Global genomic surveillance has emerged as a foundational pillar of public health in the twenty-first century, enabling real-time tracking of pathogen evolution and informing outbreak response. This chapter examines the strategic architecture of global genomic surveillance, focusing on its application to arboviruses such as chikungunya virus (CHIKV). It explores the integration of genomic data with epidemiological, clinical, and environmental information within a One Health framework, while addressing critical challenges in governance, equity, and interoperability. The discussion covers the entire genomic surveillance workflow, from sample collection and sequencing to bioinformatic analysis and phylogenetic inference, and highlights the transformative role of artificial intelligence (AI) in predictive surveillance. By analyzing global initiatives, operational barriers, and emerging technologies, this chapter underscores the necessity of sustainable, equitable, and interoperable genomic systems to proactively address current and future infectious disease threats.
Journal of viral hepatitisJiyuan Ren, Ran Ji, Zimo Zhu, Xinxin Ren, Fanyun Kong, Hongjuan You, Xiaoge Gao, Feitong Wang, Renxian Tang, Xiangye Liu
Viral hepatitis constitutes a primary cause of liver cirrhosis and carcinoma and ranks as the second leading cause of mortality worldwide due to challenges in early detection and limited preventive measures, thereby posing a significant threat to public health. This study analyses the burden and risk factors associated with viral hepatitis at global, regional, and national levels from 1990 to 2021, and projects the disease burden from 2022 to 2046. From 1990 to 2021, the global burden of viral hepatitis increased, despite a decline in age-standardized rates. Population growth emerged as the primary driver influencing this trend, with the highest disease burden observed in the African region. A high body-mass index (BMI) demonstrated a distinct and significant association with the sustained increase in disease burden. Excessive alcohol consumption was identified as the leading cause of hepatitis B, while drug abuse was predominantly linked to hepatitis C. Notably, males exhibited a markedly higher susceptibility to these risk factors compared to females. Over the next 25 years, the disease burden of hepatitis A, B, C and E is projected to remain stable or decline. Viral hepatitis remains a significant global public health challenge. It is imperative to strengthen efforts to prevent alcohol and drug abuse, consistently advance disease detection and treatment methods, and enable low- and middle-income countries to improve healthcare infrastructure and expand vaccination coverage. These measures are essential to promptly reduce the disease burden and achieve the goal of eliminating viral hepatitis by 2030.
BACKGROUND: This study aimed to systematically assess the burden and temporal patterns of vision impairment due to diabetes mellitus (DM), including moderate vision loss (MVL), severe vision loss (SVL), and blindness, and to identify the demographic drivers of future changes. METHODS: An age-period-cohort (APC) model was used to evaluate the effects of age, period, and birth cohort on diabetes-related vision impairment, with analyses stratified by diabetes type, including type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Decomposition analysis was further conducted to quantify the relative contributions of population aging, population growth, and epidemiological changes to projected changes in prevalent case numbers through 2030. RESULTS: the age-standardized prevalence rates (ASPRs) of blindness due to type 1 diabetes mellitus (T1DM) continued to rise [males: average annual percentage change (AAPC) = 0.82% (95%CI 0.40-1.23); females: AAPC = 1.31% (95%CI 0.86-1.77)]. The age effect indicated that older populations were at higher risk. Meanwhile, the cohort effect revealed that in regions with high Sociodemographic Index (SDI), high-middle SDI, and middle SDI, later-born cohorts had a significantly higher risk of diabetes-related vision impairment compared to earlier-born cohorts. Globally and in most regions, population growth was the main driver of increased in the number of prevalent MVL and SVL cases, whereas epidemiological change contributed most to increases in prevalent blindness cases. However, population aging had a particularly substantial impact in East Asia, High-income Asia Pacific, Central Europe, Eastern Europe, and Western Europe. CONCLUSION: The global burden of vision impairment due to DM increased continuously. Older populations represented high-risk groups, and the burden varied by sex, diabetes type, and socioeconomic development, with T2DM contributing most to the overall increase in diabetes-related vision impairment. Although population growth and epidemiological changes were major contributors, the impact of population aging in certain regions was also noteworthy.
Global public healthYusuf Hared Abdi, Sharmake Gaiye Bashir
Antimicrobial resistance (AMR) is one of the most consequential threats to global public health. In 2021, bacterial AMR was associated with an estimated 4.71 million deaths globally, including 1.14 million directly attributable to resistance. Yet, despite its designation as a global emergency, policy responses remain heavily focused on surveillance, antimicrobial stewardship, diagnostics, and pharmaceutical innovation. These interventions are necessary but insufficient without sustained action on the social and structural conditions shaping infection exposure, access to care, and antibiotic use. This commentary argues that the One Health framework, as currently operationalised, does not sufficiently centre poverty and structural inequality as core determinants of AMR. AMR is shaped by overcrowded living conditions, inadequate water and sanitation, disrupted health systems, weak diagnostic infrastructure, gender inequities, and unreliable access to quality-assured medicines, disproportionately affecting low- and middle-income countries (LMICs). We propose four linked policy directions: aligning national AMR action plans with the Sustainable Development Goals; integrating socioeconomic disaggregation into AMR surveillance; reforming international financing to expand fiscal space for health, WASH, and diagnostics; and embedding communities as co-designers of stewardship and governance. A justice-oriented One Health approach is essential to translate global AMR commitments into equitable and durable action.
Autism spectrum disorder (ASD) imposes a substantial public health burden. This study quantified and compared the ASD burden in China and globally from 1990 to 2021 to inform policy and planning. We analyzed Global Burden of Disease 2021 estimates of age-standardized prevalence rates (ASPR) and age-standardized disability-adjusted life-year rates (ASDR) in China and worldwide, with analyses by sex and age. Joinpoint regression characterized historical trends. Autoregressive integrated moving average (ARIMA) models generated exploratory projections for 2022 to 2031; no temporal holdout validation or comparison with alternative forecasting approaches was performed. In 2021, ASPR per 100,000 population was 655.75 (95% uncertainty interval [UI] 545.06-780.37) in China and 788.34 (95% UI 663.76-927.21) globally; ASDR was 124.19 (95% UI 83.70-175.10) and 147.56 (95% UI 100.21-208.16), respectively. From 1990 to 2021, the average annual percent changes in ASPR and ASDR were 0.22% (95% confidence interval [CI] 0.21-0.24) and 0.23% (95% CI 0.21-0.25) in China, compared with 0.06% (95% CI 0.06-0.07) and 0.07% (95% CI 0.06-0.08) globally. The estimated burden was higher in males. The exploratory ARIMA point projections suggested a modest decline in ASPR in both settings and in global ASDR but an increase in China's ASDR. These directions have not been validated out of sample. Historical estimates indicate an increasing ASD burden in China and worldwide. The ARIMA results represent model-based scenarios, not validated future trajectories. The existing burden supports sustained attention to early identification, long-term care, and family support; resource planning should not rely on these projections alone.
MedicineZhen An, Liangchen You, Xinlei Guan, Yuhong Wang, Mengdie Zhang, Bin Li
Non-HIV sexually transmitted infections (STIs) among women of childbearing age (WCBA) are a major cause of severe long-term reproductive health sequelae. However, a comprehensive analysis of the spatiotemporal trends, health inequalities, and future predictions of the disease burden specific to this population, based on global data, is still lacking. This study conducted a secondary analysis based on the Global Burden of Disease 2021 data to systematically estimate the burden of non-HIV STIs among WCBA globally from 1990 to 2021. We integrated multiple analytical approaches, including Joinpoint regression analysis, health inequality assessment (involving Sociodemographic Index [SDI] correlation and concentration index analysis), and predictive modeling, to comprehensively reveal the spatiotemporal evolution, inequalities, and future trends of the disease burden. Globally, the incidence and prevalence of non-HIV STIs showed fluctuating, nonlinear temporal patterns over the past 3 decades, while disability-adjusted life years (DALYs) displayed no sustained long-term decline. Trichomoniasis and chlamydial infection were the most significant contributors to the overall burden. The distribution of the disease burden revealed substantial geographical inequalities, with DALYs showing a strong negative correlation with SDI (R = -0.59, P < .001). Low-SDI regions, such as Western sub-Saharan Africa, bore the highest burden, whereas Western Europe had the lowest. Health inequality assessment indicated that although inequalities related to DALYs modestly improved, incidence-based inequalities intensified. Under a projection scenario based on historical age-period-cohort patterns, global incidence and DALY rates are projected to increase, exceeding 14,000 cases and 40 DALYs per 100,000 population by 2050, respectively. The burden of non-HIV STIs among WCBA remains persistent and unequally distributed globally. Model-based projections suggest that this burden may increase if historical patterns continue. New infections are increasingly concentrated among socioeconomically disadvantaged groups. These findings support targeted and equity-oriented prevention strategies to reduce disease burden and promote health equity.
MedicineMeiying Zheng, Meng Zou, Haiying Chen, Luyao Gong, Na Wang, Zhaojie Su
Nonalcoholic fatty liver disease (NAFLD) has emerged as a leading chronic liver disease globally, driven by the rising incidence of obesity, type 2 diabetes, and metabolic syndrome. Despite the increasing burden, most studies focus on prevalence rather than incidence, leaving a gap in understanding temporal patterns of NAFLD incidence. We conducted an age-period-cohort analysis of NAFLD incidence across 204 countries and territories from 1990 to 2021, utilizing data from the Global Burden of Disease Study 2021. Incidence rates were standardized per 100,000 person-years and analyzed by age, sex, region, and socio-demographic index (SDI). The global incidence of NAFLD nearly doubled from 24.9 million cases in 1990 to 48.4 million in 2021. The age-standardized incidence rate in 2021 was 593.28 per 100,000 population (95% confidence interval: 542.72-643.7). Middle SDI regions recorded the highest incidence rate (695/100,000), while low SDI regions had the lowest (483/100,000). The age-period-cohort model indicated a net drift of 0.56% (95% confidence interval: 0.53-0.6) globally. NAFLD incidence has risen substantially over the past 3 decades, particularly in middle-income regions. These findings highlight the need for targeted public health interventions and further research to address the growing global burden of NAFLD.
Artificial intelligence systems are increasingly drawn upon to inform nursing practice, education, and health policy, often on the assumption that they produce stable, broadly consistent knowledge. This paper challenges that assumption by examining how seven widely accessible large language models, developed in distinct socio-technical and geopolitical contexts, interpret a shared global nursing challenge. Through comparative qualitative analysis of responses to a standardized zero-shot prompt on the global nursing shortage, four competing policy logics were identified, namely workforce, efficiency, equity, and mobility, with patterns that appeared consistent with aspects of the institutional environments associated with those systems' development. Each response was internally coherent and presented with substantial authority, yet none acknowledged the situatedness of its own framing. The paper argues that such outputs in nursing should be understood as situated artifacts rather than as neutral knowledge, and offers a framework of questions to guide discretion for nurses, educators, and policymakers engaging with these tools. Recognizing this plurality is necessary for safe, contextually grounded decision-making and for governance that addresses both interpretive variability and accuracy.
The Lancet. OncologyHarriet Rumgay, Damien Georges, Yue Huang, Mayo Hirabayashi, Richa Shah, Catherine de Martel, Jin Young Park, Isabelle Soerjomataram, Gary M Clifford
BACKGROUND: Infectious agents are an important preventable cause of cancer globally. To inform prevention efforts, we provide a comprehensive picture of cancer burden attributable to infections, including newly established, carcinogenic infectious agents and latest global cancer incidence estimates. METHODS: In this worldwide incidence analysis, we used data from the Global Cancer Observatory's Cancer Today (GLOBOCAN) database of cancer incidence in 2024 to estimate population-attributable fractions (PAFs), absolute numbers, and age-standardised incidence rates (ASIRs) of new cancer cases attributable to 12 infectious agents classified as Group 1 carcinogens by the IARC Monographs Programme: Helicobacter pylori, human papillomavirus (HPV), hepatitis B (HBV) and hepatitis C viruses (HCV), Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus, Schistosoma haematobium, human T-cell lymphotropic virus, Opisthorchis viverrini, Clonorchis sinensis, Merkel cell polyomavirus, and HIV. Estimates stratified by sex, country, and age group were aggregated by UN geographical subregion and World Bank income group. FINDINGS: An estimated 2·3 million new cancer cases were attributable to infections globally in 2024, which is equivalent to 12% of all cancer cases. The largest number of cases was attributable to H pylori (n=760 000, PAF 4%), followed by HPV (n=750 000, 4%), HBV (n=360 000, 2%), EBV (n=260 000, 1%), and HCV (n=160 000, <1%). The largest burden of infection-attributable cancer was in eastern Asia, with 990 000 cases (42% of the global total, ASIR 31·9 per 100 000 cases). ASIRs were also higher than the global average (22·7) in sub-Saharan Africa (28·5), central and eastern Europe (24·3), and southeastern Asia (23·1). Focused analysis of EBV-attributable cancers revealed regional variation in the distribution of cancer types. INTERPRETATION: Our findings highlight the importance of infection control to achieve cancer prevention. Scientifically proven, but often underused, approaches include HPV and HBV vaccination; testing and treatment of HIV, H pylori, HBV, and HCV; safe injection practices; access to condoms and pre-exposure prophylaxis to prevent HIV transmission; and screening of precancerous lesions for HPV-driven cervical and anal cancer. Our findings also inform the investment cases for research and development for new prevention tools, most notably for EBV. FUNDING: None.
Annals of global healthElla August, Archana Shrestha, Joseph C Kolars, Pebalo Francis Pebolo, Patricia Garcia
The global health literature reflects the need to restructure systems that balance power, remove financial barriers, and ultimately enhance equity, but immediate strategies to enhance equity are often underappreciated, particularly with regard to navigating the publishing ecosystem. Our paper describes how researchers can navigate the publishing ecosystem to create greater equity within their author teams, including those related to communication, supporting junior investigators in building their writing and professional skills, selecting journals that prioritize equity, ensuring transparent recognition of all contributors, and understanding institutional requirements for professional advancement. We also suggest changes in the publishing ecosystem to further enhance equity related to the presentation and recognition of joint authorship, developing a system for identifying predatory journals, and how publishing agreements might better promote equity in authorship. Our advice can help research teams position themselves to achieve greater equity among themselves. Additionally, our suggested changes to the publishing ecosystem will encourage future efforts toward equity.
Health policy and planningSarah C Keogh, Holly Newby, Titus Divala, Parviz Abduvahobov, Sarah Baird, Tapas Chatterjee, Julianna Deardorff, Evelyne Degraff, Renée de Jong, Sithembile Dla…
Adolescence is a critical life stage marked by rapid physical, cognitive, and social development with implications for well-being in adulthood and of subsequent generations. Although global attention to adolescent well-being has grown over the past decade, efforts to measure it remain fragmented, sector specific, and include a greater number of indicators of risks and negative outcomes compared to positive well-being. To address these challenges, the World Health Organization, in collaboration with the Partnership for Maternal, Newborn and Child Health and other United Nations (UN) partners, developed new measurement guidance to support countries in assessing adolescent well-being in a holistic, multisectoral way across the five domains of the UN's consensus Adolescent Well-being Framework (AWF) focused on health and nutrition, connectedness, safety, learning, and agency and resilience. This article describes the process and results of the guidance development. The process incorporated adolescent and youth perspectives, was supported by a multidisciplinary Expert Consultative Group and included several steps, starting with operationalizing the AWF for measurement. Draft guidance was then developed, and the feasibility of its implementation was assessed in Colombia, India, and South Africa. Feedback from country stakeholders led to substantial revisions-clarifying linkages to the broader measurement landscape, strengthening implementation information, and improving usability-before finalization. The guidance supports countries to identify and assemble existing data across all domains of the AWF, identify data gaps, assess current government-led efforts to improve adolescent well-being, and translate findings into action. Rather than prescribing new indicators or data collection efforts, it provides a structured approach and an Excel-based data tool to improve the use of existing data. By promoting a practical, country-led approach and building on existing systems, the guidance aims to support governments in strengthening insight, accountability, and action for adolescent well-being.
BMJ openJesse Limaheluw, Rebecca Niese, Dieneke Bijkerk-Schram, Lisbeth F Hall, Jelske De Kraker, Saskia C J Oostdijk, Fábio Serafim, Ana Maria de Roda Husman
OBJECTIVES: Research output on the impacts of climate change and human health is growing rapidly. We aimed to synthesise peer-reviewed studies on this subject published between January 2000 and May 2024. DESIGN: Scoping review. DATA SOURCES: Literature was collected from PubMed, Embase and Scopus on 11 November 2019, 25 June 2021 and 22 April 2024. ELIGIBILITY CRITERIA: We included English language quantitative peer-reviewed primary research articles about the impacts of long-term climate change (ie, as opposed to effects of weather or single climatic events with the exception of attribution studies) on human health. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened titles and abstracts. Full-texts were screened by single reviewers, although 23% of publications selected for full-text screening received an independent second-screening. Reported exposures and health outcomes were classified. Reported quantitative effects of long-term climate change on human health were coded as increasing, decreasing, variable or non-significant. RESULTS: From 60 781 initial records we included 1223 quantitative publications in this scoping review. Health impacts of long-term climate change were studied most often in Europe, the Americas and the Western Pacific. Studies on temperature and on disease vectors, including the diseases they transmit, represented 39.3% and 30.9% of all included publications, respectively. Included results covered over 100 specific health outcomes. Diarrhoeal diseases, malaria, dengue, ischaemic heart disease and stroke were the most studied specific health outcomes. While infectious diseases were often studied in low- and middle-income countries, non-communicable diseases were rarely examined in this context. About 20% of included publications provided retrospective results, demonstrating that climate change is already impacting human health in variable ways globally. About 80% of included publications provided prospective results, projecting mostly variable or increasing impacts on human health over the coming decades. CONCLUSIONS: Our scoping review provides a comprehensive overview of existing evidence about the impacts of long-term climate change on human health. Currently, differences in research methodologies make it difficult to directly compare study findings. The outcomes of this review can help to harmonise future climate change and health research and support evidence-based climate change adaptation.
Perspectives on medical educationJamiu O Busari, Ming-Ka Chan, Arvin Damodaran, Alan Schwartz, Roberta Ladenheim, Ben Jones, Marjan Khajehei, David A Turner, Liknaw Zeleke, Holly A Caretta-Wey…
It is generally assumed that competency-based health professions education (CBHPE) is a positive and ongoing educational reform. However, the assumption that CBHPE naturally leads to more equitable outcomes has not been thoroughly examined. This 'Eye Opener' identifies global challenges in implementing equitable CBHPE, with particular attention to majority-world (low- and middle-income) contexts. These tensions include: 1) variable approaches to adoption that limit transferability, 2) uneven infrastructure for implementation and innovation, 3) export of predeveloped conceptual frameworks that may not be locally fit for purpose or implemented alongside collaborative knowledge exchange, and 4) pressures for fidelity in implementation that impede flexibility and compromise effectiveness in local contexts. In each area of tension, the authors outline challenges to equity and suggest potential ways forward. From their analysis, the authors propose that equity must be deliberately embedded in CBHPE at multiple levels, and the proposed solutions include addressing equity on three levels - the micro level of individual learner access and assessment; the meso level of curricula, faculty development, and program learning culture; and the macro level of national accreditation standards and education policies. Examples of opportunities at each level and for each of the five core components of CBHPE are also provided. The authors argue for a shift in perspective-from "outside-in," in which Western nations export CBHPE to the majority world, to "outside-in, inside-out and all around," in which CBHPE frameworks are co-created to leverage contributions from both Western and majority-world education systems. They believe that more thoughtful adaptation and embracing Global South ways of knowing, doing, and being, rather than simple replication, alongside the continuous application of a social justice lens, are needed to ensure that CBHPE serves all communities and contributes to equitable, high-quality learning and healthcare without discrimination.
BMJ openMargaret C Baker, Ginger Minahan, Aarman Khayat, C Scott Dorris, Bouchra Benghomari, Molly Brady, Diana Yousef, Aïssatou Diawara, Eva Jarawan
BACKGROUND: Global infectious disease elimination programmes have historically relied on vertical, donor-driven approaches. However, amid reduced global funding and increased emphasis on country ownership and sustainability, interest in infectious disease-specific activities integrated into routine health systems is growing. Yet evidence on how integration has been implemented remains fragmented. This scoping review takes a multi-disease approach to assess the extent and nature of evidence on the integration of infectious disease elimination and eradication programmes into routine health systems, with a focus on treatment and surveillance functions. The review was conducted following Joanna Briggs Institute guidelines and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework. OBJECTIVES: The objectives were to map and synthesise integration approaches, identify context-specific facilitators and barriers and review research methods used. ELIGIBILITY CRITERIA: Eligible studies were peer-reviewed, examined efforts to integrate treatment and/or surveillance functions for diseases with elimination or eradication goals into health systems, and reported at least one outcome. Articles were published between 2010 and 2024 on studies conducted in low- and middle-income countries. SOURCES OF EVIDENCE: MEDLINE, Embase, Global Health and Web of Science were searched. CHARTING METHODS: Data were charted using a standardised extraction form that captured study characteristics, integration activities, health system level, facilitators and barriers, outcomes measured and research methods. Extracted data were synthesised descriptively using quantitative summaries and qualitative thematic analysis to identify patterns across studies. RESULTS: The search yielded 5938 records, of which 45 studies met inclusion criteria. Studies spanned 23 countries and 20 diseases. Integration commonly involved task shifting to primary healthcare providers, expanded roles for community health workers and new responsibilities for district and national health authorities. Key facilitators included adopting a health systems strengthening approach with strong government ownership. Barriers included supply chain challenges, unclear roles and weak partner coordination. Evidence on costs was limited, though some studies described initial donor-funded start-up with longer-term absorption by governments. The study designs reflected varied disciplinary perspectives. CONCLUSIONS: This review identifies substantial gaps in the evidence base on implementing integration, particularly regarding surveillance and the economic implications of integration. However, common principles emerged across diverse settings and diseases that can inform future integration efforts. Across the included studies, integration was consistently described as a health system change process, with implications for research, policy and practice related to early planning, stronger country leadership and donor coordination, broader engagement across the health system and health system strengthening.
This paper investigates why Long Covid, despite affecting millions globally and posing a serious threat to public health and economic stability, remains largely absent from contemporary security agendas. It argues that the condition's chronic, diffuse nature presents a temporal mismatch with existing security frameworks designed for acute, visible crises. Drawing on the Copenhagen School's securitization theory and Olaf Corry's concept of "riskification," the paper shows how structural, normative, and political obstacles-namely the difficulty of constructing chronic disability as collective harm within dominant security imaginaries-prevent Long Covid from being framed as an existential threat. Comparing the response to Long Covid with that of climate change and acute Covid-19, it reveals how scientific uncertainty, fragmented governance, and limited public awareness undermine mobilization. U.S. reluctance to lead, domestic political fragmentation, and a cultural emphasis on individual responsibility further diminish the prospects for securitizing moves. Internationally, institutions like the UN and WHO exhibit similar inertia due to ambiguous mandates and competing priorities. The paper concludes that Long Covid exposes critical gaps in traditional security thinking, particularly in addressing slow-onset, mass-disabling threats. As similar slow-onset disabling conditions may emerge in future biological crises, prevailing security conceptions could leave societies insufficiently prepared. The paper therefore uses securitization theory diagnostically to argue that political conceptions of security should better account for chronic harm and disability.
Global public healthChiamaka Henrietta Onyebuchi, Jiyong Jin
The inequities observed during the COVID-19 pandemic were not an accident. They reflect deeper patterns of injustice already embedded in rules, financing models and power arrangements in global health governance. This paper argues that the paradigm of ethical health sovereignty offers a moral countermodel to the dependency shaping global health relations. It examines how sovereignty, solidarity and justice are being reinterpreted after the pandemic by drawing on the WHO Pandemic Agreement (A78/10, 2025) and Africa's regional responses through the African Union and Africa Centres for Disease Control and Prevention. The Agreement represents a partial moral advance by acknowledging equity and shared responsibility while still leaving hierarchy intact through voluntarism and sovereignty-based limits. In contrast, Africa's pooled procurement, regulatory harmonisation and coordinated diplomacy show solidarity as shared governance rather than charity. The paper concludes that global health equity requires redesigning governance so that fairness is built into institutions and sovereignty is understood as shared and cooperative decision-making.
Current pain and headache reportsKeiko Ihara, David García-Azorín, Chisato Iba, Koji Sekiguchi, Manuel Abaidoo, Augustina Charway-Felli, Mira P Fitzek, Amr Hassan, Tore Wergeland, Jason C Ray,…
PURPOSE OF REVIEW: This review aims to summarize migraine attack triggers and understand variance across lifestyles, religions, and regions. RECENT FINDINGS: Experts from 11 countries collaborated to suggest a definition of migraine attack triggers. After investigating the geographical distribution of various triggers, referring to an earlier review written by the International Headache Academy (iHEAD) of the International Headache Society, we collected literature and summarized findings on both globally observed triggers and region- or culture-specific triggers. The most common triggers included stress, menstruation, and sleep disturbances. Several triggers were observed only in certain cultural contexts, such as fasting during Ramadan or Yom Kippur, or in specific regions, including barometric pressure in Eastern Asia, Lodos winds in Türkiye, midnight sun in the Arctic region, and watermelon consumption in Brazil. We summarized migraine attack triggers reported universally and specifically in different settings. In addition to using conventional methodology, future studies should address the mechanisms and causality of these triggers.
INTRODUCTION: Cancer is a leading cause of morbidity and mortality worldwide. Previous research has observed disparities in cancer diagnosis, care and outcomes among people who have been marginalised, including incarcerated populations. Evidence suggests an excess burden of cancer among people who experience incarceration. Currently, no reviews have synthesised quantitative evidence on all types of cancer prevalence, incidence, mortality and survival, stratifying by both cancer type and sex and gender, among people who experience incarceration, compared with those who do not, globally. The objective of this review will be to describe cancer prevalence, incidence, mortality and survival among people who experience incarceration and assess the epidemiological association between incarceration and these outcomes. METHODS AND ANALYSIS: Peer-reviewed studies that will be included must report on individuals of at least one sex or gender who are currently or formerly incarcerated in correctional facilities under any legal status and report on cancer prevalence, incidence, mortality, stage at diagnosis and/or survival with or without a comparator group. Studies to be included must employ original quantitative or mixed-methods designs in which quantitative data are reported separately. Searches will be conducted in January 2027 in MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science and Sociological Abstracts, and we will review reference lists. Two independent reviewers will conduct title, abstract and full-text screening and, for included studies, complete data extraction and assess methodological quality using the Newcastle-Ottawa Scale. We will calculate pooled prevalence rates, incidence rates and effect estimates using a random-effects model. Heterogeneity and publication bias will be assessed by I2 and visual inspection of the funnel plot, respectively. ETHICS AND DISSEMINATION: This review will use aggregate data from published studies; therefore, ethical approval is not required. Findings will be shared through peer-reviewed publications and conference presentations. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261408922).
MedicineQigui Chen, Lizhi Lu, Wenwen Zhou, Jiyu Meng, Chao Xiao, Gang Liu
This study explores the global burden of female infertility across 204 countries and 21 regions from 1990 to 2021. The population-based study analyzed was conducted using data from the Global Burden of Disease 2021. We assessed age-standardized prevalence rate (ASPR), age-standardized incidence rate, disability-adjusted life years rate, and trends via average annual percent change, with projections to 2035 using the Bayesian age-period-cohort model. The outcomes revealed that female infertility sustained a global rise in ASPR (0.66% annually) and disability-adjusted life years (0.68% annually), driven by population growth and aging. Notably, while the 35 to 39 age group exhibited the highest prevalence, the 20 to 29 age group showed the fastest growth rate (average annual percent change = 1.04%), signaling a younger-onset trend. Socioeconomic disparities were prominent: low-middle sociodemographic index regions experienced the steepest ASPR increases (1.23% annually), contrasting with high sociodemographic index areas. During 2019 to 2021, ASPR stabilized, potentially linked to COVID-19-related population shifts rather than direct biological effects. Projections indicate a persistent burden, with ASPR reaching 6458.26/100,000 by 2035. These findings underscore the urgent need for targeted interventions addressing socioeconomic inequities, younger demographic risks, and sustainable reproductive health policies to mitigate the escalating global challenge of female infertility.
Ovarian cancer is one of the most lethal gynecological malignancies globally, with significant variations in incidence, prevalence, and outcomes across regions and population subgroups. This study systematically evaluates the global, regional, and national burden of ovarian cancer from 1990 to 2021, utilizing data from the Global Burden of Disease 2021 framework. Trends in incidence, prevalence, mortality, and disability-adjusted life years were analyzed, with an emphasis on their associations with the Socio-Demographic Index (SDI) and other key risk factors. The analysis highlights substantial disparities in ovarian cancer burden, with low- and middle-SDI regions experiencing the highest mortality-to-incidence ratios. In 2021, ovarian cancer accounted for approximately 298,876 new cases globally, with age-standardized incidence rates declining in high-SDI regions but increasing in low-SDI regions. Mortality trends mirrored this pattern, with significant disparities between high- and low-resource settings. The findings underscore the critical influence of age, genetics, and access to early detection and treatment. Forecasts using an ARIMA model indicate a continued rise in the global burden, particularly in regions with limited healthcare resources. This study underscores the urgent need for targeted interventions to improve ovarian cancer outcomes, including enhanced screening, equitable access to treatment, and strategies addressing modifiable risk factors, particularly in underserved regions.
Journal of global healthSze Wan Ching, Marius Wamsiedel, Jinkou Zhao
BACKGROUND: The COVID-19 pandemic and recent geopolitical shifts have strained traditional funding for global health, increasing the interest in innovative financing mechanisms. We explore how international organisations perceive and implement these mechanisms as complements to traditional funding. METHODS: In this qualitative study, we conducted semi-structured interviews with eleven senior experts from major global health organisations, gathered via purposive and snowball sampling between May and July 2024. We analysed data using systematic coding and thematic analysis, with trustworthiness enhanced through member checking and peer debriefing. RESULTS: Participants revealed that innovative financing mechanisms are not replacements, but strategic complements to traditional aid. We identified three primary patterns in our data: an evolution from direct funding to complex, multi-stakeholder risk-sharing arrangements; a fundamental transformation of stakeholder relationships, increasing coordination complexity; and the critical role of institutional capacity in successful implementation. Analysis of five innovative financing mechanisms, namely Advanced Market Commitments, Blended Finance, the International Finance Facility for Immunization (IFFIm), Debt2Health, and Micro-levies, demonstrated distinct patterns in complexity, coordination, and risk distribution across said mechanisms. The success of the implementation depended on clear problem definition, stakeholder alignment, and robust risk management. Blended Finance and IFFIm showed the highest complexity, while Debt2Health offered a more streamlined, triangular model. CONCLUSIONS: The effectiveness of innovative financing mechanisms is heavily dependent on existing institutional frameworks and local context. They represent an evolution in health financing, offering tools for resource mobilisation and efficiency, but their success hinges on careful attention to implementation context, stakeholder coordination, and institutional capacity. Policymakers should focus on matching mechanisms to specific contexts and building coordination capabilities alongside technical innovation.
MedicineMinjie Yuan, Miao Ye, Chen Li, Yana Zhao, Haina Chen, Tan Lyu
The long-term trend in atrial fibrillation (AF) and atrial flutter (AFL) incidence has rarely been reported from a global perspective. We aimed to explore the past temporal trends (1990-2021) in AF/AFL incidence in group of 20 countries and to predict future trends (2022-2050). Data on yearly AF/AFL incidence by age group and sex were extracted from the global burden of disease study 2021. Age-standardized incidence rates (ASIR) were computed from 1990 to 2021. The number of new cases and incidence rates were predicted to 2050 using the Bayesian age-period-cohort model. The ASIR for AF/AFL exhibited a slight increasing trend on a global scale from 1990 to 2021, with an average annual percent change of 0.5% (95% confidence interval: 0.5-0.5). Canada had the highest ASIR of AF/AFL (97.53/100,000) and showed a significant declining trend from 1990 to 2021, while the USA and Germany showed a clear upward trend and a "wave-like" upward trend, respectively. Notably, Italy experienced a significant increase in the ASIR of AF/AFL during the COVID-19 pandemic (2019-2021), with an annual percent change of 9.3% (95% confidence interval: 6.6-12.0). The ASIR of AF/AFL in developing countries increased more significantly than in developed countries (ASIR change percentage: 4.79% vs 0.20%). The ASIR of AF/AFL is predicted to remain stable or increase in most countries by 2050. AF/AFL remains a significant public health concern, necessitating the development of more precise strategies for prevention, control, and surveillance, particularly among specific populations and endemic countries.
MedicineLianglei Hou, Yiwei Huang, Bin Lin, Anwu Huang
Ischemic heart disease (IHD) remains a leading global health burden influenced by demographic transitions, socioeconomic disparities, and modifiable risk factors. Comprehensive analyses of global patterns are crucial to inform public health interventions. Using data from the Global Burden of Disease study 2021, we assessed global, regional, and national trends in IHD burden (1990-2021). Age-standardized rates of incidence, prevalence, mortality, and disability-adjusted life-years were evaluated. Trends were analyzed using estimated annual percentage change, age-period-cohort models, Bayesian forecasts, risk-factor attribution, decomposition analyses, health inequality, and frontier efficiency analyses. From 1990 to 2021, global IHD prevalence nearly doubled despite stable age-standardized rates, driven by population aging and growth. Eastern Europe exhibited consistently high disease burdens compared to sub-Saharan Africa. Significant gender disparities persisted, with higher burdens among males. High blood pressure, low-density lipoprotein cholesterol, and dietary risks dominated globally. Although age-standardized incidence and mortality declined, especially in high-sociodemographic index countries, absolute numbers increased due to demographic momentum. Forecasts suggest continued increases in absolute cases and deaths through 2035 despite declining standardized rates.Despite reductions in age-standardized IHD burden, substantial disparities persist. Future strategies should address demographic drivers, expand preventive efforts in lower-sociodemographic index regions, and enhance health system efficiency.
International journal of chronic obstructive pulmonary diseaseLu Xu, Xuelian Chen, Xueyun Mao, Jiaqi Chu, Ting Fang, Guozhang Xu, Siyan Zhan, Pengjun Zhang, Zhike Liu
BACKGROUND: Population-based evidence quantifying the incidence burden of cardiovascular diseases (CVDs) attributable to chronic obstructive pulmonary disease (COPD) remains limited. This study aimed to estimate the global incidence burden of CVDs attributable to COPD. METHODS: Data for individuals aged ≥45 years were obtained from the Global Burden of Disease (GBD) 2021 study. Population attributable fractions (PAFs) were calculated using Levin's formula, based on COPD prevalence from GBD 2021 and pooled relative risks derived and re-pooled from published systematic reviews and meta-analyses. The attributable incidence counts and age-standardized incidence rates (ASIRs) were derived for total CVD and four specific types: ischemic heart disease (IHD), lower extremity peripheral arterial disease (LE-PAD), atrial fibrillation and flutter (AF), and stroke. Trends from 1990 to 2021 were assessed using estimated annual percentage change (EAPC). Future burden was projected to 2050 using the Bayesian age-period-cohort models. RESULTS: In 2021, the global ASIR of total CVD attributable to COPD was 248.93 per 100,000 (95% uncertainty interval (UI): 227.03 to 271.05). Among specific CVDs, IHD had the highest ASIR (93.44 per 100,000), followed by LE-PAD (49.16), AF (24.55), and stroke (23.30). The burden was highest in Eastern Europe, Central Asia, and North Africa and the Middle East, and in low-middle SDI regions. From 1990 to 2021, incident counts of all CVD types more than doubled (EAPC: 2.16% to 2.80%), whereas ASIRs declined modestly (EAPC: -0.89% to -0.10%). By 2050, ASIRs for LE-PAD and AF are projected to increase markedly (EAPC: 3.03% and 3.04%, respectively), with particularly pronounced increases among females. CONCLUSION: Modelled estimates suggest that COPD accounts for approximately 11% of incident CVD cases among adults aged ≥ 45 years globally. These findings support consideration of COPD in future cardiovascular prevention strategies and risk assessment frameworks.
Health system resilience is essential for effective pandemic response and health security, yet existing assessments often lack actionable guidance for policymakers. This study develops a data-driven framework to identify key resilience contributors and country capability profiles using the complete 2021 Global Health Security Index (GHSI) dataset for 195 countries. Through a multi-method analytical approach, we derive a composite resilience measure that captures 70.6% of shared variance across six GHSI domains. After accounting for inter-domain correlations, Detection, Health Capacity, and Prevention show the strongest independent associations with overall resilience (ridge coefficients of 0.242, 0.228, and 0.219, respectively), with Detection contributing most. Cluster analysis reveals two distinct country typologies: a high-performing, balanced-capability group (33% of countries) spanning both high-income and several upper-middle-income countries, and a larger group (67%) with lower and more structurally uneven capabilities, particularly in Prevention and Health Capacity. These profiles suggest different strategic pathways for system strengthening-from sustaining advanced capacities in high-performing countries to targeted investments in detection and core health functions in settings with more fragmented capabilities. Our findings provide an essential framework for comparing resilience across countries and prioritising investments where they matter most, offering practical guidance for national and global health security planning.
Annals of medicineTingting Guo, Qing Su, Yuening Chu, Weirong Gu, Lei Liu
BACKGROUND: Unsafe sex is a major risk factor for HIV/AIDS and cervical cancer, yet its burden among older adults remains poorly characterised. Despite rapid global population ageing, older adults remain underrepresented in sexual health research and policy. We aimed to quantify long-term trends and inequalities in the disease burden attributable to unsafe sex among adults aged 60 years and older. METHODS: Using data from the Global Burden of Disease Study 2023, we estimated deaths, disability-adjusted life years (DALYs), and age-standardised mortality and DALY rates attributable to unsafe sex among adults aged ≥60 years across 204 countries and territories from 1990 to 2023. Analyses were stratified by sex, age group, region, and socio-demographic index (SDI). RESULTS: Globally, attributable deaths increased from 113,842 (95% UI: 97,186-136,215) in 1990 to 242,987 (95% UI: 207,451-288,012) in 2023, while DALYs increased from 2.60 (95% UI: 2.20-3.11) million to 5.89 (95% UI: 5.05-6.97) million. Age-standardised rates declined modestly overall. Cervical cancer remained the leading contributor, although its proportional contribution decreased, whereas HIV/AIDS deaths increased more than fourfold. Population growth among adults aged ≥60 years was the predominant contributor to the increase in absolute burden. Age-standardised mortality rates declined among women but increased among men. Marked geographical and socioeconomic inequalities persisted, with mortality rates in low-SDI regions more than seven times those in high-SDI regions. The highest burden occurred in sub-Saharan Africa, while HIV-related mortality increased rapidly in parts of South and Southeast Asia. CONCLUSIONS: Unsafe sex remains a substantial burden among older adults, with increasing absolute burden despite modest declines in age-standardised rates. HIV/AIDS contributed increasingly, although cervical cancer remained the largest contributor in 2023. Population growth was the predominant driver, highlighting the need for life-course prevention and disease-control strategies for healthy ageing.
BACKGROUND: Global distribution of human resources for health (HRH) is highly unequal and less resourced regions may particularly be vulnerable to disastrous emergencies. We examined HRH losses attributable to epidemics of infectious diseases, both globally and geographically. METHODS AND FINDINGS: First, using 30-year ecological data from the 1990 to 2019 records at international Emergency Events Database and HRH density statistics from the Global Burden of Disease study, we extracted estimates of annual country-specific epidemic events and cadre-specific HRH density data across 194 countries and territories. The association between the number of epidemics and HRH density (number of HRH per 10,000 population) was established using the Generalized Estimating Equation model, adjusted for geographic and socioeconomic status. Second, based on the country- and year-specific number of epidemics, HRH density, and epidemic-HRH density associations, we further estimated the annual average absolute number of HRH losses and the average relative number of HRH losses per 10,000 HRHs that can be attributed to epidemic events, globally, by region, and by country. From 1990 to 2019, 1,185 epidemic events were recorded in 194 countries and regions. Globally, an increase in 1 epidemic event in the preceding year was associated with an average decrease of 57.5 × 10-3 (95% confidence interval (CI) [18.5, 96.4]; p = 0.004) in HRH density in the following year. Assuming the observed epidemic-HRH associations were causal, we estimated that globally an average loss of 17,549 (95% CI [5,661, 29,437]) HRHs, or 2.57 (95% CI [0.83, 4.31]) per 10,000 HRHs were attributable to epidemics each year. During the entire observation period, South Asia and sub-Saharan Africa had the highest average attributable fractions, at 20.52 and 18.03 per 10,000, respectively. Low- (15.89 per 10,000) and lower-middle-income (12.76 per 10,000) countries showed higher average attributable fractions than upper-middle- (0.96 per 10,000) and high-income countries (0.12 per 10,000). The top 10 countries with the highest average attributable fractions were observed mostly in sub-Saharan Africa, such as Niger (57.06 per 10,000), Somalia (44.19 per 10,000), and Ethiopia (37.12 per 10,000). The results may be biased due to uncontrolled confounders and reverse causation, and potential underestimation in countries with weaker disaster-surveillance systems. CONCLUSIONS: Epidemics of infectious diseases are associated with HRH losses globally, particularly in low- and middle-income countries, further aggravating the global inequity in the health workforce.
Pteropine orthoreoviruses are emerging bat-borne zoonotic viruses of the genus Orthoreovirus (family Reoviridae), increasingly recognized as causes of acute respiratory disease in humans. Originally grouped with the largely non-pathogenic mammalian orthoreoviruses, they have challenged that view through their association with severe influenza-like illness, evidence of human-to-human transmission, and a broad geographic range across the Old World. Maintained primarily in fruit bats of the family Pteropodidae, they are now linked to neurological as well as respiratory disease. This narrative review synthesizes current knowledge of their molecular pathogenesis, zoonotic ecology, and global epidemiology, integrating recent advances in phylogeography, reassortment-driven evolution, spillover dynamics, and translational biomedical applications within a unified One Health framework. Genomic diversity, reassortment potential, and the unique fusion-associated small transmembrane proteins together underpin viral adaptability and pathogenicity. Major gaps nonetheless remain in transmission dynamics, host adaptation, shedding ecology, and pandemic potential. Future priorities should include integrated genomic surveillance, improved diagnostic strategies, validated experimental models, and interdisciplinary One Health approaches to strengthen outbreak preparedness and prevention.
Pediatric surgery internationalYemi S Lawrence, Chisom R Udeigwe-Okeke, Nimanya A Stella, Kara L Faktor, Ramesh M Nataraja, Caroline Q Stephens, Doruk E Ozgediz, Emmanuel A Ameh, Global Init…
PURPOSE: Simulation-based education (SBE) is increasingly used in surgical training worldwide. With a shortage of specialized surgeons, SBE allows for skills acquisition in a safe environment, preserving patient safety and standardizing care. However, in global children's surgery, knowledge about SBE interest, use, and feasibility is limited. METHODS: A 17-item survey was developed to examine simulation in global children's surgery. The survey was piloted (Nov 2024) and distributed (Dec 2024-Feb 2025) through the Global Initiative for Children Surgery (GICS), an organization with 1100+ members across 60 countries. Descriptive statistics and free responses were reported. RESULTS: Of 85 respondents from 36 countries (approximately 7.7% response rate), over half used SBE in the past year, reaching about 1270 learners. The most common methods were low-cost models, mannequins, and bench trainers. Respondents identified several significant barriers to establishing SBE programs. Most (75%) simulation costs were under $300. CONCLUSION: Access to SBE resources remains a major barrier, highlighting the critical need for access to open-source education materials. The low cost suggests a need to evaluate cost-effectiveness. Despite a limited response rate and sampling from one organization, the use of low-cost simulation and interest in advanced technologies reflect a trend toward enhancing simulation in global children's surgical education.
Ciencia & saude coletivaFábio Luiz Mialhe, Katarinne Lima Moraes, Vanessa da Silva Carvalho Vila, Helena Alves de Carvalho Sampaio, Virginia Visconde Brasil, Flávio Rebustini
Health literacy (HL) is considered by the World Health Organization (WHO) as an important determinant of health and several instruments have been elaborated and adapted to measure this construct. In 2022, a group of researchers started a project aimed at developing a HL assessment instrument with global applicability, based on different versions of the European Health Literacy Survey Questionnaire (HLS-EU-Q). This article critically analyses the characteristics of those instruments to help improve health assessment practices and avoiding omitting measurement of locally important information, therefore committing an epistemic injustice. Analysis detected several flaws in the instruments' aforementioned aspects and the conceptual model proposed by WHO which limits their application as global instruments. Countries worldwide should develop specific instruments to measure the general HL of their population based on its sociocultural characteristics and specificities of their health care systems thus avoiding wrong decision-making, which can compromise the effectiveness of policies resulting from these surveys.
Medical sciences (Basel, Switzerland)Surapon Nochaiwong, Chidchanok Ruengorn, Kajohnsak Noppakun, Kiatkriangkrai Koyratkoson, Mati Chuamanochan, Panjit Chieosilapatham, Pajaree Mongkhon, Nuttaya W…
Background/Objectives: Since peritoneal dialysis (PD) has been used in nephrology practice for several decades, contemporary evidence on global, regional, and country incidence rates of PD-associated peritonitis has not been comprehensively synthesized. We performed a systematic review and meta-analysis to estimate the incidence rates of PD-associated peritonitis worldwide in contemporary PD practice. Methods: We systematically searched 6 electronic databases to identify all relevant English-language articles that reported rates of PD-associated peritonitis according to International Society for Peritoneal Dialysis (ISPD) criteria, regardless of age, sex, or PD modality, from 2011 to 2026. We used a random-effects meta-analysis to estimate the pooled incidence rate (episodes per patient-year), with corresponding 95% confidence intervals. We reported summary incidence rates of PD-associated peritonitis for the global estimation (overall rate), World Health Organization (WHO) region, and each country. We also estimated meta-syntheses by causative microorganism of PD-associated peritonitis. Results: We identified 12,364 records, of which 153 unique study populations of PD patients fulfilled the study selection criteria. These included over 132,000 PD patients from 37 countries worldwide. Despite substantial heterogeneity, the global incidence rate estimate of PD-associated peritonitis was 0.31 (0.28-0.34) episodes per patient-year (total peritonitis episodes, 88,769; total patient-years at risk, 264,296.30). According to WHO region (p for difference between regions <0.001), the regional incidence rates of PD-associated peritonitis were 0.99 (0.68-1.45) for the African Region; 0.38 (0.31-0.45) for the Region of the Americas; 0.41 (0.35-0.48) for the South-East Asia Region; 0.37 (0.30-0.46) for the European Region; 0.39 (0.31-0.49) for the Eastern Mediterranean Region; and 0.21 (0.19-0.24) for the Western Pacific Region. Across 37 different countries, the top three highest incidence rates of PD-associated peritonitis were observed in South Africa, followed by Portugal and Sri Lanka. Meanwhile, the top three lowest incidence rates of PD-associated peritonitis were observed in South Korea, followed by mainland China and Japan. According to the ISPD benchmark, 10 of the 37 included countries had an overall PD-associated peritonitis rate > 0.40 episodes per patient-year. Regarding the causative microorganisms of PD-associated peritonitis, Gram-positive bacteria had the highest pooled incidence rate of PD-associated peritonitis (0.127 [0.113-0.142]), followed by culture-negative (0.073 [0.065-0.083]), Gram-negative bacteria (0.065 [0.058-0.073]), polymicrobial (0.017 [0.014-0.021]), fungus (0.009 [0.008-0.011]), and Mycobacterium (0.004 [0.003-0.006]). Conclusions: These global estimates of PD-associated peritonitis incidence rates demonstrated variation across regions and countries. Given differences in healthcare systems across countries, sharing innovations and knowledge for continuous quality improvement and standardizing and harmonizing PD practice settings are warranted to improve quality indicators and patient well-being and reduce inequalities in PD management worldwide.
Universal health coverage (UHC) is a central objective of the global health agenda, supported by internationally standardised indicators that facilitate monitoring and accountability across countries. Although standardised global UHC indicators, such as the Sustainable Development Goals (SDGs), UHC service coverage index, and out-of-pocket healthcare expenditures, support international accountability and collaboration, they do not fully capture domestic healthcare complexities driven by demographic ageing, epidemiological transitions, and evolving health system challenges. These limitations are particularly evident in countries facing complex population health needs. This viewpoint argues that UHC measurements should be adapted to national contexts, considering demographic characteristics, epidemiological profiles, healthcare delivery and financing structures, and political priorities. National governments, in cooperation with international organisations, must adopt a two-tiered monitoring approach that combines global and country-specific indicators and is underpinned by scientifically rigorous data collection. Such a multilayered framework can strengthen both domestic governance and international efforts to achieve UHC.
Colonial legacies continue to shape who decides, leads, and benefits from global health research. Funders play a pivotal role in this landscape, determining which settings, problems, and approaches are prioritized in research. This paper introduces a checklist for research funders aimed at tackling some of the structural and political dimensions of inequity in global health research. Grounded in a framework that understands 'decolonising global health' across three intersecting dimensions (colonialism within global health, colonisation of global health, and colonialism through global health), the checklist is structured into six strategic areas: (1) shifting power within the health research ecosystem; (2) prioritising health equity in the research portfolio; (3) redressing historical underinvestment in health research systems; (4) addressing potential conflicts of interest that could undermine equity; (5) equitably distributing the outputs of global health research; and (6) reporting on research outcomes and impact. Acknowledging that decolonization would require a full dismantling of the existing aid/funding system, the checklist attempts to broaden the present discourse on decolonising global health research by placing the onus on funding agencies to adopt and implement measures to address structural inequities within the funding ecosystem. While the checklist will require piloting and further refinement, meaningful change within research funding agencies must be accompanied by broader social, political, and epistemic transformations in the field of global health.
Hepatology communicationsGurmehr Brar, Brian P Lee
Chronic liver disease is a leading cause of global morbidity and mortality, with an evolving etiologic landscape driven by rising metabolic dysfunction and persistent alcohol use. The introduction of metabolic and alcohol-associated liver disease (MetALD) recognizes the coexistence of these exposures as dual drivers of liver-related outcomes as a distinct clinical entity. This review synthesizes current evidence on the global epidemiology, clinical outcomes, and public health implications of MetALD. Current evidence suggests that ~10%-20% of individuals worldwide with hepatic steatosis meet criteria for MetALD. Emerging data demonstrate that the combination of cardiometabolic risk factors and alcohol is associated with more aggressive liver disease, including accelerated fibrosis progression, increased risk of cirrhosis and hepatic decompensation, and higher incidence of hepatocellular carcinoma compared with either exposure alone. In addition to major adverse liver outcomes, individuals with MetALD experience increased all-cause mortality, reflecting both progressive liver disease and the systemic effects of metabolic dysfunction and alcohol use. These factors contribute substantially to global disability-adjusted life years, particularly among working-age populations. The burden of MetALD varies across regions, reflecting differences in metabolic risk, alcohol consumption, and socioeconomic determinants, and is expected to rise further in both high- and middle-income settings. Despite its growing clinical relevance, the global burden of MetALD remains incompletely characterized due to limitations in standardized definitions, data availability, and ascertainment of alcohol use. Improved recognition, harmonized definitions, and integrated clinical and public health strategies are essential to better characterize and mitigate its impact on global liver health.
Pediatric surgery internationalSage A Vincent, Vatche Melkonian, Andrea Bischoff, Kaitlin E Olson, Jill Ketzer, Hendren Project Global Surgery Research Initiative, Alberto Peña, Luis de la T…
PURPOSE: Hirschsprung disease (HD) is a rare condition. It requires well-oriented care regardless of birthplace. We aimed to understand global HD management and identify areas of consensus and variability in perioperative care. METHODS: The Hendren Project distributed a survey to all members of its global network of pediatric surgeons and invited those who had performed five or more HD operations at their institution to participate. Surgeons were asked to retrospectively review their five most recent operations and answer a series of questions regarding diagnostic workup, surgical intervention, and complications. RESULTS: 105 surgeons completed the survey, representing 81 hospitals in 58 cities and 42 countries, reporting on 403 distinct patients. HD diagnosis was most often made by open transanal biopsy (52.4%). Preoperative rectal irrigations, used as medical treatment for obstruction, were administered to 84.8% of patients. Primary pull-through was performed in 58.8% of patients, and staged repair with a previously created colostomy was performed in 41.2%. Postoperative complications occurred in 23.6% of patients, most commonly stricture and reoperation. CONCLUSION: A global survey of pediatric surgeons identified variation in perioperative management of patients with HD, with 25% of patients experiencing surgical complications. Opportunities for quality improvement and educational efforts to improve outcomes and surgical disparities were detected.
Annals of global healthMarie H Martin, Ash Rogers, Joseph Starnes, Elizabeth S Rose, Harriett Myers, Julius Mbeya, Milton Ochieng', James Nardella, Katherine Carpenter, Frederick Och…
Background: Global health partnerships between academic institutions and non-governmental organizations (NGOs) are increasingly recognized as essential mechanisms for strengthening health systems in low-resource settings. Despite their proliferation, few partnerships demonstrate long-term, equitable collaboration grounded in established ethical frameworks. Objectives: To describe and evaluate a 20-year partnership between Lwala Community Alliance, a community-based NGO in western Kenya, and Vanderbilt University in the United States, using the Brocher Declaration principles as an evaluative framework for ethical, sustainable, and mutually beneficial global health collaboration. Methods: We employed a qualitative descriptive case study design, drawing on internal documentation, program records, and publicly available data. The partnership was analyzed across three interdependent pillars-education and training, research, and service-and assessed against each of the six Brocher Declaration principles: mutual partnership with bidirectional learning; empowered host country and community defining needs; sustainable programs and capacity building; compliance with applicable laws and ethical standards; humility and cultural sensitivity; and accountability for actions. Findings: Over 20 years, the partnership engaged 57 graduate students in 33 discrete projects and yielded 12 peer-reviewed publications from a longitudinal household survey encompassing more than 20,000 households. Key outcomes include a reduction in under-five mortality from 105 to 29.5 deaths per 1000 live births, policy reforms formalizing community health worker compensation and digitization across Kenya, and sustained bidirectional capacity strengthening. Adherence to Brocher Declaration principles, including community-led project design, ethical oversight through Kenyan review boards, and structured financial compensation to the host partner, was central to the partnership's longevity and impact. Conclusions: This case illustrates how the Brocher Declaration can be operationalized to evaluate and strengthen long-term academic-NGO collaborations. The Lwala-Vanderbilt model offers a replicable framework for ethical, impactful, and mutually reinforcing global health partnerships that advance health equity in low-resource settings.
International journal of biometeorologyYiru Zhang, Xi Hua, Shengjie Xu
BACKGROUND: Chronic kidney disease (CKD) is a growing global health burden, and non-optimal temperature is increasingly recognized as an environmental contributor; however, the long-term population-level mortality burden attributable to temperature exposure across the Group of Twenty (G20) has not been systematically characterized. METHODS: A multicountry longitudinal analysis was conducted for the G20 overall and 19 member countries from 2010 to 2023. Deaths from CKD attributable to non-optimal temperature, attributable percent, and temporal trends were estimated and stratified by sex and age group, with high temperature and low temperature assessed separately. Long-term trends were quantified using the estimated annual percentage change (EAPC). RESULTS: Across the G20, total CKD deaths increased from 599,066 in 2010 to 838,263 in 2023, and the CKD death rate rose from 14.00 to 17.67 per 100,000 (EAPC 1.74). CKD deaths attributable to non-optimal temperature increased from 45,071 to 58,041 (+ 28.84%), while the attributable percent declined from 7.52% to 6.92% (EAPC - 0.36). In 2023, attributable fractions ranged from 0.93% in Indonesia to 15.33% in Saudi Arabia, and attributable deaths were highest in the United States (11,950) and China (11,932). Low temperature dominated the burden (39,435 to 50,617 deaths; 6.04% in 2023), whereas high temperature contributed a smaller share (0.94% in 2023; 7,846 deaths) with greater instability. The burden was greatest in adults aged ≥ 75 years, while younger age groups showed declining attributable deaths. National EAPC patterns were heterogeneous, with declines in several countries (e.g., Mexico, United Kingdom, France, Germany, Japan) but increases or near-stable trends in others, notably Indonesia and the Russian Federation. CONCLUSIONS: Non-optimal temperature contributes meaningfully to CKD mortality in the G20, which is examined here as a policy-relevant group rather than a global proxy. The marked heterogeneity highlights the need for tailored adaptation, especially for cold exposure and aging populations.
MycopathologiaTianyang Chen, Mingyuan Han, Ying Miao, Xinlin Zhu, Nan Hong, Xin Huang, Jianping Xu, Sybren de Hoog, Weihua Pan, Min Chen
Exophiala dermatitidis is an opportunistic pathogen belonging to the so-called black yeasts, a group of fungi capable of causing a wide range of infections. Here we systematically reviewed 77 global cases of E. dermatitidis infections reported between 1989 and 2024. Most cases were reported from Japan (19/77), United States (16/77) and China (10/77), with 64.9% (50/77) cases reported since 2010, indicating an increasing global awareness of this fungus. Our results indicated that reported E. dermatitidis infections occurred in both immunocompromised (54.55%; 42/77) and apparently immunocompetent hosts (45.45%; 35/77), with deep-seated infections being the most common (76.62%; 59/77). Infections are associated with a high mortality rate, especially those affecting the central nervous system (63.63%; 7/11). Leukemia, nephropathy, diabetes, cystic fibrosis and CARD9 deficiency were identified as important predisposing factors for E. dermatitidis infection. All included cases were culture-confirmed, with a subset additionally supported by histopathological examination and/or molecular identification. Although there is currently no consensus about antifungal treatment for E. dermatitidis infections, our findings suggest that voriconazole was the most frequently used antifungal agent among the reviewed cases.
BACKGROUND: Adolescent diabetes mellitus (DM) constitutes a significant global public health challenge. This study seeks to quantify the burden of DM in adolescents aged 10-19 years from 1990 to 2023 and to forecast trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) through 2040. METHODS: Epidemiological data for DM among adolescents in 204 countries and territories were obtained from the Global Burden of Disease (GBD) 2023 database. The global burden was evaluated using age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR), stratified by region, sex, age, and Socio-demographic Index (SDI). Health inequality was assessed using the slope index of inequality (SII) and concentration index (CI). Future trends were forecast using an autoregressive integrated moving average (ARIMA) model with model-specific validation (AICc, Ljung-Box test). RESULTS: From 1990 to 2023, global adolescent DM burden increased substantially. ASIR, ASPR, and ASDR rose consistently, whereas ASMR remained relatively stable with a slight decline. In 2023, an estimated 6.07 million adolescents were living with DM (ASPR: 458.07 per 100,000). The highest ASPR was observed in low-SDI regions (482.25 per 100,000), followed by high-SDI regions (442.81 per 100,000). Low-SDI regions also carried the highest DALY and mortality burdens. Males progressively exceeded females in both incidence and prevalence by 2023, although this observed sex reversal may partly reflect changes in screening and diagnostic practices. The overall burden increase was primarily driven by adolescents aged 15-19 years. ARIMA forecasts indicate that ASIR, ASPR, and ASDR are projected to continue increasing through 2040, while ASMR is expected to remain low and stable. CONCLUSIONS: The burden of adolescent DM increased considerably from 1990 to 2023, with marked heterogeneity by age, sex, and geography. The rising non-fatal burden (incidence, prevalence, DALYs) contrasts with stable mortality, suggesting improvements in acute care alongside growing morbidity. Persistent health disparities and projected increases underscore the need for age-, sex-, and region-specific public health strategies.
Expert review of vaccinesMahan Ghafari, Oliver J Watson, Stefan Dascalu, Sandra Hsu Hnin Mon, Lucie Abeler-Dörner, Mohammad Saeid Rezaee-Zavareh, Caitlin Pley, Shahram Kordasti, Kaja A…
INTRODUCTION: COVID-19 showed that rapid vaccine development and roll-out, while lifesaving, can still yield large, avoidable harms when equity is not considered from the outset. Disparities in vaccine timing and coverage, especially in low-resource settings, amplified health and economic burdens, highlighting the need for preparedness frameworks that combine speed with fairness. AREAS COVERED: We synthesize evidence from literature and policy reports regarding global vaccine roll-out, focusing on avertable mortality under alternative sharing scenarios, procurement design, pooled mechanisms such as COVAX, and the role of distributed manufacturing and delivery capacity. We also examine how transparent data-sharing, effective public communication, genomic surveillance, adaptive trial designs, and modeling hubs can support more responsive and equitable vaccine deployment. Across six reflection points, we translate these lessons into practical priorities for future pandemic readiness, including strengthening healthcare infrastructure, equitable procurement, data transparency, and safeguarding public health decision-making from political and commercial distortion. EXPERT OPINION: We argue that equity-by-design is essential if vaccine innovation is to deliver equitable public health impact. This requires geographically distributed manufacturing, transparency, equity-conditioned advance purchase agreements, and pre-agreed, epidemiology-triggered allocation of vaccines. We recommend institutionalizing disaggregated reporting, standardized data-sharing, greater pathogen genomic sequencing capacity, and communication strategies that support public health protection while countering misinformation.