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Implementing dynamic smart windows is imperative toward the construction of net-zero buildings. However, the prevailing ion (de-)embedding-based electrochromic (EC) or thermosensitive hydrogel-based thermochromic (TC) windows fail to achieve large optical modulation across the solar spectrum owing to their optical absorption mechanisms. Herein, a dual-responsive electro-thermochromic smart window is designed and assembled by coupling an anodically coloring Prussian blue (PB) electrode with hydroxyl cellulose-based hydrogel electrolyte (HPC). Through judicious formulation, the HPC hydrogel electrolyte affords large TC transmittance modulation (∆T ∼ 83% @633 nm), mechanical stability (strain = 514%), and a high ionic conductivity (σ = 62.58 mS/cm), enabling the PB electrode with a high coloration efficiency (CE = 108.21 cm2 C-1) and fast switching kinetics (tb = 5 s, tc = 6.8 s). As a result, the as-assembled smart window features four distinct operating modes, exhibiting outstanding visible-light T% modulation (ΔTlum = 87.3%) and superior solar modulation capability (ΔTsol = 50.5%), enabling a 35%-55% reduction in annual energy consumption in representative regions, and achieving annual energy savings up to 129 MJ m-2. This dual-responsive smart window is an embodiment of coupled opto-thermal regulation strategies toward building energy modulation, inspiring future efforts in energy-efficient optoelectronics in the era of decarbonization.

Breast cancer is the most common cancer among women in Jordan, with many cases detected at advanced stages, leading to higher costs and poorer outcomes. Despite mammography's proven benefits for early detection, its use remains low. This study evaluates the cost-effectiveness and budget impact of implementing mammography screening in Jordan's healthcare system. A cost-effectiveness analysis was conducted from the perspective of the Jordanian healthcare system, comparing mammography-based screening with no screening (opportunistic detection) among women ≥ 40 years. A Markov model estimated disease progression, costs, and quality-adjusted life years (QALYs), using primarily local/regional data, supplemented by international sources when necessary. Results were expressed as incremental cost-effectiveness ratios (ICERs), i.e., cost per QALY gained. Sensitivity analyses tested model robustness. A budget impact analysis (BIA) assessed the financial implications of implementing nationwide screening. Comparing mammography-based screening with no screening among women ≥ 40 years, ICER was estimated at $5341 per QALY gained, which is well below Jordan's willingness-to-pay threshold. Over a lifetime horizon, mammography screening among eligible women aged 40-50 years was projected to prevent 779 breast cancer deaths. Both one-way and probabilistic sensitivity analyses confirmed the robustness of the base-case results under uncertainty. Over five years, nationwide screening yielded net savings of $17.6 million compared to current screening estimates. Mammography-based breast cancer screening appears to be a cost-effective strategy in Jordan, with potential to reduce breast cancer mortality. These findings suggest possible improvements in population health outcomes and more efficient use of healthcare resources.

Chronic non-communicable disease (NCD) care in Nigeria remains largely financed out of pocket, exposing households to affordability barriers and harmful coping strategies. This study examined the prevalence and patterning of affordability barriers, financial coping strategies, and predictors of foregone care and distress financing among chronic NCD patients attending public health facilities in Lagos, Nigeria. A facility-based cross-sectional survey was conducted among 480 adults receiving outpatient care for chronic NCDs, such as hypertension, type 2 diabetes, cardiovascular disease, chronic kidney disease, cancer, chronic respiratory conditions, and sickle cell disease across primary, secondary, and tertiary public facilities. Participants were recruited using a multistage sampling approach, with eligible patients selected systematically from clinic registers. Data were collected using a structured, interviewer-administered questionnaire capturing sociodemographic and household characteristics, employment status, chronic NCD diagnosis and treatment duration, out-of-pocket healthcare expenditure, affordability barriers, and financial coping strategies. Affordability outcomes included being offered unaffordable treatment, cost-driven treatment decisions, irregular clinic attendance, and inability to access care because of inability to pay. Financial coping strategies were grouped as self-directed financing, social-network support, and distress financing, defined as borrowing or the sale of assets. Prevalence estimates were reported with exact 95% CIs. Facility-tier differences and subgroup associations were assessed using chi-square, Fisher's exact, and ANOVA tests.&#xa0;Binary logistic regression models identified predictors of foregone care and distress financing, with average marginal effects and adjusted predicted probabilities estimated to aid interpretation.&#xa0;Statistical significance was set at a two-sided p<0.05. Affordability barriers were common: 42.9% of patients had been offered unaffordable treatment, 41.9% reported that cost shaped treatment decisions, and 45.0% had forgone care because they could not pay. Among affordability challenges, medication unaffordability was especially prominent and was comparable across facility tiers, suggesting system-wide pharmaceutical cost pressures rather than isolated access gaps. Coping followed a clear financial hierarchy: patients first relied on savings or household income (82.9%), many then mobilized social-network support (69.6%), and a substantial minority resorted to distress financing through borrowing or asset sale (28.5%). Financial-exposure intensity and treatment duration independently predicted distress financing; financial-exposure intensity also predicted foregone care. Pension income reduced the probability of distress financing by 15.2 pp, while insurance showed no detectable protection. Chronic NCD care in Lagos public facilities becomes a financial crisis through pervasive affordability barriers, prominent medication unaffordability, reliance on informal household coping, financial-exposure intensity, and treatment chronicity, which drive care rationing and distress financing. Nigeria's universal health coverage agenda should include scaling insurance enrolment for chronic NCD patients, benefit-package redesign, pharmaceutical-pricing reform, and income-protection mechanisms that absorb the recurrent costs of chronic illness care.

This cross-sectional study uses Medicare data to examine outcomes associated with the New York 2023 Medicaid and Medicare Savings Program eligibility expansion in the number and characteristics of dually enrolled beneficiaries.

The TheraP trial compared cabazitaxel to Lutetium-177-labeled PSMA-617 (Lu-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) following docetaxel and an androgen receptor pathway inhibitor (ARPI). Lu-PSMA demonstrated improved PSA response (66% vs 37%; p&#x2009;<&#x2009;0.0001) and progression-free survival (HR = 0.63; p&#x2009;=&#x2009;0.0028), while overall survival (OS; median 16.4 vs. 19.4&#x2009;months) and rates of Grade 3 (0.88 vs. 0.96 events/patient) and Grade 4 adverse events (AE; 0.11 vs. 0.08 events/patient) were comparable. The comparative economic implications of these two therapies in the United States (US) remain uncertain. A cost-consequence Excel model was developed from the US Medicare perspective to evaluate the direct cost outcomes for mCRPC patients receiving cabazitaxel or Lu-PSMA. Inputs were derived from TheraP, supplemented by literature and clinical expert validation. Costs included PSMA testing, drug acquisition and administration, supportive care, AE management, and end-of-life care. Outcomes (derived from TheraP inputs) included OS, progression-free survival (PFS), PSA-PFS, and radiographic-PFS (rPFS). An 18-month time horizon aligned with clinical follow-up. Costs were reported in 2025 USD. At 18&#x2009;months in the modeled cohort of 100 patients, cabazitaxel was associated with nine additional modeled survivors; this should be interpreted cautiously, as TheraP reported no statistically significant difference in OS between cabazitaxel and Lu-PSMA. In contrast, Lu-PSMA demonstrated improved PFS outcomes in the modeled cohort, with eight more patients remaining progression-free and 15 more radiographic progression-free. From the Medicare perspective, cabazitaxel was associated with a per-patient cost of $107,729, versus $303,338 per patient for Lu-PSMA (-$195,608). Cost differences were driven primarily by lower drug acquisition costs for cabazitaxel. Cabazitaxel provides a clinically validated and economically favorable treatment option post-docetaxel and ARPI, providing substantial cost savings across payer scenarios with no observed difference in OS. Lu-PSMA offers improved PSA-based outcomes and progression-related endpoints at higher treatment costs. These findings support clinical-economic trade-off considerations when sequencing therapies for mCRPC.

Background Healthcare systems face increasing administrative burdens, workforce shortages, rising labor costs, and growing patient expectations for rapid communication. Telephone call management remains one of the most labor-intensive nonclinical functions in outpatient medicine. Artificial intelligence (AI)-driven voice assistants have emerged as a potential solution to improve patient access while reducing operational costs. Beyond cost savings, AI communication platforms may increase revenue by improving the capture of new patient consultations and diagnostic referrals otherwise lost to communication delays. Objective To evaluate the operational, financial, and revenue impact of implementing an AI-powered telephone answering and patient communication system in a high-volume outpatient neurology practice, emphasizing patient access, referral capture, and new patient acquisition. Methods A retrospective, observational pre-post cohort study was conducted at Espinosa Neuroscience Institute, a practice of three neurologists and four advanced practice providers. After deploying an AI-powered call center platform, inbound communications - including appointment scheduling, demographic intake, insurance collection, FAQs, message routing, and patient triage - were managed through a Health Insurance Portability and Accountability Act (HIPAA)-compliant automated voice interface. The study evaluated operational metrics, staffing requirements, call volume, communication backlog, referral capture, and estimated labor costs by comparing a 90-day pre-implementation period (December 2025-February 2026) to an 86-day post-implementation period (March-May 2026). As a retrospective analysis of de-identified data for quality improvement, it was exempt from Institutional Review Board (IRB) approval. Results The practice receives 400-500 inbound calls daily. Before AI implementation, unresolved communication queues frequently exceeded 500 messages, with patients reporting prolonged wait times and delayed responses. Following deployment, all incoming calls could be answered simultaneously without queue limitations. During the first 86 days, the AI platform processed communications representing 5,484 unique patient encounters and managed an average of 63.8 new patient interactions per day. Communication backlogs were reduced by over 98%, with fewer than 10 active conversations open at any given time. Eliminating communication bottlenecks improved the capture of new patient consultations and referrals for neurological evaluations, EEG, EMG, and MRI. Requests previously lost to unanswered calls or excessive hold times were more consistently scheduled and completed, resulting in increased utilization of clinical and diagnostic services. Financial modeling estimated annual labor cost savings of approximately $216,500 while creating new revenue opportunities through improved referral conversion and patient acquisition. Conclusions Implementing an AI-powered call center significantly improved patient access, reduced communication backlogs, increased operational efficiency, and lowered staffing costs in a high-volume neurology practice. Beyond cost containment, the system enhanced new patient acquisition and referral capture, generating new lines of business through increased utilization of neurological and diagnostic services. AI-assisted communication represents a scalable strategy for improving financial sustainability and patient access in outpatient healthcare.

Background Large language models (LLMs) are entering clinical practice, but real-world use in hospital medicine is not well described. Methods We conducted a two-month pilot of a general-purpose LLM application in a hospital medicine division. Two cross-sectional anonymous surveys were administered - one at pilot initiation and one at pilot conclusion. Results Response rates were 71.4% (initial) and 48.6% (end of pilot). Reported use was high at both timepoints (18/20 [90.0%] vs 15/17 [88.2%]); median prompts per workday were 2.0 (IQR, 1.0-6.3) and 1.5 (IQR, 1.0-2.0), respectively. Net Promoter Score was +20.0 at initiation and +11.8 at pilot conclusion. Early use emphasized clinical reasoning and administrative tasks; later use shifted toward documentation, summarization, and research work. Efficiency and time savings were the dominant perceived benefit, whereas hallucinations, source transparency, and privacy concerns were the main risks. Conclusions General-purpose LLM applications may offer near-term value as supervised tools for lower-risk workflows, but clinical implementation should include structured governance, training, and ongoing evaluation.

The use of antidepressants is increasing globally. Despite their obvious benefits, ongoing use of these medications is often not properly monitored or deprescribed when a person returns to better mental health. In addition, providing prescriptions to those who do not have clinical depression leads to personal and societal cost burdens. This trial aims to assess the clinical effectiveness and cost-effectiveness of an online support tool designed to help patients with mild to no symptoms of depression and their general practitioners manage the careful and appropriate tapering and cessation of antidepressants at 6 months, and compare the effectiveness to that of usual care. This stratified, single-blind, parallel, 2-arm, superiority randomized controlled trial includes Australian primary care patients (aged 18-75 years) with mild to no symptoms of depression who have been on antidepressant medication for longer than 12 months. After obtaining informed consent, 340 eligible patients will be randomized in a 1:1 ratio to an active intervention arm and an attention control arm, with stratification by general practice or state of residence, if recruited via social media. Those in the active intervention arm will be asked to reduce their antidepressant use with the aid of a clinically guided online support tool (WiserAD), while those in the attention control arm will continue to receive usual care. Participants in both arms will be provided with information about antidepressants through the Beyond Blue website and followed up at 3, 6, 12, and 18 months to record antidepressant use, depression and anxiety symptom severity, quality of life, and health economic data. An intention-to-treat analysis will determine the clinical effectiveness of the online tool compared with usual care. The primary outcome is the between-arm difference in the proportion of participants who successfully cease medication use at 6 months and have mild or absent depressive symptoms. Cost-consequence and cost-utility analyses will be used to determine the cost-effectiveness of the intervention and its impact on quality of life, and comparisons will be made with usual care. The study was funded by the National Health and Medical Research Council in 2019. At submission of this manuscript in July 2025, 310 participants have been randomized, and recruitment ongoing. The target number of 340 randomized participants was achieved in January 2026. Trial outcomes will be reported in peer-reviewed journals in Febraury 2027. The WiserAD online support tool assists patients and their general practitioners with deprescribing and may lead to successful cessation of antidepressant medication, resulting in enhanced quality of life and cost savings over the longer term.

Short-term studies have demonstrated that single-pill combinations (SPCs) improve adherence, reduce hypertension-related complications, and lower costs; however, long-term benefits remain unclear. This study compared adherence, healthcare resource utilization (HCRU), and costs over 11 years in patients treated with SPCs versus free-pill combinations (FPCs) of antihypertensive drugs in routine Italian practice. We analyzed a large administrative dataset (2010-2022) covering approximately 7 million Italian citizens. Adults initiating perindopril (PER)-based SPC or FPC with amlodipine and/or indapamide were included. PER-based therapies were selected because their SPCs were among the first marketed in Italy, allowing for extended follow-up. Adherence was measured by proportion of days covered (PDC), with high adherence defined as PDC &#x2265; 80%. Among 24,476 patients (mean age: 64.6 years; 59.7% male), 92.6% received SPCs, and 6.0% FPCs. High adherence was observed in 75.5% of SPC users compared with 32.0% of FPC users. SPC users had fewer all-cause hospitalizations and outpatient visits (both p < 0.001). Average annual healthcare costs were &#x20ac;242.96 lower for SPC users (95% CI &#x20ac;55.03-&#x20ac;430.89; p < 0.05), with significant reductions in costs related to all-cause and cardiovascular-related hospital admissions (p < 0.001). In this long-term, real-world study, SPC use was associated with better adherence, reduced HCRU, and lower healthcare costs compared with FPC regimens. These economic benefits were evident within 1 year and may yield substantial long-term savings for national health systems, given the high prevalence and chronic nature of hypertension.

Antimicrobial resistance (AMR) has evolved into a critical global health security challenge, threatening the effectiveness of modern medicine and increasing morbidity and mortality worldwide. This review integrates current evidence on the molecular and environmental drivers of AMR, alongside global epidemiological patterns, resistome dynamics, and one health-based intervention strategy. Recent surveillance data indicate that AMR contributes to approximately 4.7&#xa0;million deaths annually, with the highest burden concentrated in low- and middle-income countries, where resistance rates in key pathogens such as Escherichia coli, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus remain alarmingly high. At the molecular level, AMR is driven primarily by horizontal gene transfer mediated by mobile genetic elements, including plasmids, integrons, and transposons, enabling rapid dissemination of multidrug resistance among clinically important pathogens, including critical high-risk threats and critical multidrug-resistant organisms. Environmental reservoirs, including wastewater effluents, agricultural runoff, soil, and hospital discharge systems, serve as major hotspots for the selection and amplification of resistance genes. These environments facilitate the evolution of environmental resistomes, in which subinhibitory antibiotic concentrations, heavy metals, and other pollutants exert strong coselective pressures. Additionally, biofilm formation, metabolic adaptation, and climate-related stressors further increase the persistence and spread of resistance determinants. The integration of genomic surveillance and metagenomic approaches have improved the understanding of resistome structure and transmission pathways, yet significant gaps remain in linking environmental and clinical datasets. To address these challenges, emerging One Health strategies emphasize coordinated interventions across the human, animal, and environmental sectors. Novel approaches such as antimicrobial stewardship, phage therapy, CRISPR-based antimicrobials, and AI-driven drug discovery are being explored alongside improved diagnostics and environmental control measures. Collectively, a cross-sectoral, integrated One Health framework is essential to mitigate the emergence of AMR and sustain antimicrobial efficacy globally.

Emerging evidence highlight metabolic markers as key indicators of health status, linking subtle metabolic changes with the rising global rate of non-communicable diseases. Therefore, this study aimed to investigate the relationship between lifestyle and metabolic markers among university workers in Ghana. A cross-sectional design was employed. Data were collected from 94 participants (34 teaching, 60 non-teaching) via surveys and clinical measurements at the Kwame Nkrumah University of Science and Technology. Metabolic markers such as fasting blood glucose, cholesterol levels, abdominal obesity, and blood pressure were defined using the World Health Organisation cutoffs. Univariable logistic regression and multivariate models were adopted to analyse the association between lifestyle components and cardiometabolic markers. Non-teaching staff reported higher work stress (Job Content Questionnaire = 73.3%), while teaching staff showed lower physical activity (76.5%). Three dietary patterns were identified: Indigenous Ghanaian, Westernised, and High Protein. The most prevalent metabolic markers were high abdominal obesity (52.1%) and elevated blood pressure (19.1%). In multivariable logistic regression adjusting for age, education, income and staff category, high protein diet was associated with high blood pressure (aOR = 1.869, 95% CI&#x2009;=&#x2009;1.011-3.455, p&#x2009;=&#x2009;0.046). The results showed significant associations between some cardiometabolic markers and certain dietary patterns, while no significant association was found between work stress, physical activity, and cardiometabolic markers. The high prevalence of abdominal obesity and elevated blood pressure highlights the need for targeted workplace interventions. Based on border literature, workplace wellness programs aimed at reducing work stress and promoting physical activity while improving healthy diets will be beneficial to the staff.

This perspectives article explores magical thinking (which is often dismissed as irrational or pathologized) as a potentially valuable personal orientation and resource for people living with chronic pain: as a way to make more sense of their complex and challenging life experience, psychologically as well as socially. Magical thinking entails a broader acceptance of connectivity between phenomena generally considered to be independent, and it includes symbolic meaning-making acts such as rituals. The authors explicitly exclude in their discussion magical superstitions which involve the conviction that magical acts can directly impact physical reality (such as enabling levitation or turning people into frogs). Drawing on a reflective, interpretive, and conversational methodology, a pain scientist, a nurse researcher, and a writer-practitioner of magical thinking explored how magical thinking functions as a personal orientation and resource that enables symbolic meaning-making and supports emotional regulation and relation with self, others and the wider world. As such, it may be potentially valuable for people living with chronic pain. The article shows that traces of magical thinking can be found within psychology and medicine and invites a broader conversation about how the symbolic and imaginative modes of magical thinking might be valuable in pain care.

Trauma is a major global public health problem and one of the leading causes of death and disability worldwide, particularly among individuals younger than 44 years of age. Approximately 6&#xa0;million people die each year as a result of traumatic injuries, with nearly 90% of these deaths occurring in low- and middle-income countries. Previous epidemiological studies have reported postoperative complication rates ranging from 18% to 42% and mortality rates between 8.5% and 13%. To evaluate the patterns of injury, clinical presentation, organ involvement, associated injuries, management strategies, and outcomes among adult patients with abdominal trauma in Mogadishu, Somalia. A prospective observational study was conducted from August 2023 to July 2024 at Mogadishu Somali-T&#xfc;rkiye Recep Tayyip Erdo&#x11f;an Training and Research Hospital. A total of 146 adult patients with abdominal trauma were enrolled. Data were collected using a pretested structured questionnaire and analyzed using Stata version 16. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with in-hospital mortality. The study population consisted predominantly of young adult males, with a mean age of 30.18&#x2009;&#xb1;&#x2009;9.2 years, and males accounted for 97.3% of all patients. Penetrating trauma was the predominant mechanism of injury (95.9%), with gunshot wounds representing the most common cause (71.9%). The small intestine and colon were the most frequently injured organs, each accounting for 40.4% of cases, and multiple organ injuries were identified in 56.8% of patients. Surgical intervention was performed in 88.4% of patients, while the overall in-hospital mortality rate was 16.4%. Multivariable logistic regression identified intensive care unit (ICU) admission (adjusted odds ratio [AOR]&#x2009;=&#x2009;12.85; 95% confidence interval [CI]: 2.34-70.59) and delayed surgical intervention (&#x2265;&#x2009;6&#xa0;h) (AOR&#x2009;=&#x2009;107.9; 95% CI: 12.9-903.5) as independent predictors of mortality. Penetrating abdominal trauma, predominantly caused by gunshot wounds, represents the leading mechanism of injury in Mogadishu and primarily affects young adult males. Injuries to the small intestine and colon were the most common, and multiple organ involvement was frequently encountered. Most patients required operative management, and prompt surgical intervention was associated with improved survival. ICU admission and delayed surgical intervention were independent predictors of in-hospital mortality. These findings underscore the urgent need to strengthen trauma care infrastructure, optimize emergency surgical services, and implement preventive strategies tailored to Somalia's high-risk environment.

Non-operative management (NOM) has become the standard of care for haemodynamically stable patients with liver trauma, yet robust data from low- and middle-income countries (LMICs) remain scarce, particularly in settings with a high burden of penetrating trauma. This single-centre retrospective cohort study analysed 251 adult patients with liver injuries managed non-operatively at a major trauma centre in Johannesburg, South Africa, between January 2017 and December 2023. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day survival and associated injury patterns. Overall mortality was 1.20% (3/251; Wilson 95% confidence interval [CI]: 0.41-3.45). All deaths occurred within 30 days. Admission lactate was the only variable significantly associated with mortality in the univariate analysis (odds ratio [OR]: 1.53 per 1 mmol/L increase, 95% CI: 1.11-2.10, p = 0.009). Sensitivity analysis using Firth's penalised logistic regression yielded consistent results (penalised OR: 1.48, 95% CI: 1.08-2.03, p = 0.015). The American Association for the Surgery of Trauma (AAST) liver injury grade showed no association with mortality. Chest injuries were the most common associated injury (42.6%). Associated injury patterns were consistent across Grades III-V. In appropriately selected haemodynamically stable patients, NOM achieved excellent outcomes despite a substantial polytrauma burden. Physiology, rather than anatomic grade or associated injury pattern, determined survival. These findings support physiology-led selection in resource-constrained environments. This study provides key insights into the real-world outcomes of non-operative management (NOM) of liver trauma in a high-volume, resource-constrained South African trauma centre. It demonstrates exceptionally low mortality (1.20%) with physiology-led patient selection despite a high burden of penetrating trauma and polytrauma. The primary contribution is evidence that admission lactate is a strong predictor of mortality, while anatomic injury grade (AAST) is not. These findings reinforce physiology-guided decision-making in LMIC settings and align directly with the journal's focus on clinical practice and surgical outcomes in Southern Africa.

Diabetes is a major global public health problem. Inequity in access to healthcare services represents a significant challenge for healthcare management and particularly affects vulnerable populations, understanding the intersectionality of these social determinants of health is essential. To evaluate the adequacy of care provided to individuals with diabetes in Brazil, considering the intersection of gender, race, and socioeconomic profile. This study was based on data from the Brazilian National Health Survey (2019-2020). 6,967 individuals self-reported a diagnosis of diabetes and composed the study sample. The "adequacy of care" outcome variable was analyzed according to sociodemographic characteristics. The intersection of gender, race and socioeconomic profile was considered according to the intersectionality theory. Descriptive and multivariate analyses were conducted using Poisson regression (prevalence ratio [PR]) with robust variance and corresponding 95% confidence intervals (95%CI). Black women with low income was the predominant profile of people with diabetes (22.0%; 95%CI: 20.5 to 23.3). Prevalent gaps in care delivery encompassed a lack of care for diabetic foot and failure to refer patients to a specialist doctor. The highest prevalence of low adequacy of care was observed in black men (79.6%; 95%CI: 75.7 to 83.1) and women (79.1%; 95%CI: 76.2 to 81.8) with low income. In the multivariate model, low adequacy of care was associated with black women and men with low income (PR&#x2009;=&#x2009;1.09 [95%CI: 1.00 to 1.20] and 1.10 [95%CI: 1.00 to 1.21]), absence of diabetes-related complications (PR&#x2009;=&#x2009;1.18 [95%CI: 1.11 to 1.25]), and no history of diabetes-related hospitalization (PR&#x2009;=&#x2009;1.12 [95%CI: 1.03 to 1.22]). Baseline challenges of living with diabetes in Brazil are further exacerbated for socially vulnerable groups. Our findings highlight structural racism and poverty as critical social determinants of health. Adopting an intersectionality approach enables a more nuanced understanding of health inequities.

Administrative costs account for nearly one-quarter of US hospital expenditures and are substantially higher than those in other high-income countries. Although mandatory value-based payment programs implemented by the Centers for Medicare & Medicaid Services (CMS) aim to improve quality and efficiency, they may be associated with increased administrative burden. To evaluate the association between participation in CMS mandatory value-based payment programs and hospital administrative costs. This cohort study used a synthetic difference-in-differences design to compare hospital administrative costs obtained from the Medicare cost report data from fiscal years 2006 to 2020. The sample included Medicare-certified general acute care hospitals, critical access hospitals, and long-term acute care hospitals. Administrative costs at hospitals participating in mandatory value-based payment programs, including the Hospital Value-Based Purchasing (HVBP) program, Hospital Readmissions Reduction Program (HRRP), and Hospital-Acquired Condition Reduction Program (HACRP), were compared with hospitals not participating in these programs. In addition, hospitals participating in the Comprehensive Care for Joint Replacement (CJR) model were compared with hospitals not participating in this model. Data were analyzed between July 5 and December 25, 2025. Hospital participation in CMS mandatory value-based payment programs initiated under the Affordable Care Act (HVBP, HRRP, and HACRP) or the CJR model. The primary outcome was hospital administrative costs, defined as the sum of administrative and general, nursing administration, and medical records costs reported in Medicare cost report data. A total of 4332 hospitals were included in the sample. Of these hospitals, 2820 (65.1%) participated in the mandatory value-based payment programs (HVBP, HRRP, and HACRP). Nonparticipating hospitals included 42 general acute care hospitals in Maryland (0.9%), 1159 critical access hospitals (26.8%), and 311 long-term acute care hospitals (7.2%). In addition, 357 hospitals participated in the CJR model compared with 2029 that did not participate in the model. Participation in the 3 mandatory value-based programs was associated with annual increases in administrative costs of $1.23 (95% CI, $0.11-$2.36) million per hospital compared with general acute care hospitals in Maryland, $0.93 (95% CI, $0.27-$1.59) million compared with critical access hospitals, and $0.65 (95% CI, $0.01-$1.29) million compared with long-term acute care hospitals. Participation in the CJR model was associated with an annual increase in administrative costs of $1.40 (95% CI, $0.30-$2.49) million per hospital. Aggregated nationally, these increases corresponded to more than $3 billion in additional annual administrative costs. In this cohort study, participation in mandatory value-based payment programs was associated with increased hospital administrative costs. These findings suggest that policymakers should consider administrative burden when designing and evaluating payment reforms to ensure that anticipated improvements in cost, quality, and access are not offset by increased complexity.

The aim is to provide an overview of our early experience in pediatric surgeon-directed management of abdominal trauma presenting to a University Hospital. Retrospective analysis of the data from all children presented with abdominal trauma (<14 years of age) who needed hospital admission and were listed on the trauma registry between May 2021 and May 2022. One hundred and twenty children, 88 (73.3%) males and 32 (26.7%) females, were identified. The median age was 6 years. Out of the 120 patients, 8 (6.66%) presented with penetrating abdominal injury and 112 (93.33%) presented with blunt abdominal injuries. The principal mechanism of blunt injury was road traffic accidents (RTAs) (44.6%). The most frequently affected abdominal organ was the spleen (33.8%). Twenty patients (16.6%) underwent surgery, and the rest (83.4%) were managed conservatively. The overall in-hospital mortality rate was 5%, with a median length of stay of 5 days. The highest mortality was among patients with bowel injury (66.7%). The patterns of injury in the pediatric trauma population are comparable to those in other African pediatric trauma centres. RTAs remain the most common cause of injury. Operative management is similar to international standards. Mortality is high compared to high-income countries and some low-medium income countries as well.

Mid-upper arm circumference (MUAC) is a simple anthropometric measure proposed as a marker of adiposity and cardiometabolic risk, but its relationship with diabetes and prediabetes in children and adolescents has not been fully characterized. This study assessed the association between MUAC and glycemic status in a nationally representative pediatric sample. We performed a cross-sectional analysis of pooled data from the 1999 to 2018 NHANES cycles, including 27,543 children and adolescents (age 6-19 years), of whom 2165 were classified as having diabetes or prediabetes by standard laboratory and self-report criteria. MUAC was measured at the midpoint of the right upper arm. Survey-weighted logistic regression models evaluated MUAC as both a continuous and categorical (quartiles) predictor of diabetes/prediabetes, adjusting for age, sex, race, education, poverty&#x2011;income ratio, body mass index, elevated blood pressure, and dyslipidemia. Restricted cubic spline analysis examined nonlinearity; subgroup analyses tested robustness. Higher MUAC was independently associated with higher odds of diabetes/prediabetes: per 1&#x2011;cm increase odds ratio: 1.04 (95% confidence interval [CI]: 1.01-1.08; P&#x2005;=&#x2005;.020). Versus Q1, adjusted odds ratios were Q2 2.57 (95% CI: 1.81-3.67), Q3 2.40 (95% CI: 1.60-3.61), Q4 2.49 (95% CI: 1.57-3.97) (all P&#x2005;<&#x2005;.001). Restricted cubic spline revealed a significant non&#x2011;linear association (P&#x2011;nonlinearity&#x2005;<.001) with an inflection near MUAC&#x2005;&#x2248;&#x2005;25.6&#x2009;cm, above which odds increased more steeply. Subgroup analyses indicated stronger associations in females and in children&#x2005;<14 years. Associations remained consistent across the analyses. In this large, nationally representative sample of children and adolescents, elevated MUAC was independently associated with higher odds of diabetes and prediabetes, with evidence of a nonlinear dose-response and a threshold near 25.6&#x2009;cm. Prospective studies are needed to validate cutoffs and explore the potential role of MUAC as a risk marker for dysglycemia.

Large gaps in the detection and treatment of noncommunicable diseases (NCDs) persist globally, particularly in low- and middle-income countries progressing toward universal health coverage. Despite expanded insurance and primary care reforms, the magnitude and equity of unmet NCD care needs in Viet Nam remain unclear. We analyzed nationally representative WHO STEPS surveys in 2015 (n&#x2009;=&#x2009;1,300) and 2021 (n&#x2009;=&#x2009;2,276) to assess unmet need for diagnosis and treatment of hypertension, diabetes, and dyslipidemia and to examine inequalities by socioeconomic status, education, and ethnicity. Unmet need for diagnosis and unmet need for treatment were analyzed as separate primary outcomes. Inequalities were quantified using the Erreygers Concentration Index (ECI), while absolute and relative inequalities were assessed using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII), with survey weights applied to prevalence and inequality estimates. Unmet need for diagnosis remained high, increasing from 82.2% in 2015 to 84.5% in 2021, while unmet need for treatment was higher but changed little, from 91.9% to 90.9%. Dyslipidemia showed the largest gaps. Ethnic inequalities persisted across survey years, with RII values ranged from 1.25 (95% CI: 1.14-1.36) to 1.29 (95% CI: 1.14-1.46) for unmet diagnosis and from 1.12 (95% CI: 1.03-1.22) to 1.17 (95% CI: 1.10-1.24) for unmet treatment. Socioeconomic inequalities in diagnosis also persisted, with RII values of 0.80 (95% CI: 0.73-0.89) in 2015 and 0.90 (95% CI: 0.84-0.96) in 2021, whereas education-related inequalities observed in 2015 were no longer apparent in 2021. All three inequalities measures showed consistent patterns. Viet Nam continues to face substantial unmet needs for NCD diagnosis and treatment, with persistent ethnic and socioeconomic disparities. Equity-oriented primary care and NCD services are needed to support more equitable progress toward universal health coverage.