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Financial protection is a central objective of health systems and a key mechanism for advancing health equity within universal health coverage. To date, evidence on the equity of financial protection in high-income countries has not been systematically synthesized. To summarize the literature on the equity of financial protection for health care in high-income countries. We conducted a systematic scoping review based on a published protocol. We searched four academic (Embase, MEDLINE, IBSS, EconLit) and three grey literature (WHO, OECD, World Bank) databases for data addressing four domains: (i) variables used to characterize equity, (ii) financial protection indicators, (iii) observed financial protection distributions, and (iv) conceptualizations of equity. Eligible records were original research published in any language since 2010. Two reviewers independently assessed records for eligibility. Findings were synthesized narratively. Seventy-five records were included from 4142 screened results, covering data from 48 countries. The largest number of studies focused on the Republic of Korea (n = 13) and the United States (n = 11). Inequalities of financial protection were observed for at least one determinant of health in each setting, across diverse indicators and individual or group stratifiers. Most studies insufficiently conceptualized equity, limiting assessment of outcomes as equitable or inequitable. Notable gaps include the underrepresentation of important variables (e.g. migration status, area-level deprivation, and social class), minimal examination of disproportionate advantage, and the inconsistent application of more equity-sensitive analytical methods. This review provides the first systematic synthesis of evidence on the equity of health system financial protection in high-income countries. Key issues that warrant attention in future research and practice include clearer conceptualization of equity and the analysis of underrepresented determinants of health and disproportionate advantage.

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.

Older adults living in residential aged care facilities (RACFs), particularly in regional and rural areas, experience a high burden of untreated dental caries, tooth sensitivity, and oral pain. Workforce shortages, limited access to dental services, and competing health priorities make the delivery of timely oral health care challenging in these settings. Poor oral health contributes to pain, impaired nutrition, reduced quality of life, and increased health service use. There is an urgent need for context-appropriate, accessible, and cost-effective interventions for RACF residents. Aqueous silver fluoride (AgF), a minimally invasive topical agent with caries-arresting and desensitizing properties, offers a pragmatic approach suitable for aged care settings. This protocol aims to test the effectiveness of an AgF intervention package in reducing tooth sensitivity and tooth pain, arresting caries, and improving oral health and well-being in older adults living in regional and rural RACFs. This study is a 2-arm, parallel-group cluster randomized controlled trial, with RACFs as the unit of randomization. The trial is conducted in public and private RACFs across regional and rural Queensland and New South Wales, Australia. Eligible participants are residents with at least 1 natural tooth. At baseline, calibrated examiners perform standardized oral examinations to assess dental caries status, lesion activity, and dentin hypersensitivity. AgF is applied to eligible carious lesions and sensitive tooth surfaces following a standardized clinical protocol. Follow-up assessments at 3 months include a repeat clinical examination to assess caries arrest and changes in hypersensitivity, along with resident-reported measures of oral pain and oral health-related quality of life collected using validated instruments. Outcomes include change in tooth sensitivity and oral pain at the 3-month follow-up, caries arrest rates, and change in oral health-related quality of life. Analyses will follow intention-to-treat principles and account for clustering using mixed-effects regression models with facility-level random effects. Models will adjust for baseline covariates and prespecified confounders. Sensitivity analyses will examine the robustness of the findings. The trial will also inform a planned economic evaluation embedded within the broader research program. This trial forms part of a broader program funded by the Medical Research Future Fund Dementia, Aging and Aged Care Grant (2024439). Recruitment and data collection commenced in May 2025 and are expected to conclude in June 2026. Recruitment is ongoing across participating RACFs. Data analysis is expected to commence in mid-2026, with primary findings anticipated for publication in early 2027. This protocol outlines a rigorous evaluation of a minimally invasive, scalable oral health intervention tailored to RACF settings. The findings will provide high-quality evidence on effectiveness to inform policy, service delivery, and economic evaluation aimed at improving oral health and well-being among older adults in residential aged care.

To examine how federal appellate courts evaluate constitutional claims concerning custodial dental care and to characterize the clinical and procedural features of these cases. Decisions of the U.S. courts of appeals issued between 1980 and 2025 were identified through structured database searches. Cases substantively evaluating dental care were coded for severe pain, infection, abscess (coded separately), functional impairment, delay, custody type, representation status, defendant level, and appellate outcome. Descriptive statistics summarized case characteristics, and logistic regression evaluated associations between selected variables and appellate outcomes. A total of 182 appellate decisions met inclusion criteria, of which 174 evaluated adequacy of care. Severe pain was described in 86% of coded cases and functional impairment in 62%. Infection was documented in 41% of cases, with an abscess specifically identified in 16%. Delay was alleged in 73% of cases. Overall, 35% of decisions resulted in reversal or remand. Among cases with documented delay duration, the median delay was substantially longer in plaintiff-favorable cases, and delays exceeding 90 days were associated with higher odds of reversal or remand. Appellate review emphasizes documented awareness and response rather than equivalence to community standards. This legal threshold does not ensure timely clinical resolution. Public health evaluation of custodial dental systems should consider disease progression and access to definitive treatment in addition to legal compliance. Improvements are likely to depend on system-level monitoring of access and timeliness of care rather than litigation alone, reflecting the distinction between legal sufficiency and clinical adequacy.

Dental Public Health (DPH) plays a critical role in promoting oral health and addressing community needs, yet remains an unpopular career choice among dental graduates. Understanding students' attitudes toward DPH is essential for strengthening the dental workforce in prevention-oriented fields, particularly in developing countries such as Egypt. The purpose of the study is to assess the attitudes of dental students in governmental and private universities in Egypt toward pursuing a career in DPH, and to examine how demographic characteristics, academic preferences, and opinions about the DPH subject relate to these attitudes. A cross-sectional survey was conducted among final-year dental students and interns from six Egyptian dental schools (three governmental, three private). A validated, adapted paper-based questionnaire was administered. Attitudes toward DPH were measured using a five-point Likert scale and categorized as positive, neutral, or negative. Chi-square tests were used to analyze associations between variables. A total of 393 students participated (response rate: 93.8%). Nearly half (49.9%) showed a positive attitude toward DPH. However, only 6.4% considered pursuing a career in the specialty. A few students (6.4%) favored DPH as an undergraduate subject, and 3.6% preferred it for postgraduate specialization. University type showed no significant association with attitude (P = 0.41), nor did gender or area of residence. However, regression analysis demonstrated that public university students were 1.7 times more likely to pursue a career in the specialty. About 51% of the students showed interest in serving the public and working in public service. Significant differences in future career plans were observed between students in governmental and private universities (P = 0.03). Egyptian dental students generally exhibit positive attitudes toward DPH, yet few intend to pursue it as a career. Attitudes were not influenced by university type, gender, or area of residence, but were strongly shaped by students' opinions of the subject of DPH in the undergraduate curriculum. Strengthening early exposure, enhancing practical components, and promoting the importance of DPH are strategies that have the potential to improve interest in this specialty.

Oral health disparities disproportionately affect low-income populations, with cost a significant barrier to accessing dental care. In Canada, individuals with untreated oral conditions often visit publicly funded medical services, which are not designed to provide dental treatment. The recently launched Canadian Dental Care Plan (CDCP) is intended to expand access to dental services for low-income populations. This commentary argues that reduced medical service use for non-traumatic dental conditions (NTDCs) is a potential benefit that should be monitored to evaluate the impact of the CDCP. Canadian studies reporting use and cost estimates of physician visits, emergency department use, and hospital-based care for dental conditions were described. Data sources for routine monitoring of use were identified. In Ontario Canada, use and costs of physician and emergency department visits, and hospital-based care for NTDCs were estimated at over $29M annually during 2003-2015 (population approximately 30 million). These estimates were conservative, with other studies suggesting higher visit volumes and costs depending on case definitions. National hospital and provincial physician billing databases are available for routine monitoring but indicators need to be standardized and data quality assessed. Stratified reporting can monitor equity impacts. Medical oral health care use is a potential indicator of effectiveness of public dental programs. A decline could signal improved access to dental services while persistent rates may highlight gaps in program reach. Monitoring this indicator is relevant to Canada and other jurisdictions seeking to advance oral health equity through expanded public coverage.

Head and neck cancers (HNC) significantly impact patients' quality of life (QOL), with oral health often being significantly compromised, especially in advanced stages. Green tea, with its known anti-inflammatory and antioxidant properties, may help to improve oral health in these patients. Therefore, this study aims to investigate the effect of green tea-based mouth rinse on oral health status, pain, and QOL of advanced HNC patients. This randomized controlled trial was conducted in the palliative care outpatient department of a tertiary hospital in New Delhi. Then, 64 patients with stage III/IV HNC receiving palliative care were randomly assigned to the experimental and control groups. In addition to usual care, the experimental group used a green tea-based mouth rinse thrice daily for 6&#xa0;weeks. The study examined oral health status as the primary outcome, which was assessed at baseline and every 2&#xa0;weeks up to 6&#xa0;weeks using the Oral Assessment Guide (OAG) and Oral Hygiene Index-Simplified (OHI-S). The secondary outcomes pain and quality of life of the patients were assessed using the Numerical Pain Rating Scale and Oral Health Impact Profile-14 (OHIP-14), respectively. Repeated measure ANOVA revealed that experimental group had significantly improved OAG-score (F&#x2009;=&#x2009;34.32, P&#x2009;= <&#x2009;0.001, &#x14b;p2&#x2009;=&#x2009;0.39) and OHI-S-score (F&#x2009;=&#x2009;5.67, P&#x2009;= <&#x2009;0.001, &#x14b;p2&#x2009;=&#x2009;0.11) over time. However, any significant between-group difference is not found in terms of pain (P&#x2009;=&#x2009;0.73) and QOL (P&#x2009;=&#x2009;0.34). Green tea-based mouth rinse was found to be effective in improving the oral health status of advanced HNC patients. Nurses should incorporate such cost-effective options to improve the oral health of cancer patients. The trial had been registered under the Clinical Trial Registry of India on 17/05/2024. (Registration No: CTRI/2024/05/067571).

Oral cancer represents a significant public health burden globally, with multiple challenges to its effective control particularly in developing economies. Despite established risk factors, early detection remains suboptimal, resulting in poor prognosis and increased mortality. This review aimed to systematically synthesize evidence on the effectiveness of training programs for frontline health workers in improving oral cancer screening outcomes. A comprehensive search was conducted in PubMed, Google scholar, Scopus, Cochrane by two independent investigators using defined eligibility criteria. Data were extracted using a standardized form, and study quality was assessed using the Newcastle-Ottawa Scale, Joanna Briggs Institute tool, and Cochrane Risk of Bias 2.0. Primary outcomes were post-training change in knowledge, sensitivity and specificity of examinations, predictive values, and establishment of referral pathways. Data synthesis included qualitative analysis and random-effects meta-analysis where possible. PRISMA guidelines were followed. The search resulted in identification of 32,212 records out of which fifteen articles were included for qualitative synthesis. The meta-analysis indicated an improvement in knowledge scores among frontline health workers following the training program; however, the effect was not statistically significant (SMD -2.81; 95% CI (-5.98 to 0.35), with substantial heterogeneity across studies (I&#xb2; = 98%). Diagnostic accuracy of oral visual examination demonstrated a sensitivity of 74% and a specificity of 94%, suggesting good discriminatory ability; however, considerable heterogeneity across studies warrants cautious interpretation. This review provides evidence that strengthening primary health care capacity through training of frontline health workers is essential for the early detection and prevention of oral cancer. Such efforts are critical to reducing the burden of oral cancer, particularly in high-risk populations.

Approximately 12% of the American population live with a form of diabetes mellitus (DM). People living with DM (PLD) are at a significantly higher risk of developing comorbid conditions, such as periodontal disease (PD). The pathological link between DM and PD is well documented, but the social factors, or social determinants of health (SDH) which may contribute to the link between the diseases are less understood. Our objective is to examine the SDH factors associated with PD among PLD using a national database with the aim of informing intervention strategies for affected subpopulations. Utilizing the All of Us national database, we drew a sample of PLD, including those with and without PD, that completed surveys regarding SDH, their overall health, and healthcare utilization. We calculated marginal odds ratios between each variable and PD diagnosis. Analyses were performed using the All of Us Workbench and R 4.3.1. The total cohort consisted of 7971 participants; 342 participants had PD. Significant variables found to increase PLD's risk of PD included male gender, being a current smoker, reporting inability to afford healthcare, and perceived discrimination in healthcare. Using a large, national cohort, we demonstrate the association between specific SDH and PD among PLD. Our work underscores the importance of considering these variables for intervention strategies and emphasizes the need for preventative oral care programs for PLD.

Oral health is an important yet often neglected aspect of antenatal care. Despite evidence linking poor maternal oral health with adverse pregnancy outcomes, pregnant women underutilize dental services due to individual, cultural, and systemic barriers. This is the first systematic review using mixed-methods approach that synthesized quantitative and qualitative evidence on this topic. A mixed-methods systematic review was conducted using Joanna Briggs Institute (JBI) methodology and reported per PRISMA guidelines. Eligible studies included those exploring barriers and facilitators to dental service utilization among pregnant women. Searches across six databases and grey literature sources were conducted. Quantitative data were qualitized and integrated with qualitative findings using JBI's convergent integrated approach. Findings were reported based on Andersen's Behavioral Model of Health Services Use. The review included 55 studies (37 quantitative, 17 qualitative, 1 mixed-methods) from 24 countries. Eight key themes based on Andersen's Behavioral model emerged. Barriers included misconceptions, safety concerns, dental treatment fear, high costs, lack of insurance coverage, poor referral systems, limited provider training, competing priorities, and cultural taboos. Facilitators included higher education, employment, urban residence, and provider support. This is the first systematic review offering a comprehensive synthesis of the multifaceted barriers and facilitators shaping pregnant women's decisions to seek oral care. It integrated global prevalence data from quantitative studies with the lived experiences of pregnant women through qualitative studies. Andersen's model enabled structured interpretation of individual, contextual, and health-related determinants. It is important to develop culturally sensitive and integrated strategies to enhance maternal oral health service utilization across diverse settings. Policies should mandate integration of oral health into antenatal care, expand dental insurance for pregnant women, and enhance interprofessional training. Further research should explore longitudinal patterns, develop validated tools, and address intersectional disparities in access. PROSPERO CRD42025642722.

American Indians and Alaska Natives have lower life expectancies, and poorer oral health compared to other US populations. These negative health outcomes are somewhat preventable with routine care, but provider shortages, proximity to health services, and other factors create barriers. The Community Health Aide Program (CHAP) is a multidisciplinary system of certified mid-level behavioral, medical, and dental providers working alongside licensed providers to increase access to quality care. The objective was to evaluate benefits and challenges of integrating the CHAP model within existing Tribal health systems. De-identified data from open-ended responses related to CHAP expansion efforts in three Tribal Nations residing in Oklahoma were qualitatively analyzed using a SWOT analysis framework. Themes were developed deductively under the umbrella of Strengths, Weaknesses, Opportunities, and Threats. Five subthemes commonly affecting existing Tribal healthcare systems were identified. A special emphasis on dental healthcare was highlighted. 99 strengths (36.4%), 52 weaknesses (19.1%), 69 opportunities (25.4%), and 52 threats (19.1%) were identified. Subthemes included: Interprofessional and Community Connections and Programs (n&#x2009;=&#x2009;88); Technology, Physical Infrastructure, and Resource Capacity (n&#x2009;=&#x2009;80); Workforce Staffing and Efficiency (n&#x2009;=&#x2009;49); Scope of Administrative Coordination, Budget, and Funding (n&#x2009;=&#x2009;30); and Cultural Responsiveness (n&#x2009;=&#x2009;25). Specific to dental healthcare were 59 strengths (n&#x2009;=&#x2009;20), weaknesses (n&#x2009;=&#x2009;11), opportunities (n&#x2009;=&#x2009;21), and threats (n&#x2009;=&#x2009;7). CHAP has historically proven to be a successful healthcare delivery model for underserved populations. More strengths and opportunities than weaknesses and threats regarding the integration and expansion of CHAP to improve medical, behavioral, and dental healthcare access were identified.

Patterns of smartphone use vary across ages; however, adolescents and young adults may be at particular risk, with more behavioral addictions and adverse health effects. This study explored the prevalence of smartphone addictions among health adolescent professional students and examined how problematic smartphone usage interferes with their level of physical activity as well as health-related quality of life. A cross-sectional Analytical study based on self-perceived outcome measures such as the smartphone addiction scale-short version, the 'International Physical Activity Questionnaire-short form', and 'Patient-Reported Outcomes Measurement Information System 29'-item profile was done with a sample of 400 participants. A total of 400 individuals (125 Males & 275 females) with mean age being 20.8 + 2.06 years recruited for the study. Smartphone addiction was most prevalent in dentistry students (43 %), followed by medicine (32 %) and allied health science (30.5 %), with no statistically significant differences in the addiction rate among the three programs. Compared with smartphone-addicted individuals, nonaddicted individuals had marginally greater physical function (mean difference =0.670, p<0.001), and those addicted to smartphones had significantly higher. anxiety (mean difference = 2.776, p<0.001), depression (mean difference =2.264, p< 0.001), and fatigue (mean difference =2.264, p<0.001). Physical activity was found to have no statistically significant difference between addicted and non-addicted individuals and except for sleep disturbance, none of the domains of PROMISE-29 showed any statistically significant correlation with physical activity. The findings highlight the need for recommendation for setting a time limit for the usage of smartphones for formal and informal academic activities, as well as policy measures to promote normal smartphone use.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1&#xb7;3 billion (95% uncertainty interval [UI] 1&#xb7;2 to 1&#xb7;4) individuals were estimated to be living with MASLD (ie, 16&#xb7;1% of the global population), with an age-standardised prevalence rate of 14&#x2009;429&#xb7;3 (95% UI 13&#x2009;268&#xb7;3 to 15&#x2009;990&#xb7;6) per 100&#x2009;000 population, representing a percentage increase of 142&#xb7;7% (95% UI 139&#xb7;2 to 146&#xb7;7) in crude numbers from 1990 (0&#xb7;5 billion [0&#xb7;5 to 0&#xb7;6]) and of 28&#xb7;6% (27&#xb7;8 to 29&#xb7;5) in the rate (11&#x2009;217&#xb7;2 [10&#x2009;276&#xb7;8 to 12&#x2009;467&#xb7;0] per 100&#x2009;000 in 1990). An estimated 3&#xb7;6 million (2&#xb7;8 to 4&#xb7;5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39&#xb7;6 (31&#xb7;2 to 49&#xb7;9) per 100&#x2009;000 population. Despite a 116&#xb7;3% (93&#xb7;3 to 139&#xb7;4) increase in crude DALYs (from 1&#xb7;7 million [1&#xb7;3 to 2&#xb7;1] in 1990), its age-standardised estimate remained consistent (1&#xb7;8% [-8&#xb7;6 to 12&#xb7;8]) from 1990 (38&#xb7;9 [30&#xb7;1 to 49&#xb7;8] per 100&#x2009;000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29&#x2009;246&#xb7;1 [26&#x2009;848&#xb7;3 to 32&#x2009;048&#xb7;7] per 100&#x2009;000) and Andean Latin America showed the highest DALY rate (152&#xb7;3 [114&#xb7;1 to 194&#xb7;7] per 100&#x2009;000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653&#xb7;5 [7923&#xb7;7 to 9592&#xb7;8] per 100&#x2009;000) and east Asia had the lowest DALY rate (16&#xb7;3 [13&#xb7;5 to 19&#xb7;9] per 100&#x2009;000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15&#x2009;616&#xb7;4 [14&#x2009;349&#xb7;2 to 17&#x2009;263&#xb7;3] per 100&#x2009;000 people in 2023) than in females (13&#x2009;245&#xb7;2 [12&#x2009;132&#xb7;0 to 14&#x2009;692&#xb7;6] per 100&#x2009;000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2&#xb7;2 [95% UI 1&#xb7;6 to 3&#xb7;1] per 100&#x2009;000 people), followed by high BMI (1&#xb7;4 [0&#xb7;6 to 2&#xb7;4] per 100&#x2009;000 people) and smoking (1&#xb7;0 [0&#xb7;3 to 1&#xb7;8] per 100&#x2009;000 people). Our forecasting model estimates that 1&#xb7;8 billion (95% UI 1&#xb7;6 to 2&#xb7;0) individuals are likely to have MASLD by 2050, representing a 42&#xb7;0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15&#x2009;774&#xb7;9 (95% UI 14&#x2009;613&#xb7;9 to 17&#x2009;336&#xb7;2) per 100&#x2009;000 people in 2050, representing an average annual percentage change of 0&#xb7;3% (95% UI 0&#xb7;3-0&#xb7;3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16&#xb7;1% and approximately 1&#xb7;3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.

Despite the growing recognition of Community-Oriented Health Professions Education (COHPE) as an essential framework for developing socially accountable healthcare practitioners, there remains a critical knowledge gap regarding faculty members' perceptions of COHPE across different health professions disciplines and institutional contexts. This study investigates faculty perceptions of COHPE implementation across multiple disciplines and institutions in Egypt. A concurrent mixed-methods design was used, involving 454 faculty members from governmental and non-governmental health professions institutions. Quantitative data were collected via validated surveys and analysed using descriptive statistics and agreement indices. Qualitative data from focus group discussions underwent thematic analysis. Integration of both datasets followed a convergent design to identify patterns and contradictions in implementation experiences. Overall, COHPE implementation was rated as neutral (mean agreement index: 2.8/5), suggesting uncertainty rather than an endorsement issue. Four domains reflected moderate implementation: relevance to community needs, priority health problems, cultural sensitivity, and health systems integration. Domains such as community empowerment, involvement, and partnership development received the lowest scores. Ten overarching themes were identified, with logistical constraints, curriculum rigidity, and faculty development gaps being the most recurrent. Faculty experience did not correlate with stronger COHPE implementation, revealing a paradox in traditional education models. Findings highlight a widespread conceptual awareness of COHPE principles, but persistent structural and cultural barriers limit their full integration. The convergence of quantitative neutrality and qualitative concern indicates systemic rather than isolated challenges. Strategic reforms targeting curriculum design, faculty training, and stakeholder engagement are essential to transition COHPE from idealistic talk to embedded practice.

This study examines whether better oral health is associated with greater social engagement in later life and whether oral health and social engagement are associated with depressive symptoms among older adults. We analyze Waves 7-9 (2018, 2020, 2022) of the Korean Longitudinal Study of Ageing, restricting to adults aged &#x2265;65 years. Oral health is measured by the General Oral Health Assessment Index (GOHAI). Social engagement is captured as a binary indicator for meeting close friends/relatives/neighbors in the past year and the annual frequency of such meetings (days/year). Depressive symptoms are defined as self-reported depression lasting &#x2265;2 weeks or antidepressant use. We estimate associations using panel fixed-effects model and Double Machine Learning to address unobserved individual heterogeneity and reduce model misspecification bias. A standard deviation improvement in GOHAI was associated with an approximately 2-percentage-point higher likelihood of meeting close contacts and about 3 additional meeting days per year. Both meeting close contacts and better oral health were associated with a lower probability of depressive symptoms. Results are robust across sensitivity and falsification tests. The findings indicate that better oral health is linked to greater social engagement in later life, with potential welfare gains for older adults through a lower risk of depression. Interventions that improve oral health in older adults may yield benefits beyond function and comfort by supporting social connectedness and reducing psychological risk. Conventional evaluations may understate the social benefits of improving oral health.

This study explored how individuals in an online anti-CWF community construct and sustain opposition narratives to inform evidence-based communication and policy engagement. A qualitative study was undertaken with adults who self-identified as not supportive of CWF. Fourteen participants from the United Kingdom, Australia, and the United States of America were recruited via the Fluoride Action Network Facebook page, a prominent global hub for anti-fluoridation discourse. Semi-structured interviews were conducted via Zoom between January and July 2025. Data were analyzed using inductive qualitative content analysis. Codes were organized into main, generic, and sub-categories and quantified by endorsement frequency. Reporting followed SRQR and COREQ guidelines. Five main categories were identified: (1) Knowledge, Attitudes, Perceptions, and Policy Views; (2) Information Sources and Trust; (3) Reasons for Opposition; (4) Grassroots and Community Actions; and (5) Alternatives and Conditions for Acceptability. Opposition to CWF was shaped by ethical, health, and institutional concerns rather than by scientific disagreement alone. Eight generic categories captured key reasons for opposition, including perceptions of mass medication without consent, health and social harms, institutional distrust, concerns about industrial waste, ethical objections, skepticism about benefits, preference for individualized alternatives, and experiences of professional dismissal. Anti-fluoride networks and social media were the most trusted sources of information (86%), while trust in mainstream science and health authorities was very low (<&#x2009;15%). Opposition to CWF is sustained through network-mediated information ecosystems and reinforced by behavioral economic mechanisms, including loss aversion, autonomy bias, and default framing effects. Effective public health responses must therefore move beyond evidence dissemination to incorporate network-aware communication and behavioral insights-informed strategies that prioritize transparency, public participation, and equitable framing of CWF within broader oral health policy.

Organised lung cancer screening (LCS) programs are being developed worldwide in response to recent landmark trial evidence. Targeting high-risk individuals primarily based on smoking history, LCS faces challenges from smoking-related stigma, which can cause psychological harm and hinder participation. With limited interventions addressing this issue, this study aimed to co-design a communication-based strategy to reduce stigma in the LCS context. Using best-practice co-design principles, this study involved workshops, focus groups, and interviews with 5 consumers (people eligible for LCS in Australia) and 44 health professionals and other experts (including clinicians, radiographers, behavioural scientists, and health managers). Participants were purposively sampled to achieve representation across key variables - e.g., smoking history for consumers, professional roles for experts. Consultation with experts was conducted as part of a larger project developing a suite of information materials for the National Lung Cancer Screening Program in Australia. Key literature and concurrent qualitative research with consumers (n&#x2009;=&#x2009;24) also informed co-design. Qualitative data were analysed using abductive thematic analysis. Early consultation identified the preferred format for the strategy as a resource targeted for health professionals involved in the LCS pathway. Resource content was iteratively revised, with three key themes developed: (1) Taking the onus off the individual; (2) Fostering understanding and empathy; (3) Positive framing. A lexicon guide promoting person-first and empowerment language was also included guided by previous literature. The final resource was a four-page A4 document for health professionals and LCS staff, designed to support effective, stigma-sensitive communication during LCS. We co-designed a practical, scalable resource to reduce stigma for use in the Australian National Lung Cancer Screening Program, expected to ultimately reduce psychological harm for LCS participants and enhance screening participation. Future research should evaluate the resource as an implementation strategy for LCS uptake. Cultural adaptation and tailoring of the resource for specific populations considering intersectional stigmas is also needed. We collaborated with a consumer advisor for the project's duration, including study design, co-facilitation of consumer workshops, analysis and manuscript writing.

To compare the knowledge and attitudes regarding patient safety among medical students and faculty between public and private medical institutions. The mixed-method concurrent study was conducted from July 2020 to January 2021 at the private-sector Liaquat College of Medicine and Dentistry, Karachi, and the public-sector Sindh Medical College, Karachi. Data was collected using Attitudes to Patient Safety Questionnaire-III from medical students of either gender from the third to fifth year of the academic programme, and through in-depth interviews with selected students and healthcare professionals at both the institutions. Quantitative data was analysed using SPSS 26, while qualitative data was subjected to thematic analysis. Of the 225 students with mean age 22.6&#xb1;1.41 years, 116(51.6%) were from the private institution, 149(66.2%) were females, 87(38.7%) were in the fourth year of the academic programme, and 85(37.8%) reported exposure to medical errors in the preceding year. Students from the private institution exhibited significantly more positive attitudes towards patient safety compared to those from the public institution (p&#x2264;0.05). Qualitative analysis yielded three key themes: "Stances on patient safety", "Stance on medical errors", and "Ways to bring about change". A more favourable attitude towards patient safety was noted among students at the private-sector institution compared to their counterparts in the public sector. Participants from both the institutions expressed enthusiasm for learning, and advocated the need to integrate patient safety into the medical curriculum.

This retrospective cohort study describes public dental service use among children aged 0-4&#x2009;years attending public sector oral health services in Metro North and Metro South Hospital and Health Services, Southeast Queensland. This study analyzes age and reason for first dental visits, and whether access pathways, including Lift the Lip (LtL), influence access for key sociodemographic groups. We analyzed electronic oral health records for 41,614 children with a first dental visit between January 2014 and December 2022. Age at first visit and reason for attendance were summarized descriptively. Early attendance (&#x2264;&#x2009;12 and&#x2009;&#x2264;&#x2009;24&#x2009;months) was compared across LtL and non-LtL pathways and risk groups using chi-square tests with risk differences and risk ratios. The mean age at first visit was 37.7&#x2009;months (SD 17.0). Overall, 11% of children attended by 12&#x2009;months and 27% by 24&#x2009;months, and 83% first presented for general care. LtL-referred children were more likely to attend by 12 (27.7% vs. 4.7%) and 24&#x2009;months (66.7% vs. 12.4%) than non-LtL children. Early attendance remained lower for Indigenous children, those living with greater disadvantage, and Child Dental Benefits Schedule-eligible children, and higher for children from culturally and linguistically diverse backgrounds. Attendance by 12&#x2009;months increased after 2016, from 5.2% to 12.0%. Few children accessed public dental care by the recommended age of first visit. While LtL substantially improved early attendance, equity gaps persisted, highlighting the need to strengthen early-referral pathways and parent/carer awareness of the recommended timing for a first dental visit.