(6):641-53.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
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.
A work-related death from sudden causes among physicians is not a new problem although still not enough explored in the scientific literature. Estimating the scale of the phenomenon is important from a social and public health point of view. Thus, the aim of this paper is to gather the current state of knowledge on the frequency and the main causes of unexpected sudden causes of death within physicians' community. The authors of the article reviewed medical databases on publications in English concerning the topic released in this century. The cases of sudden death, work-overload death including those resulting from suicide and incidences of direct violence from other individuals while performing professional duties were analyzed. It turns out that the problem appears regardless of the region of the world and has been increasing in frequency in recent times. Some medical specialties, i.e., surgery, psychiatry, anesthesiology, intensive care and emergency medicine, seem to carry significantly higher risk than others. In addition to the conclusions from literature review, also letters to the editors and mass-media reports from different parts of the world indicate that the problem is alarming and requires more specific research and urgent solutions. Int J Occup Med Environ Health. 2026;39(3).
Although occupational activity is a key determinant of human well-being, labor market participation among people with visual impairments remains low. While barriers to employment for individuals with low vision or blindness have been explored, little is known about how they perceive their own work ability. This study therefore aimed to assess the level of work ability in this population in Poland and identify its correlates, using the person-environment fit model as a theoretical framework. A cross-sectional online survey was conducted among 67 participants with visual impairments, of whom 41 were partially sighted and 60% were women. The questionnaire collected sociodemographic, health, disability, and job-related information, as well as data on social support from colleagues and supervisors (Copenhagen Psychosocial Questionnaire). A dependent variable was measured with the Work Ability Index. Descriptive statistics, correlation, and hierarchical multiple regression analyses were performed. Participants reported a generally good level of work ability (M±SD 37.54±6.46). Correlation analysis identified 5 variables significantly associated with work ability. In the regression model, 4 remained significant predictors: satisfaction with household income (β = 0.34, p < 0.001), self-rated health (β = 0.27, p < 0.01), presence of additional disability (β = -0.22, p < 0.01), and shift work (β = -0.23, p < 0.05). The model explained 62% of the variance in work ability (R² = 0.62). Additional analyses indicated that the examined variables explained more variance in the subjective-resource component of WAI than in its objective health component. The findings highlight key personal and occupational factors shaping work ability among employees with visual impairments. Considering these factors in workplace interventions may help sustain employment and promote occupational well-being in this group. Int J Occup Med Environ Health. 2026;39(2):163-78.
This study aimed to develop a comprehensive ICF Core Set for children with cancer to facilitate the documentation of their health and functioning. Two preparatory phase studies were conducted to gather perspectives from caregivers and healthcare professionals. Semi-structured interviews with caregivers and a cross-sectional survey with healthcare professionals were conducted to understand the challenges children face due to cancer and its treatment, as well as environmental factors impacting their functioning. Interviews were audio-recorded, transcribed verbatim, and analyzed qualitatively. The themes derived from the analysis were coded and linked to the ICF framework using Cieza linking rules. A comprehensive ICF Core Set comprising 156 categories was formulated by combining responses from 21 healthcare professionals and 18 caregivers. Categories were distributed across the body structure, body functions, activities/participation, and environmental factors domains. Specifically, 40 categories related to body structure, 65 to body functions, 23 to activities/participation, and 27 to environmental factors. The use of the ICF to develop the Core Set is significant as it provides a multidimensional perspective on the health and functioning of children with cancer. Incorporating intrinsic and extrinsic factors, the Core Set can assist multidisciplinary treatment teams in delivering individualized and holistic care to pediatric patients. Additionally, it can serve as a foundation for standardizing assessment tools and planning preventative and intervention strategies for this population.
Egypt has made significant strides in strengthening its healthcare system, guided by Vision 2030 and aligned with the United Nations' Sustainable Development Goals (SDGs). Despite progress, challenges persist, including a high burden of non-communicable diseases, strained resources and a fragmented health system. The Universal Health Insurance System (UHIS), launched in 2018, aims to address these issues by providing equitable access to quality health services while ensuring financial protection. This study explores stakeholders' perspectives on implementing Universal Health Coverage (UHC) in Egypt, focusing on the relationships and resources required, successes and challenges and its impact on citizens' access to care. A qualitative, cross-sectional study was conducted between 2021 and 2022, involving in-depth interviews with eight key stakeholders from government bodies and international organizations. Data were analyzed using thematic content analysis to identify critical themes underpinning Egypt's UHC implementation. Stakeholders highlighted that strong political will, alignment with the SDGs and existing infrastructure, including digital systems and healthcare education programs, were pivotal in launching UHC. This study's key contribution is to provide qualitative insights from these key stakeholders, demonstrating how their experiences with the Port Said pilot implementation revealed successes in increased service accessibility and improvements in governance. However, challenges remain, including financial sustainability, workforce shortages and gaps in public awareness and cultural adaptation. While infrastructure and governance reforms have enhanced health service access, further efforts are needed to sustain and scale these improvements nationally. Egypt's UHC reforms demonstrate the potential to transform health outcomes, aligning with goals of equity and financial sustainability. The study's findings provide specific policy recommendations and implications, highlighting the need to focus on the financial sustainability of the system, reform governance and prioritize public awareness for effective execution. Lessons from the Egyptian experience, particularly the phased rollout, serve as valuable insights for other countries. Maintaining momentum requires adaptive strategies integrating global best practices to ensure UHC's long-term success.
Vessels constitute a unique type of workplace, primarily due to their operation in non-standard external environments and the spatial constraints inherent to their design. As a result, onboard working conditions play a critical role in ensuring the health and safety of crew members. This study aimed to evaluate the subjective assessment of working conditions among seafarers and to analyze the relationship between perceived environmental burdens and job satisfaction. The study was conducted on a group of 300 employees working on inland, port, coastal, and Baltic Sea vessels. A questionnaire survey was used to collect data on the subjective evaluation of working conditions and the perceived intensity of environmental factors such as noise, vibrations, and microclimate. Correlations between these factors and job satisfaction were analyzed. The assessment revealed that 84% of surveyed seafarers rated their overall working conditions positively. However, environmental burdens were prevalent: noise (82%), vibrations (71%), and microclimate (65%) were identified as the most common nuisances. A negative correlation was observed between the perception of environmental burdens and job satisfaction. Although the general assessment of working conditions on vessels was positive, noise, vibrations, and microclimate remain significant issues affecting the well-being and job satisfaction of seafarers. Preventive measures aimed at mitigating these burdens may contribute to improving occupational health and safety onboard vessels. Int J Occup Med Environ Health. 2026;39(1):1-15.