Zambia has one of the highest child marriage rates in the world. Drivers of child marriage are multifaceted, complex and interrelated, firmly embedded in the social and cultural context. This study explored why, despite lower poverty and equal teenage pregnancy levels, child marriage is more prevalent in Eastern than in Western province in Zambia; and mapped effective preventive interventions. This knowledge is vital for informing the development of effective preventive interventions in Eastern Zambia and beyond. Guided by a conceptual framework on drivers of child marriage by Psaki et al. (2021), this study combined a rapid review of the literature on drivers and preventive interventions concerning child marriage relevant to Zambia with three participatory stakeholder meetings in Zambia to discuss, validate and complement findings. Poverty and lack of opportunity, including low education levels, are among the main drivers of child marriage in Zambia. Influenced by socio-cultural and gender norms and practices, people in the Western and Eastern provinces seem to react differently to teenage pregnancy. In Eastern province, pregnancy is often followed by marriage, while in Western province, a historical high value of education makes more pregnant girls to continue school. Conditional cash transfers to keep girls in school and, to a lesser extent, empowerment interventions emerged as the most effective evidence-informed preventive interventions. Limited acceptability of young people's sexuality and needs for information and services and too little involvement of traditional and religious leaders need further attention to address child marriage in both provinces. Interventions to prevent child marriage in Zambia need to focus on the main drivers of the practice. Norm change around the value of education, conditional cash transfer, working towards increased acceptability of sexual and reproductive health information and services for young people, empowerment interventions and strategic alliances with traditional and religious leaders, can contribute to combat child marriage. Zambia has one of the highest child marriage rates in the world. The reasons behind this are complex and rooted in the social and cultural context. This study aimed to understand why child marriage is more common in Eastern Province, despite lower poverty and similar teenage pregnancy rates, compared to Western Province. The research combined a rapid review of the literature and findings from three stakeholder meetings to explore the main drivers and potential preventive interventions for Eastern province and beyond.The study revealed that poverty and limited opportunities, linked to low education levels, play a major role in driving child marriage in Zambia. Societal responses to teenage pregnancy and notions of shame differ between Eastern and Western provinces. In Eastern Province, teenage pregnancy more often directly leads to child marriage, while in Western Province, with a strong historical emphasis on education, there is a stronger desire for children to finish school, including when faced with teenage pregnancy.In conclusion, to effectively tackle child marriage in Zambia, interventions need to target the root causes. Especially in Eastern province, it is important to address sociocultural norms related to gender, sexuality, shame, and teenage pregnancy; and there is a need to strengthen positive attitudes towards education. Conditional cash transfer programmes, which provide money to families if their daughters stay in school, could help reduce the financial reasons for child marriage in the country. Efforts to increase access to sexual and reproductive health information and services are needed across Zambia.
Circumstantial evidence suggests that a high proportion of cases of epilepsy in countries across sub-Saharan Africa (SSA) remain undiagnosed. The magnitude of the burden is unknown. Screening tools offer promise for early detection and prevalence estimation that will enable evidence-informed management of epilepsy in SSA. This review will systematically assess the accuracy and reliability of screening tools for detecting epilepsy in communities and primary care settings in SSA. Relevant databases, non-database sources and grey literature will be searched for studies on epilepsy screening tools. PubMed, LILACS, CINAHL, PsycINFO and Google Scholar, from inception to 31 May 2026, will be searched for studies on screening tools (questionnaires) administered by non-expert physicians to populations or hospital/clinic-based cohorts with no language restrictions. The following search terms will be used: screening tool, screening questionnaire, screening test, screening instrument, diagnostic tool, diagnostic accuracy, epilepsy, sensitivity, specificity, true positive, false positive, true negative and false negative and SSA. All countries in SSA will be included as search terms. Cochrane databases, African Journals Online, African Index Medicus, HINARI and Preprint and Thesis repositories will also be searched. Reference lists of potentially relevant studies will be reviewed, and experts will be contacted to identify additional studies missed in our searches. Study selection (using a pretested study selection flow chart), data extraction (using a validated data extraction form) and risk-of-bias assessment (using the revised Quality Assessment of Diagnostic Accuracy Studies-2) will be performed independently by at least two reviewers, and any discrepancies will be resolved through discussion. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) will be estimated from 2-by-2 tables of true positives, false positives, true negatives and false negatives. Possible causes of heterogeneity between studies will be assessed through pre-specified subgroup analyses. A meta-analysis will be conducted using a bivariate random-effects model to summarise sensitivity, specificity and DOR per patient. A summary receiver operating characteristic curve will be plotted to determine the overall diagnostic performance of the index tests. Sensitivity analyses will be conducted to test the robustness of pooled estimates of screening accuracy, and all estimates will be presented with their 95% CIs. This study will synthesise empirical evidence from publicly available published and unpublished studies, and hence no ethical approval is required. An eligible study with serious ethical issues will be excluded from the analysis and the reasons for exclusion will be documented. The review findings will be shared with all relevant stakeholders, including healthcare providers, patient advocate groups, agencies involved in implementing epilepsy care and policies, civil society, social services providers and researchers. The review findings will be shared widely at scientific symposia and conferences, and the final report will be published in a high-impact-factor peer-reviewed journal. CRD42024566976.
Cardiovascular disease (CVD) is the leading cause of death worldwide and is associated with a broad range of physical, emotional and social burdens. Existing tools such as Systematic Coronary Risk Evaluation and WHO CVD risk charts identify clinical risk factors but fail to capture patient-perceived burden and the risk of burden awareness. The Assessment of Burden of Chronic Conditions (ABCC)-tool, a validated, person-centred instrument, offers a more holistic approach. The aim of the current study is to develop and validate a new module within the ABCC-tool for patients with an elevated cardiovascular (CV) risk or CVD (cardiovascular risk management (CVRM) module). A mixed-methods design was used across four phases and expert meetings to identify the items for the module. All phases took place in the Netherlands. Phase 1 (literature search) was performed in 2021, phase 2 (semistructured interviews) was completed between January and October 2021, phase 3 (survey) was completed in November 2023 and December 2024, and phase 4 (semistructured interviews) was completed in January 2025. Phase 2 involved 14 experts by experience (patients with CVD or people at elevated risk) and 10 healthcare professionals in the field of CVD. Phase 3 included 86 healthcare professionals. Phase 4 included 12 experts by experience. In total, four expert meetings took place, attended by three experts by experience, nine healthcare professionals and seven researchers. The module was refined iteratively, using qualitative and quantitative insights at each phase of development. The model was only finalised after thorough content validation. No suitable patient-reported outcome measures (PROMs) focusing specifically on CVRM were identified in the literature. Interviews revealed significant burdens in terms of physical, emotional and social burdens. Feedback from expert meetings and validation rounds led to substantive refinement. The final module contains 10 items and was deemed valid by both experts by experience and healthcare professionals. The CVRM module of the ABCC-tool has been systematically developed and validated in terms of content. The final module focuses on the multidimensional burden of CVD and dealing with its risk factors and aims to support self-management. The module complements existing risk assessment tools by focusing on the burden experienced by the patient and the burden resulting from risk awareness.
Older adults facing social or structural marginalization for reasons such as lower literacy, digital exclusion, financial constraints, restricted living environments, or complex health histories, face persistent barriers to much-needed health screening. Digital health tools, particularly those using audio computer-assisted self-interview (ACASI) technology, offer potential to overcome these barriers (audio-delivered and self-administrable), but their application to marginalized populations remains underexplored. Moreover, guidance is limited for developing such tools which require collaboration within cross-disciplinary teams. This paper presents development insights and user testing findings from the ASCAPE (Audio App-Delivered Screening for Cognition and Age-Related Health in Prisoners) project, which aimed to develop equitable digital frailty and cognition screening for older people in Australian prisons. This study aims to describe the collaborative development of the "ASCAPE-HS" prototype, a tablet-based ACASI-delivered Frailty Index and aging screener, and to synthesize key lessons from the project that can inform equitable digital health tool development in hard-to-reach older adults. Also, to present findings on the usability and acceptability of ASCAPE-HS in a diverse community sample. The ASCAPE-HS prototype was developed through an iterative process involving researchers, clinicians, software developers, and end users under a digital health equity framework. The prototype included a self-administered, audio-delivered Frailty Index, alongside other items relevant to aging. The design process prioritized accessibility, sociocultural relevance, and technical feasibility, with regular multidisciplinary consultation and iterative refinement. Exploratory user testing with 20 older adults (aged 47-93 years, including n=5 who had not finished secondary schooling, n=3 people with previous imprisonment history, and n=9 with mild or moderate cognitive impairment) provided feedback on usability and acceptability. A 50-item Frailty Index was developed, alongside an additional selection of holistic questions that could meaningfully capture age-related health, and transferred to an iOS app (Apple, Inc), with ACASI features. Key elements included lay wording, consistent interface, simple "tapping" response options with repeatable audio feedback, a tutorial, and artificial intelligence-generated audio guidance. Key development considerations were synthesized into a checklist for teams undertaking similar projects. Successful strategies for the collaborative design process included diverse teams abreast of emerging literature and policy with varying expectations for engagement during development, and dedicating time to flexible, iterative development processes. Acceptability (median scores ≥4 out of 5 across 6 constructs) and usability (mean System Usability Scale score 79.0, SD 8.8) were high. A collaborative approach can produce ACASI-based health screening tools that are well-received by older adults. We highlight the feasibility of integrating frailty and aging assessment into a usable and acceptable digital tool, and offer actionable principles for collaborative, evidence-based development of equitable health screening tools in diverse, hard-to-reach populations.
Primary healthcare (PHC) emergency services are critical as the first line of defence against life-threatening conditions, significantly reducing mortality and morbidity. Globally, life-threatening emergencies (LTEs) such as acute myocardial infarction, stroke, severe trauma and respiratory failure frequently present first at PHC centres, particularly in low- and middle-income countries. However, inadequate emergency preparedness at the primary care level contributes to substantial avoidable mortality and long-term disability. Many PHC centres, especially in underserved and rural areas, face substantial challenges including inadequate equipment, insufficient training and poor referral systems which compromise emergency care quality and outcomes. Despite the recognised importance of PHC in emergency care, there is currently no synthesised evidence comprehensively mapping the barriers and facilitators that influence LTE management at this level. This systematic review aims to synthesise evidence on barriers and facilitators in managing LTEs at PHC centres to inform effective interventions and policy development. This systematic review will comprehensively search PubMed/MEDLINE, Scopus and Web of Science for relevant literature published up to 31 May 2026. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent researchers will conduct a three-stage screening process: initial title/abstract evaluation, full-text assessment and manual review of reference lists. Any disagreements between reviewers will be adjudicated by the lead investigator. The eligibility criteria and research question will be established using the SPIDER framework, which examines Sample, Phenomenon of Interest, Design, Evaluation and Research Type components. Methodological quality will be appraised using the Mixed Methods Appraisal Tool (2018). Extracted data will be systematically collected using a standardised form. A 'best fit' framework synthesis approach, complemented by thematic analysis, will be employed to integrate qualitative evidence. The protocol for this systematic review has received ethical approval from the Research Ethics Committee of Tabriz University of Medical Sciences (approval number: IR.TBZMED.VCR.REC.1404.061). The committee confirmed that the study objectives do not involve direct patient contact or clinical interventions, and therefore, the review meets ethical standards for research based exclusively on published literature. Findings will be disseminated through peer-reviewed publication, conference presentations and policy briefs. Registration number PROSPERO CRD420251071584.
Background: Supplementation with long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may mitigate exercise-induced muscle damage (EIMD) and enhance post-exercise recovery. However, the systematic reviews/meta-analyses evaluating these effects across populations and exercise models are limited and do not provide dosing recommendations. Objective: This systematic review and meta-analysis aimed to evaluate the effects of LC n-3 PUFA supplementation on key post-exercise recovery outcomes, including muscle soreness, muscle function, and muscle damage biomarkers in healthy adults. Methods: Following the PRISMA guidelines, a comprehensive search of PubMed, Scopus, and clinical trial registry databases was conducted (to January 2025). All studies that met the inclusion criteria underwent appropriate methodological quality assessments using established tools. The data were extracted for inputting into random-effects models, with effect sizes reported as Hedges' g and 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. Results: Among the 2539 records, 43 studies met the inclusion criteria for the systematic review, and nine met the inclusion criteria for the meta-analysis. The effect of LC n-3 PUFA supplementation on recovery outcomes was equivocal, with significant methodological limitations noted across the literature. However, the meta-analysis of nine placebo-controlled, eccentric exercise trials demonstrated that LC n-3 PUFA supplementation significantly reduced delayed onset muscle soreness (DOMS) (Hedges' g = -0.75; 95% CI: -1.14 to -0.36), creatine kinase (CK) (Hedges' g = -0.40; 95% CI: -0.70 to -0.10), and muscle swelling (Hedges' g = -0.45; 95% CI: -0.83 to -0.07), and significantly improved muscle strength (Hedges' g = 0.45; 95% CI: 0.07 to 0.83) and range of motion (ROM) (Hedges' g = 0.93; 95% CI: 0.33 to 1.53) at peak impairment compared with placebo. Conclusions: LC n-3 PUFA supplementation may support recovery from EIMD. However, due to the methodological limitations across the literature base it was not possible to assess effective dosing strategies. Future studies should address dose-response and duration requirements and incorporate objective assessments of omega-3 status (e.g., the Omega-3 Index [O3I] or comparable biomarkers) alongside standardized compliance measures. These approaches are necessary to determine effective dosing strategies and to test the relationship between omega-3 status and recovery outcomes.
The systemic immune-inflammation index (SII) has been linked to outcomes in various malignancies and has demonstrated utility in the diagnosis and prognosis of many conditions. This biomarker is gaining increasing recognition in the medical community. Understanding its developmental trajectory, critical areas of research, and future directions is essential for advancing its clinical application. However, there has been no literature bibliometric analysis on the SII. This study intended to visually analyze the research status and hotspots related to the SII. We utilized the Web of Science database to retrieve literature pertaining to the SII. Annual publication trends were statistically analyzed using Excel, VOSviewer, and CiteSpace for the visual analysis of authorship, institutional affiliations, countries, keywords, and co-cited references. Two thousand seven hundred sixty-three publications were included. Fifteen thousand one hundred forty-eight authors contributed to these publications; 726 core authors represented 4.79% of the total. The leading countries were China (1532), Turkey (641), USA (91), Italy (86), and Japan (67), with the United States displaying the highest centrality score of 0.55. The top 3 institutions that contributed to the literature were the University of Health Sciences, Capital Medical University, and Sichuan University. Keyword analysis indicated that the research hotspots predominantly focused on tumors and their prognosis. Co-citation clustering revealed evolving themes, including prognostic significance, national health, myocardical infarction, covid-19 patient and disease activity, and multicenter study. The SII has garnered significant attention as a novel inflammation-related biomarker. However, further longitudinal and cross-sectional studies should be conducted to expand our understanding of its applications.
While surgery of single-suture sagittal craniosynostosis (SS) is effective for cranial shape correction, its role in preventing neurocognitive impairment or intracranial pressure (ICP)-related sequelae is uncertain. We conducted a mini-survey of experts and a narrative literature review to evaluate current perspectives and evidence guiding treatment indications for SS. A mini-survey was distributed to 25 pediatric neurosurgery experts following a debate at the 2025 Varna meeting. Respondents were presented with clinical scenarios of infants with moderate or severe SS and queried regarding counseling on non-cosmetic consequences of nonoperative management. In parallel, a narrative PubMed literature review (December 2025) examined neurocognitive outcomes, ICP prevalence, treatment timing, surgical technique, and methods of ICP assessment in SS. Survey responses demonstrated marked heterogeneity in expert opinion. While many surgeons viewed cosmetic correction as the primary indication for surgery, others recommended intervention to mitigate uncertain risks of neurodevelopmental delay or elevated ICP. The literature consistently shows that most children with SS achieve normal-range intellectual functioning and attend regular schools, though mild and heterogeneous vulnerabilities in language, attention, motor skills, and learning are described compared to the normal population. These differences are also detectable in infancy, suggesting a prenatal contribution to altered brain development, that may persist despite surgery. Evidence linking surgery, age at intervention, or surgical technique to improved long-term neurocognitive outcomes is inconsistent. Untreated SS carries a variable risk of elevated ICP, which is imperfectly detected by non-invasive surrogates; postoperative ICP elevation occurs in a minority of cases. SS is generally associated with favorable neurocognitive and developmental outcomes, though mild neurodevelopmental differences and ICP-related risks warrant careful long-term surveillance. Given limited and heterogeneous evidence, individualized counseling and shared decision-making remain essential.
Intensive care unit (ICU) staff attrition has been exacerbated by the COVID-19 pandemic. We sought to determine what factors have led Canadian health care workers to leave or consider leaving their ICU positions since the onset of the pandemic and to identify targets for intervention. We designed an electronic survey and distributed it to national and provincial health professional organizations between August and December 2023. The survey was developed by a multidisciplinary team and informed by existing literature, including validated measures of well-being, workplace satisfaction, and moral distress. Of 490 health care workers who responded, most were from Alberta (44%), British Columbia (32%), and Ontario (20%). Represented professions included nurses (68%), respiratory therapists (9%), physicians (5%), and social workers (3%). Half (51%) had left an ICU position since 2020. Among those still employed, 72% thought about leaving at least monthly and 19% daily. For 58%, the COVID-19 pandemic contributed to their decision or desire to leave. The most important factors contributing to intent to leave included excessive workload (69%), inadequate staffing (68%), inadequate work-life balance (64%), decreased professional efficacy (51%), and dissatisfaction with organizational leadership (60%) and culture (53%). Unit-based (54%) and organization-based (20%) interventions were deemed most important to improve retention. Staff with intent to leave had similarly poor workplace satisfaction and well-being compared with staff who had already left. Intent to leave and workplace dissatisfaction remained high among ICU staff following the COVID-19 pandemic. Interventions should target unit- and organization-level factors, including staffing, workload, leadership, and culture. RéSUMé: OBJECTIF: L’attrition du personnel des unités de soins intensifs (USI) a été exacerbée par la pandémie de COVID-19. Nous avons cherché à déterminer les facteurs ayant amené les travailleurs de la santé canadiens à quitter ou à envisager de quitter leur poste aux USI depuis le début de la pandémie, et à cerner des cibles d’intervention. MéTHODE: Nous avons conçu un sondage électronique et l’avons distribué à des organisations professionnelles de santé nationales et provinciales entre août et décembre 2023. Le sondage a été élaboré par une équipe multidisciplinaire et s’appuie sur la littérature existante, notamment des mesures validées du bien-être, de la satisfaction au travail et de la détresse morale. RéSULTATS: Parmi les 490 travailleurs et travailleuses de la santé ayant répondu, la majorité provenaient de l’Alberta (44 %), de la Colombie-Britannique (32 %) et de l’Ontario (20 %). Les professions représentées comprenaient le personnel infirmier (68 %), les inhalothérapeutes (9 %), les médecins (5 %) et les travailleuses et travailleurs sociaux (3 %). La moitié (51 %) avaient quitté un poste en USI depuis 2020. Parmi les personnes toujours en poste, 72 % envisageaient de partir au moins une fois par mois et 19 %, quotidiennement. Pour 58 % des personnes répondantes, la pandémie de COVID-19 a contribué à leur décision ou à leur désir de partir. Les facteurs les plus importants contribuant à l’intention de quitter comprenaient la surcharge de travail (69 %), le manque de personnel (68 %), l'équilibre travail-vie personnelle insuffisant (64 %), la diminution de l’efficacité professionnelle (51 %), ainsi que l’insatisfaction à l'égard de la direction organisationnelle (60 %) et de la culture organisationnelle (53 %). Les interventions à l'échelle de l’unité (54 %) et de l’organisation (20 %) ont été jugées les plus importantes pour améliorer la rétention. Les membres du personnel ayant l’intention de partir présentaient une satisfaction au travail et un bien-être aussi faibles que ceux qui avaient déjà quitté leur poste. CONCLUSION: L’intention de quitter et l’insatisfaction au travail sont demeurées élevées parmi le personnel des USI à la suite de la pandémie de COVID-19. Les interventions devraient cibler les facteurs à l'échelle de l’unité et de l’organisation, notamment en ce qui concerne le personnel, la charge de travail, la direction et la culture.
Chronic and life-limiting illnesses require coordinated care beyond hospital settings, with increasing emphasis on continuity of care in community and out-of-hospital environments. Respite care plays an important role in supporting both patients and caregivers; however, its delivery is often variable and lacks structured clinical guidance. While several frameworks exist to support chronic and palliative care, these have been primarily studied in broader care settings and have not been systematically examined within out-of-hospital respite care. This scoping review aims to map clinical guidance frameworks used in respite care, describe their components and implementation and identify reported patient-level, caregiver-level and system-level outcomes. This scoping review will be conducted in accordance with Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be undertaken across the electronic databases PubMed, Scopus, Embase, CINAHL, Web of Science, PsycINFO and Global Health, along with grey literature sources (ProQuest). Studies of any design including quantitative, qualitative, mixed-methods, implementation studies and service evaluations, published in English from database inception to 31 December 2025 will be included. Two reviewers will independently screen studies, extract data using a structured data-charting form and resolve discrepancies through discussion. Extracted data will be synthesised using descriptive mapping and thematic analysis. Findings will be integrated to identify gaps and implications for low and middle-income country settings. Ethical approval is not required for this review, as it will use publicly available data. Findings will be disseminated through peer-reviewed publication, conference presentations and integration into the ongoing mixed-methods doctoral project. Open Science Framework, osf.io/avyzp.
After participating in this CME activity, the psychiatrist should be better able to:• Describe the mental, physical, and social health risks experienced by individuals bereaved by suicide across different kinship groups.• Identify key gaps in the current suicide bereavement research literature and explain their implications for clinical postvention strategies.• Differentiate suicide bereavement-related risks by kinship group (offspring, parents, spouses, siblings) and age at the time of loss.• Recognize populations with the highest suicide bereavement-related vulnerabilities. Suicide bereavement is a global public health problem associated with adverse physical and mental health outcomes. While population-based registry studies offer a promising avenue to understand the impacts of suicide bereavement, there has been no systematic review of results from such studies. This systematic review examines mental, physical, and social health outcomes among suicide-bereaved individuals in global population-based registry studies, with a focus on differences in findings by outcome, kinship, and comparison group. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies registered in PubMed and PsycInfo. The review was conducted in April 2025. The initial search revealed 404 unique records. After screening and full-text review, 36 studies published between 2005-2024 were included. Most frequently, studies examined bereaved offspring (n = 20), followed by bereaved parents (n = 8), spouses (n = 5), siblings (n = 5), and unspecified familial relations (n = 5). Overall, suicide loss was frequently associated with adverse health outcomes, including mortality, particularly due to suicide, and mental health (e.g., major depression, self-harm), and some physical health concerns. Associations meaningfully differed by kinship and comparison group. This is the first systematic review on population-based registry research concerning relationships between suicide loss and adverse mental, physical, and social health outcomes. Future studies should examine patterns of disease comorbidity, expand types of kinship examined (e.g., roommates), and probe how risk varies by time since loss.
This paper explores the critical role, experience, and wisdom of traditional healers in providing culturally-safe dementia care for Indigenous populations in North America, particularly as the prevalence of dementia in these communities continues to rise. It highlights the varying perceptions of dementia across cultures; for instance, while Western medicine often views it as a disease, many Indigenous cultures interpret it as a spiritual transition within the life cycle. A literature review conducted from 2000 to 2025 indicates that the marginalization of traditional healers within formal healthcare systems significantly hinders the delivery of culturally sensitive dementia care. Community-led models illustrate that the integration of traditional healing methods with contemporary practices is vital for offering respectful care to Indigenous people living with dementia. These models are grounded in concepts such as co-design, relational accountability, and "Two-Eyed Seeing," which establish traditional healers as crucial partners in the care process. The World Health Organization (WHO) formally recognized traditional healers as "community stakeholders" for dementia care and prevention globally. However, without the engagement and empowerment of traditional healers in the screening and diagnosis process of dementia, the implementation of the WHO Global Action Plan (2017-2025) on the public health response to dementia will be hindered, as these traditional healers are essential community stakeholders and allied partners for dementia care and prevention worldwide. The paper advocates for systemic reforms to support traditional healers and promote Indigenous self-determination in dementia care and calls for the development of medical education specifically tailored for traditional healers to establish a biocultural dementia care model that encompasses community support systems, spiritual approaches, a dementia-friendly environment, language preferences, and Indigenous culture, including arts, sciences, and philosophy.
Human trafficking poses a major public health challenge to the international community, with significant health and social consequences for those affected. Forced migrants are particularly vulnerable to becoming victims of human trafficking due to language barriers and migration-related hardships. These include social and economic deprivation. To better understand the lived experiences within this already vulnerable group, it is essential to examine individual cases in relation to risk factors, experiences of exploitation and exit, and resilience. Using a qualitative approach, this study examines social determinants and risk factors of forced migrants who survived human trafficking. It explores their experiences, eventual escape, and sheds light on their resilience. For this purpose, semi-structured interviews regarding the trafficking experiences were conducted with newly arrived forced migrants at a reception and registration centre in Germany. The presence of human trafficking was determined through an initial screening procedure and then confirmed in a personal interview. Additionally, we assessed the refugees' mental health burden with brief screening questionnaires for post-traumatic stress disorder, depression, anxiety, and the overall stress level (PC-PTSD-5, GAD-2, PHQ-2, RHS-15 distress thermometer). A total of 20 interviews were conducted with 14 female and 6 male participants. The participants came from 9 different countries. Most of them experienced sexual exploitation (N = 11), labour exploitation (N = 7). Few were trafficked but not exploited (N = 3). Participants reported that financial hardship was the main benefitting exploitation risk, and in many cases, they had been recruited by individuals they already knew. Spiritual rituals were sometimes used to increase pressure and control. Various forms of violence were inherent to the trafficking situations. In most cases, those affected managed to free themselves. Interpersonal connections and religious beliefs played a crucial role in coping with these experiences, however the screening for common mental disorders among refugees still indicated high levels of psychological distress. The results are discussed in relation to existing literature and implications for support and intervention are presented.
Intermediate care is increasingly used to reduce hospital admissions and support early discharge from hospital. In Denmark and Norway, health reforms have shifted responsibilities from hospitals to municipalities, prompting the development of community-based intermediate care services. To compare how Danish and Norwegian municipalities have organised and implemented municipal intermediate care services. A descriptive comparative study based on national legislation, policy documents, research literature and public statistics. Both countries have established municipal intermediate care structures centred on service types: acute and non-acute intermediate care. In Denmark, acute intermediate care includes statutory acute care teams and optional acute care beds, whereas Norway provides statutory acute care beds only. Acute services in both countries are regulated by national guidelines and aim to prevent unnecessary hospital admissions. Non-acute intermediate care mainly consists of temporary institutional beds used for early-supported discharge, rehabilitation, recovery, nursing home waiting placements and respite care. These services are less strictly regulated and vary between municipalities. In both countries, intermediate care primarily targets older adults with complex health needs exceeding the capacity of ordinary long-term care services. Differences were observed in referral pathways, clinical capacity and the degree of municipal autonomy, reflecting broader contextual conditions such as geography, governance structures and workforce availability. Although Denmark and Norway pursue similar policy goals, their organisational models for municipal intermediate care differ. Distinguishing between acute and non-acute intermediate care highlights the importance of adapting service models to local structural and demographic conditions and informs policy development and cross-country learning.
Haemoglobinopathies remain a major public health challenge, predominantly in endemic regions. Increasing migration has extended their prevalence in previously non-endemic areas, complicating early detection and prevention. As part of the HELIOS CA22119 COST Action Working Group 1, this narrative review critically examines established and emerging laboratory techniques for haemoglobinopathy carrier detection. It also explores diagnostic limitations, regional disparities, and opportunities for global harmonisation to support early detection, prevention, and equitable care. A literature search of MEDLINE, PubMed, Scopus, and EMBASE (2014-2024) identified studies on the screening, diagnosis, and prevention of haemoglobinopathies. Findings were synthesised across three domains: (1) preventive strategies, (2) carrier screening methods, and (3) prenatal diagnostic approaches. Advances in molecular technologies have improved diagnostic sensitivity and specificity. However, conventional haematological approaches, particularly complete blood count and haemoglobin typing, remain essential and cost-effective first-line tools. Key challenges include unequal access to advanced diagnostics and the lack of standardised protocols across regions. Strengthening prevention requires coordinated global efforts to promote accessible, accurate, and standardised diagnostic approaches tailored to regional genomic, economic, and healthcare contexts. Early and equitable carrier detection, combined with effective prenatal diagnosis, is critical to reducing the global burden and improving health outcomes in both endemic and emerging regions.
Coronavirus disease 2019 (COVID-19) is a highly contagious and pathogenic viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in Wuhan, China, and subsequently spread globally. Individuals were divided into categories (positive and control) according to their polymerase chain reaction (PCR) test results, gender, and age (< 36, 37-46, and 47-56 years). Oxidative stress parameters including 8-hydroxydeoxyguanosine (8-OHdG), total oxidative stress capacity (TOS), and total antioxidant capacity (TAS) in serum samples were investigated by enzyme linked immunosorbent assay (ELISA). Trace elements iron, zinc, copper, and selenium were measured with the Thermo Scientific ICAP-Q ICP-MS device. Statistical analyses revealed significant differences in 8-OHdG, TOS, and TAS levels between the control and COVID-19 positive groups (p < 0.01). Men had higher 8-OHdG and TOS levels than women. Iron, zinc, copper, and selenium did not show a normal distribution in the COVID-19 group; and there was a significant difference in their levels between the control and COVID-19 groups (p < 0.05). There was an increase in oxidative DNA damage and a decrease in antioxidant status in COVID-19 positive individuals due to oxidative stress parameter values. The results will contribute significantly to the current knowledge. Additional assessment of various oxidative stress and antioxidant markers and the use of alternative molecular testing systems are mandatory to further elucidate the effect of COVID-19 on oxidative stress. This study may have a pioneering status in the literature as such a comparative study has not been conducted before.
Diet is a primary and modifiable determinant of gut microbiota composition, diversity, and metabolic activity, thereby shaping microbial-derived metabolites, immune and inflammatory signalling, neuroendocrine regulation, and neural communication with the central nervous system. Western dietary patterns, characterised by high intake of ultra-processed foods, saturated fats, and low dietary fibre, are consistently associated with gut dysbiosis, impaired intestinal barrier function, chronic low-grade inflammation, and increased risk of depression, anxiety, cognitive impairment, and neurodegenerative disorders. This narrative review synthesises evidence from human observational studies, randomised controlled trials, animal models, and mechanistic investigations examining interactions among diet, gut microbiota, and mental health or neurobiological outcomes. Literature searches were conducted in PubMed, Scopus, and Web of Science for articles published up to December 2025. The study highlights the therapeutic potential and limitations of dietary interventions, prebiotics, probiotics, and psychobiotics, and critically evaluates them. Also facilitates an improved understanding of diet-microbiome-brain interactions, which may help the development of personalised, nutrition-based strategies integrated into mental health prevention and clinical care. These findings support diet-based, microbiome-informed strategies as scalable adjuncts in mental health prevention and care.
Intersectionality, as applied to health, provides a framework for understanding how overlapping social identities, such as ethnicity, gender and socioeconomic status, shape differential health outcomes and healthcare experiences. Individuals who occupy multiple marginalised identities often experience compounded disadvantages. Ethnic minority (EM) populations, defined here as social groups who are numerically smaller and/or socially marginalised within a given national or regional context based on ethnicity, race, culture, language, ancestry, or related heritage (often overlapping with racialised identities), frequently experience systemic exclusion, racism and structural barriers that also contribute to persistent disparities in morbidity, mortality and healthcare access. However, much health research relies on single-axis analyses, which can obscure within-group variation and may inadvertently reinforce inequities. Despite growing recognition of intersectionality, its empirical application to EM health remains limited. This systematic review aims to synthesise evidence on how intersectionality theory has been conceptualised and applied to understand health outcomes and healthcare utilisation among EM populations globally. This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA-Equity Extension. Comprehensive searches of peer-reviewed databases and grey literature, including MEDLINE, EMBASE, CINAHL Plus, Scopus, Web of Science and ProQuest will identify quantitative, qualitative and mixed-method empirical studies published from 2000 to 2026. Eligible studies must implement intersectionality theory to EM health or healthcare utilisation outcomes. Two independent reviewers will screen titles, abstracts and full-text articles. Data extraction will also be conducted independently and discrepancies will be discussed with input from a third reviewer. Guided by the PROGRESS-Plus equity framework, findings will be synthesised thematically, implementing a mixed-method convergent integrated synthesis design. This review only analyses previously published data, thus it does not require ethical approval. Findings will be presented at relevant academic or professional conferences and submitted for publication in a peer-reviewed journal. CRD420251248887.
Due to insufficient routine surveillance, the nationwide disease burden of hand, foot and mouth disease (HFMD) caused by coxsackievirus A6 (CVA6), an emerging serotype, in China remains unclear. This study aimed to estimate the incidence of CVA6-associated HFMD across the Chinese mainland. CVA6 positive data from 511 locations across the Chinese mainland during 2008-2022 were integrated from the national pathogen surveillance system and literature, and reported HFMD cases during the same period were obtained from the national infectious disease surveillance system. The predicted positivity rate and incidence of CVA6-associated HFMD in children under five years of age across the Chinese mainland were estimated using a Bayesian geostatistical Gaussian model based on positivity data, reported cases, and environmental, socioeconomic, demographic, and vaccination factors. The model estimated that the average positivity rate of CVA6 in the Chinese mainland from 2008 to 2022 was 24.1%, with a 95% Bayesian credible interval (BCI) of 11.9-43.3%. The corresponding average annual incidence of CVA6-associated HFMD in children under five years of age was 506 (95% BCI: 272-805) per 100,000. The yearly incidence of CVA6-associated HFMD in children under five years of age peaked in 2018 (873 per 100,000; 95% BCI: 513-1309) before a subsequent decline after 2020. The incidence was highest in South China (1571 per 100,000; 95% BCI: 890-2420) and lowest in Northeast China (208 per 100,000; 95% BCI: 106-340). The estimated CVA6-associated HFMD incidence showed a consistent upward trend across different economic level groups before 2020, and tended to be higher in high-gross domestic product (GDP) per capita regions than in medium- and low-GDP regions. Model-based estimates indicate a potentially high incidence of CVA6-associated HFMD on the Chinese mainland, particularly in South China, highlighting the need for enhanced surveillance of CVA6 and targeted control efforts in high-incidence regions.
Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, now recognized as a complex, heterogeneous disorder driven by environmental exposures, genetic susceptibility, immune dysregulation, and accelerated lung aging rather than solely by airflow limitation. This shift in understanding has fundamentally altered perspectives on its development and treatment. This narrative review synthesizes recent advances from 141 studies identified through a structured literature search of PubMed and Web of Science. It explores the molecular and cellular mechanisms of COPD pathogenesis and the resulting structural and functional lung changes. The review highlights innovations in diagnostics, including advanced imaging, physiological assessments, and biomarkers that enable more precise patient classification beyond spirometry. Progress in pharmacotherapy includes personalized inhaled therapies and targeted anti-inflammatory agents, while non-pharmacological approaches such as pulmonary rehabilitation and digital health technologies are increasingly integral to comprehensive management. Despite these advances, challenges persist, including inconsistent early detection, a lack of disease-modifying treatments, and significant variability in disease course and treatment response. This review provides a cohesive overview of current knowledge, identifies ongoing research needs, and outlines priorities for advancing personalized, mechanism-based care for COPD patients.