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Background: Intracerebral hemorrhage (ICH) in young adults demands greater attention, given its poor prognosis; however, there has been a paucity of epidemiological data. The objective of this study is to estimate the temporal trends and distribution characteristics of the disease burden in 204 countries or territories between 1990 and 2021., Methods and Results: The data, including incidence, mortality, prevalence, and disability-adjusted life year (DALY) rates were sourced from the Global Burden of Diseases Study 2021. From 1990 to 2021, there was a significant decline in the global incidence (estimated annual percentage change=-1.05), mortality (estimated annual percentage change=-0.92), and DALY (estimated annual percentage change=-1.00) rates of ICH in young adults. In 2021, the highest incidence, mortality, and DALY rates were observed in Southeast Asia, East Asia, and Oceania. Globally, high systolic blood pressure, smoking, and ambient particulate matter pollution were identified as the primary contributors to the largest proportion of DALYs associated with ICH in young adults. The health inequality of ICH in young adults has been reduced over the past 3 decades., Conclusions: There is a considerable degree of heterogeneity in the global burden of ICH in young adults. A decline in the incidence, mortality, prevalence, and DALY rates has been observed from 1990 to 2021, however, the number of absolute cases has increased. These results will enable health care professionals, policymakers, and researchers to refine the implementation of cost-effective policies, the allocation of health care resources, and the management of patients to further mitigate the burden of ICH in young adults.

Background: Nonrheumatic valvular heart disease (NRVD) is increasingly becoming a significant public health concern, particularly among older people. In the context of population aging, a detailed report on the epidemiological trends of NRVD is crucial for policymakers to effectively allocate health care resources. This study aimed to explore these trends using data from the GBD (Global Burden of Disease) 2019 study., Methods and Results: We assessed the changing trends of the incidence, mortality, and disability-adjusted life years rates for NRVD by calculating the estimated annual percentage change for each. Additionally, we examined the impact of a region's level of social development on NRVD epidemiological trends and identified key risk factors contributing to NRVD-related deaths. Between 1990 and 2019, the global incidence of NRVD showed a gradual increase, with an estimated annual percentage change of 0.39 (95% CI, 0.30-0.48). The data revealed that women and older people are more likely to develop NRVD. High-sociodemographic index countries exhibited higher age-standardized incidence and mortality rates compared with low- and middle-sociodemographic index countries. The most significant risk factor for NRVD-related mortality was identified as high systolic blood pressure., Conclusions: Over the past 3 decades, the burden of NRVD has intensified, indicating a need for more health care resources to address this issue, which is closely associated with an aging population. Currently, high-sociodemographic index countries report the highest incidences and deaths due to NRVD. However, low- and middle-sociodemographic index countries should also implement measures to manage the rapidly increasing burden of NRVD.

Introduction: The role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors' views on the application of their global health knowledge in the clinical setting remains scarce. This study aimed to explore junior doctors' perceptions of global health and sustainable development, the education they have received on these issues and the relevance of this knowledge in their current and future work., Methods: This was a qualitative study based on individual interviews conducted between May and June 2022. 16 junior doctors, in mandatory clinical training after completing medical school, were purposively sampled from five Swedish hospitals. Transcripts were analysed using qualitative content analysis., Results: Three themes were identified. The first theme (1) 'medical doctors have a role in the transition to a sustainable society', shows that sustainable development is increasingly perceived as relevant for junior doctors' clinical work. The second theme (2) 'global health and sustainable development teaching is inconsistent and somewhat outdated', highlights that there is an assumption that global health and sustainable development can be self-taught. A discrepancy between what is being taught in medical school and the clinical reality is also recognised. This causes challenges in applying global health interest and knowledge in the clinical setting, which is described in the third theme (3) 'application of global health and sustainable development is difficult'. This theme also highlights opportunities for continued engagement, with the perceived benefit of becoming a more versatile doctor., Conclusion: This study emphasises the need for conceptual clarity regarding global health in medical education and raises the need for clarification regarding the level of responsibility for integrating sustainable practices in Swedish healthcare settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Physician associates/assistants (PAs) and their equivalents offer a solution to the supply and demand crisis to alleviate global healthcare needs. This study investigated how PA and PA equivalents address global healthcare needs across different healthcare systems, revealing recommendations for their use. The study also sought to catalog the global healthcare needs that PAs and equivalents are successfully alleviating, the roles in which they function, and the barriers facing implementation., Methods: A systematic review was conducted from October 2021 to April 2022 and rerun in June 2023 following PRISMA 2020 guidelines; additionally, supporting interviews were conducted with PAs and global health experts. Primary outcomes were geographic region, economy, healthcare needs, and healthcare systems. Secondary outcomes were PA use, license recognition, and successes or barriers when implementing PAs., Results: The literature and interviews focused on the global use of PAs and PA equivalents in six geographic regions, 63 countries, and five US territories where PAs or PA equivalents are employed, have been employed, are volunteering, or are being considered to support global healthcare needs. Most countries have a developing economy and an out-of-pocket healthcare system. PAs and PA equivalents hold 35 different practice titles, and most work in primary care. PAs alleviate healthcare shortages and economic disparities, specifically related to inequitable healthcare access. Globally, the profession is limited by a lack of legislation, regulation, and support., Conclusions: PAs and PA equivalents worldwide belong to an adaptable profession that has well-documented success in alleviating the global healthcare shortage and addressing healthcare needs. Countries desiring PAs or PA equivalents should identify their specific needs, train their existing workforce, employ pilot programs, and focus on seeking early legislation and regulation. Broad support for existing PA and PA equivalent international organizations is recommended for global collaboration. This study serves as a guide for those advocating for the continued or future implementation of PAs and PA equivalents in their own country and provides a comprehensive resource to aid in the globalization of this profession. We offer recommendations to address the dire healthcare needs and workforce shortage faced across the globe., (Copyright © 2024 American Academy of Physician Associates.)

Reducing systemic inequities in testing, access to care, social protection - and in the scientific process - is essential to end TB. Incorporating social science methods and expertise on inequity into the mainstream TB response would help ensure that political commitments to equity move beyond symbolic gestures. We convened a meeting between TB social scientists, people with lived experience, civil society and community members to discuss equity within the global TB response. Here, we propose five means by which a social science lens can strengthen equitable, person-centred responses and reconcile the public health significance of TB with the principles of social justice.

As the global burden of disease shifts from communicable to non-communicable diseases and trauma-related debility, the global health-care community has increasingly advocated for equitable access to surgical services. Much of this attention has focused on bolstering clinical and research expertise through the expansion of clinical training programmes and research resources. However, despite the crucial role of equipment, including medical devices, in safe clinical care, comparatively little attention has been paid to sustainably bridging the biomedical and technical gaps that exist in global health. Although closing these gaps with locally driven solutions is the goal, the reality in many settings is that partnerships between institutions in high-income countries and low-income and middle-income countries currently remain necessary. Thus, this Viewpoint provides guidelines conscious to biomedical engineering for institutions looking to expand or begin global health initiatives with the Partners In Health Five S's-staff, stuff, space, systems, and social support-framework for health systems strengthening as a guide. We focus first on initiatives involving staff, stuff, and space, encouraging institutions to ask, listen, and enable, through a set of questions and actionable recommendations. Then, we urge institutions to strengthen systems and social support, underscoring the need for wider societal scaffolding to support and sustain initiatives beyond initial efforts., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

This global systematic review and meta-analysis of Vibrio cholerae prevalence, covering environmental, food, animal, and human samples, analysed 111 studies from five databases. The meta-analysis, adhering to standard reporting guidelines, revealed a pooled prevalence of 10.6 % (95 % CI; 8.2 - 13.5; I 2 = 99.595 %, p < 0.001) from 176,740 samples, including 27,219 cholera cases. Despite significant publication bias (Egger's test, p = 0.00018), prevalence estimate remained stable in leave-one-out analysis. Subgroup analysis showed prevalence varied by region, with Indonesia highest (55.2 %) and Jordan lowest (0.2 %). Asia continent had the highest prevalence (13.9 %), followed by South America (12.1 %), and lowest in Europe (3.8 %). Environmental samples exhibited the highest prevalence (24.9 %), while human samples had the lowest (7.1 %). The pervasive presence of V. cholerae in environmental resources highlights the persistent risk of global cholera outbreaks, necessitating urgent proactive measures and ongoing surveillance for effective cholera control., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The main causes of limb loss include trauma, complications from diabetes and peripheral arterial disease, malignancy, and congenital limb deficiency. There are significant geographic variations in the incidence of upper and lower, and major and minor limb loss worldwide. Limb loss is costly for patients and the health care system. The availability of orthotic and prosthetic services, along with cost of services, represents barrier to care and contributes to morbidity and mortality. More research is needed, especially in low-income and middle-income countries to describe the extent of limb loss., Competing Interests: Disclosure The authors declare that they have no relevant or material financial interests that relate to the research described in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: We declare no competing interests.

Background: Sternum and rib fractures represent a significant global health concern, contributing to morbidity and disability on a worldwide scale. However, there is a notable lack of recent epidemiological data detailing the global and regional burden of these fractures., Methods: We undertook a systematic analysis of the prevalence of sternum and rib fractures at the global, regional, and national levels in 2019, while also examining time trends spanning from 1990 to 2019. To achieve this, we extracted data from the Global Burden of Disease Study 2019, enabling us to determine incidence, prevalence, years lived with disability (YLDs), and their corresponding age-standardized rates., Results: In 2019, there were 4.1 million incident cases and 2 million prevalent cases of sternum and rib fractures worldwide. These figures represent increases of 43.7 % and 64.1 %, respectively, since 1990. YLDs also exhibited a notable increase, rising by 62.4 % to reach 190,834 cases. However, since 1990, their equivalent age-standardized rates, which ranged from 5.5 % to 7.1 %, have decreased. Notably, China had the greatest incidence (1.2 million cases), prevalence (573,000 cases), and number of YLDs (55,400 cases), all in 2019. The greatest age-standardized incidence rate (143/100,000) and age-standardized prevalence rate (65/100,000) were both recorded in Greenland in the same year. It's critical to emphasize that men experience these fractures at considerably higher rates than women. Around 70 % of incident instances included unintentional injuries worldwide and across all regions. High-socioeconomic regions had the highest rates of incidence, prevalence, and YLDs, albeit these rates have declined by 6.4 % to 7.1 % since 1990, whereas low-middle and low-income areas have had rises., Conclusions: This study, which spans the years 1990 to 2019, provides a thorough and current assessment of the global burden attributed to sternum and rib fractures. In terms of nations, regions, sociodemographic index (SDI) levels, age groups, genders, and reasons, it reveals significant variances and trends. The knowledge obtained from this study can be extremely useful in formulating health policy, allocating resources, and developing methods to prevent these injuries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Common metabolic diseases, such as type 2 diabetes mellitus (T2DM), hypertension, obesity, hypercholesterolemia, and metabolic dysfunction-associated steatotic liver disease (MASLD), have become a global health burden in the last three decades. The Global Burden of Disease, Injuries, and Risk Factors Study (GBD) data enables the first insights into the trends and burdens of these metabolic diseases from 1990 to 2021, highlighting regional, temporal and differences by sex., Methods: Global estimates of disability-adjusted life years (DALYs) and deaths from GBD 2021 were analyzed for common metabolic diseases (T2DM, hypertension, obesity, hypercholesterolemia, and MASLD). Age-standardized DALYs (mortality) per 100,000 population and annual percentage change (APC) between 1990 and 2021 were estimated for trend analyses. Estimates are reported with uncertainty intervals (UI)., Results: In 2021, among five common metabolic diseases, hypertension had the greatest burden (226 million [95 % UI: 190-259] DALYs), whilst T2DM (75 million [95 % UI: 63-90] DALYs) conferred much greater disability than MASLD (3.67 million [95 % UI: 2.90-4.61]). The highest absolute burden continues to be found in the most populous countries of the world, particularly India, China, and the United States, whilst the highest relative burden was mostly concentrated in Oceania Island states. The burden of these metabolic diseases has continued to increase over the past three decades but has varied in the rate of increase (1.6-fold to 3-fold increase). The burden of T2DM (0.42 % [95 % UI: 0.34-0.51]) and obesity (0.26 % [95 % UI: 0.17-0.34]) has increased at an accelerated rate, while the rate of increase for the burden of hypertension (-0.30 % [95 % UI: -0.34 to -0.25]) and hypercholesterolemia (-0.33 % [95 % UI: -0.37 to -0.30]) is slowing. There is no significant change in MASLD over time (0.05 % [95 % UI: -0.06 to 0.17])., Conclusion: In the 21st century, common metabolic diseases are presenting a significant global health challenge. There is a concerning surge in DALYs and mortality associated with these conditions, underscoring the necessity for a coordinated global health initiative to stem the tide of these debilitating diseases and improve population health outcomes worldwide., Competing Interests: Declaration of competing interest John D. Ryan received consultancy fees from Falk, Gilead, Pfizer and a speaker honorarium from Takeda. Luca Valenti reports consulting fees from Gilead, Pfizer, Astra Zeneca, Novo Nordisk, Intercept pharmaceuticals, Diatech Pharmacogenetics, IONIS, Viatris; honoraria from MSD, Gilead, AlfaSigma, AbbVie, Resalis, grants from Gilead. Alice Pik-Shan Kong has received research grants and/or speaker honoraria from Abbott, Astra Zeneca, Bayer, Boehringer Ingelheim, Dexcom, Eli-Lilly, Kyowa Kirin, Merck Serono, Nestle, Novo-Nordisk, Pfizer and Sanofi and Zuellig Pharma. Gregory Y. H. Lip serves as consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos. He is a National Institute for Health and Care Research (NIHR) Senior Investigator and co-PI of the AFFIRMO project on multimorbidity in AF (grant agreement No 899871), TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement No 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement No 101080189), which are all funded by the EU's Horizon Europe Research & Innovation programme. Anoop Misra has received honorarium from Abbott, Roche, Jannsen, Boehringer Ingelheim, Lupin, Cipla, US Vitamins, and Novo Nordisk. Christopher D. Byrne has received grant support from Echosens. Wah-Kheong Chan is a consultant or advisory board member for Abbott, Roche, Abbvie, Boehringer Ingelheim and Novo Nordisk; and a speaker for Abbott, Novo Nordisk, Echosens, Viatris and Hisky Medical. Christos S. Mantzoros reports grants through his institution from Merck, Massachusetts Life Sciences Center and Boehringer Ingelheim, has received grants through his Institution and personal consulting fees from Coherus Inc. and AltrixBio, he reports personal consulting fees and support with research reagents from Ansh Inc., collaborative research support from LabCorp Inc., reports personal consulting fees from Olympus, Genfit, Lumos, Novo Nordisk, Amgen, Biodexa, Laekna, Corcept, Intercept, 89 Bio, Madrigal, Aligos, Esperion and Regeneron, travel support and fees from UptoDate, TMIOA, Elsevier, and the Cardio Metabolic Health Conference. Ming-Hua Zheng has received honoraria for lectures from AstraZeneca, Hisky Medical Technologies and Novo Nordisk, consulting fees from Boehringer Ingelheim. No other disclosures were reported., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background & Aims: The contribution of suboptimal diets to gastrointestinal (GI) cancer incidence globally remains unquantified, and we aimed to evaluate it., Methods: Comprehensive meta-analyses and rigorous evidence-grading assessment identified the associations between suboptimal diets and 6 GI cancers and their subtypes. A comparative risk assessment model was used to estimate the proportional attributable burden and attributable rate of GI cancers to suboptimal diets by using the corroborative association estimates. In addition, correlation assessments with the Sociodemographic Index were carried out., Results: In 2018, 21.5% (95% uncertainty interval, 19.1%-24.5%) of incident GI cancer cases globally were attributable to suboptimal diets, maintaining a relatively stable proportion since 1990 (22.4%; 19.7%-25.6%), whereas the absolute diet-attributable cases doubled from 580,862 (510,658-664,076) in 1990 to 1,039,877 (923,482-1,187,244) in 2018. Excessive processed meat consumption (5.9%; 4.2%-7.9%), insufficient fruit intake (4.8%; 3.8%-5.9%), and insufficient whole grain intake (3.6%; 2.8%-5.1%) were the most significant dietary risk factors in 2018, a shift from 1990 when the third major concern was insufficient nonstarchy vegetable intake. In addition, Central and Eastern Europe and Central Asia experienced the highest attributable burden across regions in both 1990 (31.6%; 27.0%-37.4%) and 2018 (31.6%; 27.3%-36.5%), and a positive correlation (P < .001) between the Sociodemographic Index and the attributable GI cancer incidence was observed., Conclusions: Although the proportional attributable GI incidence remains relatively stable, the doubling of absolute cases from 1990 to 2018, along with the discrepancies among urbanicity and countries/regions, informs dietary priorities and more targeted preventive measures., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

In 2020, the World Health Assembly endorsed the Immunization Agenda 2030 (IA2030), a 10-year strategy to reduce vaccine-preventable disease (VPD)-associated morbidity and mortality. IA2030 goals include improving equitable vaccination coverage, halving the number of unimmunized (zero-dose) children, and increasing the introduction of new and underutilized vaccines. The COVID-19 pandemic disrupted health systems worldwide, hindering years of childhood vaccination achievements and putting global public health goals at risk. This report presents trends in World Health Organization (WHO) and UNICEF routine vaccination coverage estimates through 2023 across the 194 WHO member countries. During 2022-2023, global coverage with the first and third doses of diphtheria-tetanus-pertussis-containing vaccine (DTPcv) (89% and 84%, respectively) and the first dose of measles-containing vaccine (83%) stagnated and remained lower than prepandemic levels. The 31 WHO member countries with fragile, conflict-affected, and vulnerable (FCV) settings include approximately one half of the world's 14.5 million children who did not receive the first DTPcv dose. The introduction of new and underutilized vaccines, such as a second MCV dose in the African Region, has improved countries' overall protection against VPDs. Accelerating country-specific routine immunization and catch-up vaccination programs to reach unvaccinated and incompletely vaccinated children, especially those living in FCV settings, is critical to reducing morbidity and mortality associated with VPDs., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Jan Grevendonk reports grants to the World Health Organization from Gavi, the Vaccine Alliance and the Bill and Melinda Gates Foundation. No other potential conflicts of interest were disclosed.

Air pollution is a critical global health issue that significantly impacts cardiovascular health. The air pollutant PM 2.5 (particulate matter with a diameter of 2.5 micrometres or less) has been positioned as a leading environmental risk factor for morbidity and mortality, especially from cardiovascular diseases (CVDs). Using data from the World Health Organization (WHO), Global Health Observatory, and the United Nations Environment Programme, we explored global trends in air pollution, with a focus on PM 2.5 levels, the implications for cardiovascular health, and the policy measures aimed at reducing their impact. Despite progress in reducing pollution levels in high-income countries, global trends show a limited annual reduction in PM 2.5 concentration. The analysis highlights disparities between regions, with low- and middle-income countries bearing the brunt of air pollution-related CVDs. In 2019 alone, ambient air pollution was responsible for approximately 4.2 million deaths worldwide. Of these, 70% were caused by CVDs, with approximately 1.9 million deaths from ischemic heart disease and 900,000 deaths from stroke. Policy gaps remain a challenge, with many countries lacking adequate legally binding air quality standards. We recommend the adoption of WHO air quality guidelines, enhanced monitoring of air pollution levels, and increased investment in interdisciplinary research to understand the full scope of air pollution's effects on cardiovascular health. Addressing the global cardiovascular crisis linked to air pollution will require coordinated efforts from policymakers, healthcare systems, and global health organisations., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Kidney diseases have become a global epidemic with significant public health impact. Chronic kidney disease (CKD) is set to become the fifth largest cause of death by 2040, with major impacts on low-resource countries. This review is based on a recent report of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) which uncovered gaps in key vehicles of kidney care delivery assessed using World Health Organization building blocks for health systems (financing, services delivery, workforce, access to essential medicines, health information systems and leadership/governance). High-income countries had more centres for kidney replacement therapies (KRT), higher KRT access, higher allocation of public funds to KRT, larger workforces, more health information systems, and higher government recognition of CKD and KRT as health priorities than low-income nations. Evidence identified from the current ISN-GKHA initiative should serve as template for generating and advancing policies and partnerships to address the global burden of kidney disease. The results provide opportunities for kidney health policymakers, nephrology leaders and organizations to initiate consultations to identify strategies for improving care delivery and access in equitable, resource-sensitive manners. Policies to increase use of public funding for kidney care, lower the cost of KRT and increase workforces should be a high priority in low-resource nations, while strategies that expand access to kidney care and maintain current status of care should be prioritized in high-income countries. In all countries, the perspectives of people with CKD should be exhaustively explored to identify core kidney care priorities., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Le texte complet de l'article est aussi disponible en français., (© Turke et al.)

Background: Historically, the US has been the largest contributor to development assistance for health (DAH), although its allocation has shifted in response to outside forces. This included, for example, the establishment of the Millennium Development Goals (MDGs) in 2000, which emphasised child mortality, maternal health, HIV/AIDS, and malaria. This led to funds being earmarked for disease-specific interventions rather than health system strengthening (HSS). In 2007, the World Health Organization (WHO) published six health system building blocks, representing essential components of strong health systems. In 2015, the MDGs were replaced by the Sustainable Development Goals (SDGs), which emphasised capacity-building as opposed to specific health problems. The Lancet Commission on Global Surgery, meanwhile, highlighted surgical capacity building as essential to achieving Universal Health Coverage (UHC). Given the renewed emphasis on a comprehensive approach rather than disease-specific interventions, one might anticipate the US aligning with this rhetoric in its allocation of DAH. However, we hypothesise that this is not the case., Methods: We queried the Organization for Economic Co-operation and Development (OECD) database for allocation of US DAH to low- and middle-income countries between 1995 and 2019, thereby excluding data after 2019 to avoid the influence of the coronavirus disease 2019 pandemic. OECD entries were assigned to health systems strengthening (HSS) or disease-specific interventions categories. The WHO building blocks were used as a framework for health systems strengthening., Results: From 1995 to 1999, US DAH allocated to HSS decreased from 42% to 34%. The allocation decreased further from 34% in 2000 to 4% in 2007; correspondingly, DAH allocated to disease-specific interventions increased from 67% to 96%. Between 2008 and 2019, the distribution of US DAH remained relatively stable, with funds allocated to HSS versus disease-specific interventions ranging from 3-12% and 88-98% respectively., Conclusions: While total US DAH contributions in the 1990s and early 2000s were significantly lower compared to the decade that followed, the distribution of these funds was more evenly divided between HSS and disease-specific interventions. Despite attempts by the WHO and United Nations to redirect attention to HSS as the path to achieving UHC, the US continues to largely support disease-specific interventions and overlook the importance of HSS, including surgical capacity building., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: The role of evaluation evidence in guiding health systems strengthening (HSS) investments at the global-level remains contested. A lack of rigorous impact evaluations is viewed by some as an obstacle to scaling resources. However, others suggest that power dynamics and knowledge hierarchies continue to shape perceptions of rigor and acceptability in HSS evaluations. This debate has had major implications on HSS resource allocation in global-level funding decisions. Yet, few studies have examined the relationship between HSS evaluation evidence and prioritization of HSS. In this paper, we explore the perspectives of key global health stakeholders, specifically around the nature of evidence sought regarding HSS and its potential impact on prioritization, the challenges in securing such evidence, and the drivers of intra- and inter-organizational divergences. We conducted a stakeholder analysis, drawing on 25 interviews with senior representatives of major global health organizations, and utilized inductive approaches to data analysis to develop themes., Results: Our analysis suggests an intractable challenge at the heart of the relationship between HSS evaluations and prioritization. A lack of evidence was used as a reason for limited investments by some respondents, citing their belief that HSS was an unproven and potentially risky investment which is driven by the philosophy of HSS advocates rather than evidence. The same respondents also noted that the 'holy grail' of evaluation evidence that they sought would be rigorous studies that assess the impact of investments on health outcomes and financial accountability, and believed that methodological innovations to deliver this have not occurred. Conversely, others held HSS as a cross-cutting principle across global health investment decisions, and felt that the type of evidence sought by some funders is unachievable and not necessary - an 'elusive quest' - given methodological challenges in establishing causality and attribution. In their view, evidence would not change perspectives in favor of HSS investments, and evidence gaps were used as a 'convenient excuse'. Respondents raised additional concerns regarding the design, dissemination and translation of HSS evaluation evidence., Conclusions: Ongoing debates about the need for stronger evidence on HSS are often conducted at cross-purposes. Acknowledging and navigating these differing perspectives on HSS evaluation may help break the gridlock and find a more productive way forward., (© 2024. The Author(s).)

Introduction: A proportion of people develop Long Covid after acute COVID-19, but with most studies concentrated in high-income countries (HICs), the global burden is largely unknown. Our study aims to characterise long-term COVID-19 sequelae in populations globally and compare the prevalence of reported symptoms in HICs and low-income and middle-income countries (LMICs)., Methods: A prospective, observational study in 17 countries in Africa, Asia, Europe and South America, including adults with confirmed COVID-19 assessed at 2 to <6 and 6 to <12 months post-hospital discharge. A standardised case report form developed by International Severe Acute Respiratory and emerging Infection Consortium's Global COVID-19 Follow-up working group evaluated the frequency of fever, persistent symptoms, breathlessness (MRC dyspnoea scale), fatigue and impact on daily activities., Results: Of 11 860 participants (median age: 52 (IQR: 41-62) years; 52.1% females), 56.5% were from HICs and 43.5% were from LMICs. The proportion identified with Long Covid was significantly higher in HICs vs LMICs at both assessment time points (69.0% vs 45.3%, p<0.001; 69.7% vs 42.4%, p<0.001). Participants in HICs were more likely to report not feeling fully recovered (54.3% vs 18.0%, p<0.001; 56.8% vs 40.1%, p<0.001), fatigue (42.9% vs 27.9%, p<0.001; 41.6% vs 27.9%, p<0.001), new/persistent fever (19.6% vs 2.1%, p<0.001; 20.3% vs 2.0%, p<0.001) and have a higher prevalence of anxiety/depression and impact on usual activities compared with participants in LMICs at 2 to <6 and 6 to <12 months post-COVID-19 hospital discharge, respectively., Conclusion: Our data show that Long Covid affects populations globally, manifesting similar symptomatology and impact on functioning in both HIC and LMICs. The prevalence was higher in HICs versus LMICs. Although we identified a lower prevalence, the impact of Long Covid may be greater in LMICs if there is a lack of support systems available in HICs. Further research into the aetiology of Long Covid and the burden in LMICs is critical to implement effective, accessible treatment and support strategies to improve COVID-19 outcomes for all., Competing Interests: Competing interests: JTS was Co-Chair of the ISARIC COVID Global follow up group. NL received a grant from the Italian Ministry of Health to support this work and received support from the National Congress of the Italian Society of Anesthesia and Critical Care Medicine SIAARTI for travel and accommodation expenses to attend a meeting. MoH Trustee is a Trustee of Long Covid Support., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Implementation research (IR) is important for addressing equity in global health. However, there is limited knowledge on how to operationalize IR for health equity, and pathways for improving health equity through IR in global health settings. This paper provides an overview of guidance and frameworks for thinking about health equity as part of IR while noting the gaps in how this guidance and frameworks apply to global health. It proposes an approach to guide implementation teams in the application of IR for achieving equity in global health considering these gaps. It describes key equity considerations for different aspects of IR (i.e., implementation contexts, strategies, outcomes, and research designs). These considerations can be applied prospectively and retrospectively, and at different stages of IR. The paper further describes causal pathways, intervention levers, and strategies for achieving health equity in global health settings through IR. Central to these pathways is the power asymmetries among different actors involved in IR in global health and how these contribute to health inequities. The paper suggests recommendations and strategies for shifting the balance of power among these actors while addressing the structural and systemic determinants of health inequities as part of IR. Explicit considerations for health equity as part of implementation research and practice are needed for the achievement of global health goals. Such explicit considerations should look back as much as possible, and entail defining and analyzing health inequities and intervening on the underlying causes and mechanisms of health inequities as part of IR on a routine basis., (© 2024. The Author(s).)

Antimicrobial resistance (AMR) poses a significant global health threat, primarily stemming from its misuse and overuse in both veterinary and public healthcare systems. The consequences of AMR are severe, leading to more severe infections, increased health protection costs, prolonged hospital stays, unresponsive treatments, and elevated fatality rates. The impact of AMR is direct and far-reaching, particularly affecting the Sustainable Development Goals (SDGs), underscoring the urgency for concerted global actions to achieve these objectives. Disproportionately affecting underprivileged populations, AMR compounds their vulnerabilities, pushing them further into poverty. Moreover, AMR has ramifications for food production, jeopardizing sustainable agriculture and diminishing the livelihoods of farmers. The emergence of antibiotic-resistant bacteria in underprivileged areas heightens the risk of complications and mortality. Climate change further contributes to AMR, as evidenced by increased instances of foodborne salmonellosis and the development of antibiotic resistance, resulting in substantial healthcare costs. Effectively addressing AMR demands collaboration among governments, entrepreneurs, and the public sector to establish institutions and policies across all regulatory levels. Expanding SDG 17, which focuses on partnerships for sustainable development, would facilitate global antimicrobial stewardship initiatives, technology transfer, surveillance systems, and investment in vaccine and drug research. The World Bank's SDG database, tracking progress towards sustainable development, reveals a concerning picture with only a 15% success rate till 2023 and 48% showing deviation, underscoring a global gap exacerbated by the COVID-19 pandemic. Tackling AMR's global impact necessitates international cooperation, robust monitoring, and evaluation methods. The five priorities outlined guide SDG implementation, while impoverished countries must address specific challenges in their implementation efforts. Addressing AMR and its impact on the SDGs is a multifaceted challenge that demands comprehensive and collaborative solutions on a global scale., (© 2024. The Author(s).)

Non-governmental organization (NGO) is one of the important non-state actors in global health governance. The importance of NGO's participation in the global health governance tend to be more prominent due to its flexibility, professionalism, voluntariness and autonomy. The World Health Organization (WHO) established a Civil Society Commission (CSC) in 2023 aiming at strengthening dialogue, facilitating collaboration so as to play its bigger role in the global health governance. This paper is to make analysis to the importance of NGO in global health governance, WHOCSC's organizational structure and operational mechanism, current status and problem of Chinese health-related NGO's participation in the global health governance, and to provide policy suggestions for strengthening Chinese health-related NGOs' participation in global health governance, including incubating Chinese NGOs into national strategy for global health, strengthening resources mobilization and coordination, as well as advocating transparency and society involvement, emphasizing international humanitarian, public welfare and propaganda.

Introduction: The global increase in the aging population presents critical challenges for healthcare systems, social security, and economic stability worldwide. Although the studies of the global rate of aging have increased more than four times in the past two decades, few studies have integrated the potential combined effects of socio-economic, climatic, and environmental factors., Methods: We calculated the geographic heterogeneity of aging population growth rates from 218 countries between 1960 and 2022. Public databases were then integrated to assess the impacts of seven global stressors: socio-economic vulnerability, temperature, drought, seasonality, climate extremes, air pollution, and greening vulnerability on growth rates of aging population (a totally 156 countries). Linear regression models were primarily used to test the statistically significant effects of these stressors on the rate of aging, and multiple model inference was then used to test whether the number of stressors exceeding specific thresholds (e.g., > 25, 50, and 75%) was consistently significant in the best models. The importance of stressors and the number of stressors exceeding thresholds was verified using random forest models for countries experiencing different population aging rates., Results: Our analysis identified significant heterogeneity in growth rates of aging population globally, with many African countries exhibiting significantly lower aging rates compared with Europe. High socio-economic vulnerability, increased climate risks (such as high temperature and intensive extreme climate), and decreased environmental quality were found to significantly increase growth rates of the aging population (P < 0.05). The positive combined impacts of these stressors were diminished at medium-high levels of stressors (i.e., relative to their maximum levels observed in nature). The number of global stressors exceeding the 25% threshold emerged as an important predictor of global aging rates. Demographic changes in regions with relatively rapid aging (e.g., Africa and Asia) are more sensitive to climate change (e.g., extreme climate and drought) and the number of global stressors, and regions with low to medium rates of aging (e.g., Europe and the Americas) are more sensitive to socio-economic vulnerability and environmental stability (e.g., drought, green fragility and air pollution)., Conclusions: Our findings underscore that policy tools or methods must be developed that consider the holistic dimension of the global factor. Further investigations are essential to understand the complex interactions between multiple stressors and their combined effects on global aging., (© 2024. The Author(s).)

Chromoblastomycosis, an implantation mycosis, is a neglected tropical disease that causes decreased quality of life, stigma, and disability. The global burden of disease is unknown and data on disease epidemiology and outcomes are severely limited by a lack of access to needed diagnostic tools and therapeutics. The World Health Organization outlined targets for chromoblastomycosis in the Road Map for Neglected Tropical Diseases 2021-2030, but little progress has been made in initiating and implementing an effective control program globally. This lack of guiding policy and progress led to the recent formation of a Global Chromoblastomycosis Working Group which has developed a global chromoblastomycosis strategy. We describe this strategy, which outlines specific steps needed to improve technical progress, strategy and service delivery, and enablers. Clinicians, researchers, public and government officials, patients, and policy makers can align their time, expertise, and resources to improve the lives of communities affected by chromoblastomycosis through this strategy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Iron deficiency (ID) remains the leading cause of anemia, affects a vast number of persons globally, and continues to be a significant global health burden. Comprehending the patterns of ID burden is essential for developing targeted public health policies., Methods: Using data from the Global Burden of Disease (GBD) 2021 study for the years 1990-2021, the XGBoost model was constructed to predict prevalence and disability-adjusted life years (DALYs) for the period 2022-2050, based on key demographic variables. Shapley Additive exPlanations (SHAP) values were applied to interpret the contributions of each variable to the model's predictions. Additionally, the Age-Period-Cohort (APC) model was used to evaluate the effects of age, period, and birth cohort on both prevalence and DALYs. The relationship between the Socio-Demographic Index (SDI) and ID's age-standardized prevalence rate (ASPR) as well as the age-standardized DALYs rate (ASDR) was also analyzed to assess the influence of socioeconomic development on disease burden., Results: The global prevalent cases of ID grew from 984.61 million in 1990 to 1270.64 million in 2021 and are projected to reach 1439.99 million by 2050. Similarly, global DALYs from ID increased from 28.41 million in 1990 to 32.32 million in 2021, with a projected rise to 36.13 million by 2050. The ASPR declined from 18,204/100,000 in 1990 to 16,433/100,000 in 2021, with an estimated annual percentage change (EAPC) of -0.36% over this period. It is expected to decrease further to 15,922 by 2050, with an EAPC of -0.09% between 2021 and 2050. The ASDR was 518/100,000 in 1990 and 424/100,000 in 2021, with an EAPC of -0.68% from 1990 to 2021. It is expected to remain relatively stable at 419/100,000 by 2050, with an EAPC of -0.02% between 2021 and 2050. In 2021, the highest ASPRs were recorded in Senegal (34,421/100,000), Mali (34,233/100,000), and Pakistan (33,942/100,000). By 2050, Mali (35,070/100,000), Senegal (34,132/100,000), and Zambia (33,149/100,000) are projected to lead. For ASDR, Yemen (1405/100,000), Mozambique (1149/100,000), and Mali (1093/100,000) had the highest rates in 2021. By 2050, Yemen (1388/100,000), Mali (1181/100,000), and Mozambique (1177/100,000) are expected to remain the highest. SHAP values demonstrated that gender was the leading predictor of ID, with age and year showing negative contributions. Females aged 10 to 60 consistently showed higher prevalence and DALYs rates compared to males, with the under-5 age group having the highest rates for both. Additionally, men aged 80 and above exhibited a rapid increase in prevalence. Furthermore, the ASPR and ASDR were significantly higher in regions with a lower SDI, highlighting the greater burden of ID in less developed regions., Conclusions: ID remains a significant global health concern, with its burden projected to persist through 2050, particularly in lower-SDI regions. Despite declines in ASPR and ASDR, total cases and DALYs are expected to rise. SHAP analysis revealed that gender had the greatest influence on the model's predictions, while both age and year showed overall negative contributions to ID risk. Children under 5, women under 60, and elderly men aged 80+ were the most vulnerable groups. These findings underscore the need for targeted interventions, such as improved nutrition, early screening, and addressing socioeconomic drivers through iron supplementation programs in low-SDI regions.

Introduction: Despite progress in the development of new cancer drugs, concerns about equity of access remain. This study aimed to examine the availability and timeliness of availability of new cancer drugs around the globe over the past three decades and their associations with country characteristics., Methods: From a pharmaceutical intelligence database we identified new cancer drugs launched between 1990 and 2022. We calculated the number of new drugs launched in each country and the delay in launches. Using a multivariable linear regression and a Cox regression model with shared frailty, we examined the associations of the country's Gross National Income (GNI) per capita, cancer incidence, number of physicians per population, and Gini index with the number of new cancer drug launches and launch delay in a country, respectively., Results: A total of 568 cancer drugs were launched for the first time globally between 1990 and 2022. Among these, 35% had been launched in only one country by 2022, 22% in 2-5 countries, 15% in 6-10 countries, and 28% in more than 10 countries. The number of new cancer drugs launched in a country in this period ranged from 0 to 345. The average delays from the first global launch to the second, third, fourth, and fifth launch were 18.0 months, 24.3 months, 32.5 months, and 39.4 months, respectively. Our multivariate models showed that higher GNI per capita and cancer incidence in a country were associated with more launches and shorter delays., Conclusion: This research reveals significant disparities in the availability and timeliness of availability of new cancer drugs across countries. These disparities are likely to have contributed to the poor cancer outcomes observed in many countries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Several preliminary studies have been conducted in the field of the prevalence of depression, anxiety, and stress in the elderly population. These studies have examined the prevalence in limited geographic areas with small sample sizes. Also, there are many limitations in the meta-analysis studies. The objective of the present study was to synthesize the global prevalence statistics of depression, anxiety, and stress in the elderly population through a systematic review and meta-analysis., Methods: The present systematic review included retrieval of primary studies from the oldest relevant study up to 2023. To find the relevant studies, international databases such as Scopus, Embase, PubMed, and Web of Science (WoS) were systematically searched. Also, a manual search was performed through the Google Scholar search engine and a review of the sources of related articles. The qualitative assessment of the studies was conducted using the Joanna Briggs Institute (JBI) checklist. Due to a high heterogeneity among the study results, a Random Effects model was chosen., Results: A total of 42 articles on depression, 47 articles on anxiety and 13 articles on stress were included in the meta-analysis. The overall estimates for prevalence based on a random-effects model were as follows: depression, 19.2% (95% CI: 13.0 - 27.5%); anxiety, 16.5% (95% CI: 11.1 - 22.8%); and stress, 13.9% (95% CI: 5.5 - 30.9%). The highest prevalence of depression and anxiety was recorded in Africa. The prevalence of depression was higher in nursing homes, and stress was more prevalent in individuals with COVID-19 compared to other populations., Conclusion: The findings revealed a high prevalence of depression, anxiety, and stress in the elderly population. Therefore, it is recommended that healthcare professionals and policymakers pay more attention to the prevention and management of these disorders in the elderly population., (© 2024. The Author(s).)

Despite some progress, universal access to safe water, sanitation and hygiene (WASH) by 2030-a remit of Sustainable Development Goal 6-remains a distant prospect in many countries. Policy-makers and implementers of the WASH sector are challenged to track a new path. This research aimed to identify core orienting themes of the sector, as legacies of past processes, which can provide insights for its future. We reviewed global policy, science and programmatic documents and carried out 19 expert interviews to track the evolution of the global WASH sector over seven decades. We situated this evolution in relation to wider trends in global health and development over the same time period.With transnational flows of concern, expertise and resources from high-income to lower-income countries, the WASH sector evolved over decades of international institutionalisation of health and development with (1) a focus on technologies (technicalisation), (2) a search for generalised solutions (universalisation), (3) attempts to make recipients responsible for environmental health (responsibilisation) and (4) the shaping of programmes around quantifiable outcomes (metricisation). The emergent commitment of the WASH sector to these core themes reflects a pragmatic response in health and development to depoliticise poverty and social inequalities in order to enable action. This leads to questions about what potential solutions have been obscured, a recognition which might be understood as 'uncomfortable knowledge'-the knowns that have had to be unknown, which resonate with concerns about deep inequalities, shrinking budgets and the gap between what could and has been achieved., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: LGBTQIA+ people worldwide experience discrimination, violence, and stigma that lead to poor health outcomes. Policy plays a crucial role in ensuring health equity and safety for LGBTQIA+ communities. Given Lancet Commissions' substantial impact on health policy across domains, we aimed to determine how LGBTQIA+ communities and their care needs are incorporated throughout Lancet Commission reports and recommendations., Methods: Using critical discourse analysis, we analyzed 102 Commissions for inclusion of and reference to LGBTQIA+ communities using 36 key terms. Three levels of analysis were conducted: 1) micro-level (overview of terminology use); 2) meso-level (visibility and placement of LGBTQIA+ references); and 3) macro-level (outlining characterizations and framing of references with consideration of broader social discourses)., Findings: 36 of 102 (35%) Commissions referenced LGBTQIA+ communities with 801 mentions in total. There were minimal (9/36) references made in the "Executive Summary," "Recommendations," and/or "Key Messages" sections of reports. LGBTQIA+ communities were most frequently discussed in reports related to HIV/AIDS and sexual and reproductive health. Few Commissions related to public health, or chronic conditions (9/60) referenced LGBTQIA+ communities. Some reports made non-specific or unexplained references; many discussed the LGBTQIA+ population without specific reference to sub-groups. LGBTQIA+ communities were often listed alongside other marginalized groups without rationale or a description of shared needs or experiences. We identified framings (legal, vulnerability, risk) and characterizations (as victims, as blameworthy, as a problem) of LGBTQIA+ communities that contribute to problematizing discourse., Conclusions: LGBTQIA+ people were rarely included in the Commissions, resulting in an inadvertent marginalization of their health needs. Policy initiatives must consider LGBTQIA+ groups from a strengths-based rather than problematizing perspective, integrating evidence-based approaches alongside community-based stakeholder engagement to mitigate inequities and promote inclusive care and policymaking., Competing Interests: These authors have no other conflicts to disclose., (Copyright: © 2024 Rosa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study provides a comprehensive analysis of global, continental, and national trends in the prevalence and mortality of prostate cancer (PC), breast cancer (BC), and thyroid cancer (TC). Utilizing 2021 Global Burden of Diseases (GBD2021) data, prevalence and death rates for 2021 were examined, with temporal trends from 1990 to 2021 analyzed via Joinpoint regression. Annual percentage change (APC) and average APC (AAPC) were calculated with 95% CI. Distributive inequalities were quantified using the slope index of inequality and concentration index. In 2021, PC, BC, and TC showed higher global age-standardized prevalence rates (ASPR) in Europe and America compared to Africa and Asia, while higher age-standardized death rates (ASDR) for PC and BC were noted in Africa. Over the study period, significant global increases in ASPR were observed for PC (AAPC = 0.78, 95% CI: 0.67 to 0.89), BC (AAPC = 0.31, 95% CI: 0.24 to 0.37), and TC (AAPC = 1.42, 95% CI: 1.31 to 1.52). Conversely, ASDR significantly decreased for PC (AAPC = -0.83, 95% CI: -0.92 to -0.74), BC (AAPC = -0.48, 95% CI: -0.56 to -0.39), and TC (AAPC = -0.23, 95% CI: -0.29 to -0.17). Variations were observed across continents and time periods, affecting 204 countries and territories. Higher Social Development Index (SDI) levels were associated with a more pronounced burden of these cancers. The findings highlight significant global heterogeneity in prevalence, death rates, and temporal trends of endocrine cancers, with important implications for epidemiology and public health policies.

Introduction: We analyzed the changes in the top 10 non-communicable diseases (NCDs) over the past century across the World Health Organization (WHO) regions., Materials and Methods: The data were extracted from the Global Burden of Disease (GBD) studies. After we accessed this source, all NCDs were sorted according to their prevalence in 2019, and the 10 most common NCDs were selected. Then, the incidence, prevalence, and mortality rates of these 10 NCDs were compared to the rates in 2000., Results: Diabetes and kidney disease had the highest increase in incidence (49.4%) and prevalence (28%) in the Eastern Mediterranean region. Substance use disorders had a huge increase (138%) in the mortality rates among women in the Americas region. On the other hand, women in Southeast Asia experienced the greatest decrease in incidence (-19.8%), prevalence (-15.8%), and mortality rates (-66%)., Conclusion: In recent years, nearly all NCDs have shown an increase, yet mortality rates have declined across all regions. Lifestyle can be a major cause of this increase, but advancements in health and medical services, such as screening and treatment, have played a crucial role in improving survival rates., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Taheri Soodejani.)

The Montreal Protocol has played a critical role in promoting global collective action to phase out the use of ozone-depleting substances, ultimately preventing millions of cases of skin cancer, cataracts and other health issues related to ultraviolet radiation exposure. This success entails transferable lessons for coordinated action required to improve the global governance of other challenges. Like ozone depletion, antimicrobial resistance (AMR) is a challenge of the global commons, requiring coordinated actions across human, animal and environmental sectors. We identify equity, flexibility and accountability as three core governance principles that underlie the success of the protocol and employ the 3-i framework to understand how interests, ideas and institutions contributed to the protocol's success. Equity-promoting strategies consisted of an inclusive negotiation process, supporting developing countries with multilateral funding and a progressive compliance model. Flexibility was built into the protocol through the development of country-specific strategies, reorienting incentive structures for industry and facilitating regular amendments in response to emerging scientific evidence. Accountability was promoted by mobilising public advocacy, establishing targets and enforcement mechanisms and conducting independent scientific and technical assessments. Applying our proposed principles presents an opportunity to improve the global governance of AMR. Finally, we acknowledge limitations to our analysis, including our focus on a single environmental treaty, significantly greater funding requirements and multifacetted stakeholder involvement in the case of AMR, differing market and incentives structures in antibiotic development and distribution, and ethical concerns with using trade restrictions as a policy tool., Competing Interests: Competing interests: SJH is the Vice-President of Corporate Data & Surveillance at the Public Health Agency of Canada (PHAC) and previously served as the Scientific Director of the Institute of Population & Public Health at the Canadian Institutes of Health Research (CIHR). The views expressed in this article are those of the authors and do not necessarily reflect those of PHAC, CIHR or the Government of Canada. All other authors declare no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

In this article, we aimed to evaluate the utility of critical posthumanism for nurses interested in planetary health-a growing area of study that requires a decentering of the human, and environmental justice considerations. We used Chinn and colleagues' method to describe and critically reflect on critical posthumanism, extending the theory analysis method to include a wide range of academic and video sources. We found that critical posthumanism is like a double-edged sword: It provides a lens through which to transcend human-centric approaches to healthcare but is marred by its lack of clarity and inaccessibility. We argue critical posthumanism can be adapted to enhance its potential at the intersection of nursing and planetary health. An analysis of critical posthumanism is followed by a discussion framed by five ways of knowing in nursing, highlighting real-world examples of how critical posthumanism can aid nurses in dealing with planetary health concerns. By exploring the intersections of critical posthumanism with nursing knowledge, we demonstrate how critical posthumanism can enable nurses to comprehend and tackle environmental issues intricately linked to human health., (© 2024 The Author(s). Nursing Inquiry published by John Wiley & Sons Ltd.)

TB disproportionately affects poorer, vulnerable people and communities, and has severe social and economic impacts on those affected. However, many countries do not yet include social protection in their programmatic response to TB. Here, we provide a critical perspective on the guidance developed by the WHO and the International Labour Organization (ILO) to help countries implement social protection programmes. The guidance emphasises the need for a multisectoral response to TB, and includes practical information on how to design appropriate social protection programmes that respond to the needs of people affected by TB.

Competing Interests: ML has received grant by the Major International (Regional) Joint Research Project, National Natural Science Foundation of China (grant number 81620108009). SW has received grants from the National Natural Science Foundation of China (grant number 82171285), the Science and Technology Department of Sichuan Province (grant number 2024YFHZ0330), and the 1·3·5 Project for Disciplines of Excellence—Clinical Research Fund, West China Hospital, Sichuan University (2024HXFH022) for stroke research.

Background: WHO infection prevention and control (IPC) minimum requirements provide standards to reduce the risk of infection during health-care delivery. We aimed to investigate the global implementation of these requirements at national levels and the progress of doing so across 2021-22 compared with 2017-18 to identify future directions for interventions., Methods: National IPC focal points were invited to complete an online survey measuring IPC minimum requirements from July 19, 2021, to Jan 31, 2022. The primary outcome was the proportion of countries meeting IPC minimum requirements. Country characteristics associated with this outcome were assessed with beta regression. Subset analyses were conducted to compare the 2021-22 indicators with a WHO IPC survey conducted in 2017-18 and to assess the correlation of the proportion of IPC minimum requirements met with the results of other WHO metrics., Findings: 106 countries (ie, 13 low income, 27 lower-middle income, 33 upper-middle income, and 33 high income) participated in the survey (56% response rate). Four (4%) of 106 met all IPC minimum requirements. The highest scoring IPC core component was multimodal improvement strategies and the lowest was IPC education and training. The odds of meeting IPC minimum requirements was higher among high-income countries compared with low-income countries (adjusted odds ratio 2·7, 95% CI 1·3-5·8; p=0·020). Compared with the 2017-18 survey, there was a significant increase in the proportion of countries reporting an active national IPC programme (65% to 82%, p=0·037) and a dedicated budget (26% to 44%, p=0·037). Evaluation of the IPC minimum requirements compared with other survey instruments revealed a low positive correlation., Interpretation: To build resilient health systems capable of withstanding future health threats, urgently scaling up adherence to WHO IPC minimum requirements is essential., Funding: WHO., Translations: For the French and Spanish translations of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)

The differential diagnosis of multiple sclerosis can present specific challenges in patients from Latin America, Africa, the Middle East, eastern Europe, southeast Asia, and the Western Pacific. In these areas, environmental factors, genetic background, and access to medical care can differ substantially from those in North America and western Europe, where multiple sclerosis is most common. Furthermore, multiple sclerosis diagnostic criteria have been developed primarily using data from North America and western Europe. Although some diagnoses mistaken for multiple sclerosis are common regardless of location, a comprehensive approach to the differential diagnosis of multiple sclerosis in Latin America, Africa, the Middle East, eastern Europe, southeast Asia, and the Western Pacific regions requires special consideration of diseases that are prevalent in those locations. A collaborative effort has therefore assessed global differences in multiple sclerosis differential diagnoses and proposed recommendations for evaluating patients with suspected multiple sclerosis in regions beyond North America and western Europe., Competing Interests: Declaration of interests JC declares receiving grants or research contracts from Biogen and Merck; personal compensation for consulting from Merck; payment or honoraria for lectures from Biogen, Merck, Bristol Myers Squibb, Novartis, and Roche; and support for attending meetings and travel from Merck. JC is a deputy chair International Medical and Scientific Board of Multiple sclerosis International Federation (MSIF), unpaid; and has received equipment, materials, drugs, medical writing, gifts, or other services from Novartis (Investigator initiated award). AJS declares receiving grant funding from National Institute of Neurological Disorders and Stroke, National Institutes of Health and Bristol Myers Squibb (investigator initiated award); has done contracted research with Sanofi, Biogen, Novartis, Actelion, and Genentech; has received personal compensation for consulting from Emmanuel Merck, Darmstadt, Serono and Octave Bioscience; has received payments or honoraria for lectures from Emmanuel Merck, Darmstadt, Serono; has received expert testimony from The Jacob D Fuchsberg Law Firm and Koskoff Koskoff & Bieder; is a participant on a Data Safety Monitoring Board for the Patient Centered Research Institute, and Yale University; declares participation on an advisory board for Genentech, Biogen, Alexion, Celgene, Greenwich Biosciences, TG Therapeutics, and Horizon Therapeutics; and is a content Chair for the American Academy of Neurology (AAN) Institute Multiple Sclerosis Quality Measure Development Work Group and Section Editor for Multiple Sclerosis and Related Disorders. JAC declares personal compensation for consulting from Astoria, Bristol-Myers Squibb, Convelo, EMD Serono, FiND Therapeutics, INMune, and Sandoz; and serving as an editor of Multiple Sclerosis Journal. BLB is funded by the National Multiple Sclerosis Society, and National Institute of Health; is a consultant for Roche, and Sanofi; and is a Board Director AAN (unpaid). TG has served as a consultant and received compensation from Genentech, Horizon, Sanofi, Alexion, and Greenwich Biosciences. BH declares grants from the European Union, Bundesministerium für Bildung und Forschung, and Deutsche Forschungsgemeinschaft; received personal compensation for consulting from Sandoz, Novartis, and GLG consulting; holds patents for antibodies against KIR4·1 in a subpopulation of patients with multiple sclerosis (2012) and genetic determinants of neutralising antibodies to interferon (filed 2010); and participated in a Data Safety and Monitoring Board for Novartis, Allergy Care DSMB, TG Therapeutics, and Polpharma, and Advisory Board for Novartis. HJK declares a research grant from the National Research Foundation of Korea and research support from Aprilbio, UCB, and Eisai; has received consultancy fees from Altos Biologics, AstraZeneca, Biogen, Daewoong, Kaigene, Kolon Life Science, MDimune, Merck Serono, and Roche; declares honoraria for lectures from Alexion, Eisai, GCPharma, Handok, Mitsubishi Tanabe Pharma, and Sanofi Genzyme; has received personal compensation for participation on a Data Safety Monitoring Board from Sanofi-Genzyme; has received compensation as Co-editor for the Multiple Sclerosis Journal and Associate Editor for the Journal of Clinical Neurology; and is a Vice President of Pan-Asian Committee on Treatment and Research in Multiple Sclerosis (unpaid). RAM declares grants or contracts from Biogen, Idec, and Roche. FM has received research funding to her institution from Sumaira Foundation, Genentech, Biogen, Horizon Therapeutics, US National Histitute Institute of Health, US Department of State, Foundation Pierre Fabre, and Novartis; has received consulting fees from Alexion, EMD Serono, Genentech, TG Therapeutics, and Horizon Therapeutics; and declares shares of the startup company Brain Capture (not related to the content of this manuscript). SDN declares grants or contracts (paid directly to institution) from Biogen, Roche, Genentech, National MS Society, Department of Defense, and Patient Centered Outcomes Research Institute; has received personal compensation for consulting from Biogen, Roche, Genentech, Bristol Myers Squibb, EMD Serono, Greenwich Biosciences, Novartis, Horizon Therapeutics, and TG Therapeutics; and is a study lead principal investigator for a Roche clinical trial programme. MAS declares personal honoraria for lectures from Roche, Biogen, Cinnagen, NanoAlvand, Merck, Novartis, and Abidi. DKS declares grants or research contracts from CNPq / Brazil 425331/2016–4 and 308636/2019–8, and Brazilian National Council for Scientific and Technological Development; has received investigator initiated awards from TEVA, Merck, and Biogen; has received personal compensation for consulting from Roche, and Alexion; declares personal honoraria for lectures from Roche, Alexion, Horizon, Merck, Americas Health Foundation; and is a member of International Society of Neuroimmunology, International Advisory Board (unpaid), and Academia Brasileira de Neurologia, Educational Committee (unpaid). DS declares a pilot research grant from the National MS Society paid to the Institution; declares receipt of personal honoraria for lecturing from Roche Pharmaceuticals; declares travel support from Roche Pharmaceutical; and is a Committee member and chair of Multiple Sclerosis International Federation (unpaid). AS has received grants or contracts from the Turkish MS Society, Istanbul University-Cerrahpasa Research Support Funds, and The Scientific and Technological Research Council of Türkiye Health Sciences Research Grants; has received consulting fees from Roche, Merck-Serono, Biogen Idec/Gen Pharma of Turkey , Sanofi-Genzyme, Novartis, and Alexion; has received honoraria for lectures from Sanofi-Genzyme, Novartis, TEVA, and Roche; and has received support for attending meetings from Sanofi-Genzyme, Roche, Merck-Serono, and Alexion. KT declares personal consulting fees from Merck and Eisai; declares payment for lectures from Merck, Eisai, Roche, and Terumo Blood and Cell Technology; and is a member of the Organizing Committee Pan-Asian Committee for Treatment and Research in Multiple Sclerosis (unpaid). MW has received publication royalties from Springer and Elsevier; has received consultancy honoraria from Icometrix, Imcyse, Novartis, Sanofi, Merck, and Biologix; declares personal compensation for lectures or presentations from Alexion, Bayer Healthcare, Biogen, Biologix, Bristol Myers Squibb, Celgene, Genilac, Imcyse, Icometrix, Merck-Serono, Novartis, Roche, and Sanofi-Genzyme; and declares support for attending meetings from Merck-Serono. BGW declares royalties from RSR, Hospices Civils de Lyon, MVZ Labor PD Dr Volkmann und Kollegen GbR , and Oxford University; declares personal consulting fees from Roche, Horizon Therapeutics, Cambridge Pharmaceuticals, and Mitsubishi Tanabe; has received payments for lecture presentations from Roche and Horizon; has a patent planned for NMO-IgG for diagnosis of neuromyelitis optica; and declares participation on a Data Safety Monitoring Board and Advisory borads for Alexion MedImmune/VielaBio/Horizon, and UCB Biosciences. KF declares grants from Ministry of Education, Culture, Sports, Science and Technology of Japan and Ministry of Health, Welfare and Labor of Japan; has received personal compensation for consulting from Merck Biopharma, Japan Tobacco, and Abbvie; has received payment or honoraria forlectures and presentations from Biogen, Eisai, Mitsubishi Tanabe, Novartis, Chugai/Roche, Alexion, VielaBio/Horizon Therapeutics, Teijin, Asahi Kasei Medical, Merck, and Takeda; declares participation in an Advisory Board for Biogen, Mitsubishi Tanabe, Novartis, Chugai/Roche, Alexion, VielaBio/Horizon Therapeutics, and UCB; serves as President of the Pan-Asian Committee for Treatment and Research in Multiple Sclerosis (unpaid), President of the Japanese Society of Neuroimmunology (unpaid), is a Board Member of the Japan Multiple Sclerosis Society (unpaid), is a board member of theEuropean Charcot Foundation (unpaid), and is a Member of the International Medical and Scientific Board, MSIF (unpaid). All other authors declared no competing interest., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)