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Background: To date, no studies have assessed how the World Health Organization's (WHO) work operationalizes health equity in practice. To fill the gap, this study investigates the WHO's Urban Health Equity Assessment and Response Tool (Urban HEART) that focuses on assessing and responding to inequities within cities. This qualitative research answers the question: "how does Urban HEART and associated policy and practice align (or not) with inconsistent approaches to health in/equity?" In other words, asking if past findings from investigating WHO key texts also transpire into Urban HEART and its practices., Methods: Purposive sampling was employed to undertake synchronous electronic interviews with key informants to glean a multi-faceted perspective of how equity was operationalized through Urban HEART. Data was collected from 18 key informants who had diverse experiences with Urban HEART., Results: The results of this study provided insights on how the WHO's Urban HEART fares with respect to the three inconsistencies. For the first inconsistency, measurement, Urban HEART was evaluated to measure inequities across districts and neighbourhoods, but not inter-city, demonstrating alignment with WHO texts discussing measurement across groups and not individuals. For the second inconsistency, the goals or approaches sought in striving for health equity, despite Urban HEART presenting "three main approaches to reduce health inequities," informants expressed the most alignment of Urban HEART action with only one of these approaches ("targeting disadvantaged population groups or social classes"). However, informants also shared how actions taken as part of Urban HEART largely aligned with "striving for a baseline level of health for all," which is not explicitly specified by the WHO as a main approach. And lastly, in assessing the third inconsistency of whether Urban HEART aligned with addressing inequity through focusing on socioeconomic status/position versus broader social determinants of health, Urban HEART was strongly aligned with the latter., Conclusions: This study presents disconnects between WHO's intentions and actions that followed from Urban HEART. Moving forward, it would be important to discuss goals or approaches sought, prior to any global health initiatives, whether explicitly focused on health equity or not., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Health Sciences Research Ethics Board at the University of Toronto (protocol number: 39543) and informed consent was received from all key informants. This study was performed in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: MA reports short-term instances of consulting for the World Health Organization and membership with the World Health Organization Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity. ED reports co-directing the World Health Organization Collaborating Centre in Health Promotion. AS reports involvement on the World Health Organization Commission on Social Determinants of Health. The remaining authors declare that they have no competing interests., (© 2025. The Author(s).)

Introduction: The health consequences of secondhand smoke (SHS) are a long-standing concern. The WHO Framework Convention on Tobacco Control (FCTC) is an evidence-based treaty that aims to protect people from health and environmental harms of commercial tobacco use and exposure to SHS. This study quantified the prevalence of daily smoking inside the house (indoor smoking) and change over time and examined the determinants of indoor smoking in 24 WHO FCTC Parties., Methods: We used data from the 2 most recent Demographic and Health Surveys (DHS) from 24 countries. Counties were selected if they submitted at least one FCTC implementation report and had two DHS surveys conducted after 2010. The weighted prevalence and percentage changes in daily indoor smoking in the two consecutive surveys were calculated, including rate of change, and a two-sample test of proportions was used to assess changes. Multinomial logistic regression model was employed to examine the association between socioeconomic characteristics and indoor smoking. All results were presented by country., Results: A significant decline in the prevalence of daily indoor smoking was detected in 16/24 countries, with the rate of decline ranging from -45.8% in Liberia to -15.2% in India. Jordan reported a significant increase in daily indoor smoking from 57% to 60%; p=0.002. The meta-analytical estimate showed that overall, the relative risk ratio (RRR) of daily indoor smoking was significantly lower for households in the 5th wealth quintile compared with counterparts in the 1st quintile (RRR=0.40; 95% CI: 0.30 to 0.52), and in households where head of the household attended higher education compared with no formal education (RRR=0.60; 95% CI: 0.53 to 0.69)., Conclusions: This study demonstrated that prevalence of daily indoor smoking was associated with low socioeconomic status. Reducing SHS exposure is critical, including addressing inequities to help improve health outcomes. Currently, over 2.8 billion people in low-income countries are not protected by smoke-free environment laws, and only 18% of the world's population is covered by strong restrictions on tobacco marketing., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

The WHO South-East Asia Region (SEAR), with its high population density, is recognised by epidemiologists as a critical reservoir for the emergence and global dissemination of novel influenza strains, making it a potential epicentre for future influenza pandemics. Despite this significant risk, most SEAR countries lack comprehensive seasonal influenza vaccination policies, resulting in low vaccine uptake across the region. This review analysed the latest WHO National Influenza Programme factsheets from the 11 SEAR member states and supplemented this with extensive manual literature searches using electronic databases and government websites. As of October 2022, only three countries-India, Bhutan and Thailand-had established seasonal influenza vaccination policies. Among them, Bhutan and Thailand have policies that cover all five WHO-recommended high-risk groups. While national influenza surveillance systems are in place across SEAR, only India and the Democratic People's Republic of Korea claim full population coverage. Influenza vaccine production capacity is limited to Bangladesh, India and Indonesia. The region's varied climatic conditions and insufficient local data have further obscured the true burden of influenza. Thailand offers a successful model for other countries in the region, beginning with the most vulnerable groups and gradually expanding coverage. To effectively develop and implement national influenza vaccination policies, SEAR countries must close the evidence gap by strengthening surveillance systems to provide accurate, timely data and prioritise context-specific research, leverage existing vaccine infrastructure, enhance public education and finally engage with local and international stakeholders to establish strong international cooperation to support these efforts and improve pandemic preparedness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: The Oral Health Country/Area Profile Project (CAPP) is the largest global database on oral health, compiling information from 205 countries, including 193 members of the World Health Organization (WHO). Although this database is a source of information and provides an overview of global oral health, the extent to which it accurately reflects oral health in specific countries is uncertain., Objective: To analyze the quality of evidence underlying the global oral health profile provided by CAPP., Methods: The Appraisal tool for Cross-Sectional Studies (AXIS) was adapted and used to assess data extracted from the methods section of included records. The results were then analyzed using the Item Response Theory (IRT) to establish the weightings of each dimension. The score was assessed in relation to variables of interest: age group, year of the record, and geographic region., Results: The quality of oral health data showed polarization, with The quality of data from included documents varied according to age group analyzed, year of assessment, and geographic region. The Americas and Western Pacific regions demonstrated the highest quality of oral health data., Conclusion: The global oral health profile depicted by CAPP may not accurately reflect reality. The process for including data in the database needs to be reviewed to ensure its reliability., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright: © 2025 Queiroz Marques dos Santos, Giuseppe Roncalli da Costa Oliveira. 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.)

Abstract: The International Consensus (ICC) and World Health Organization fifth edition (WHO5) classifications introduced new, but differing, categories of myeloid disease defined by TP53 mutations. We reviewed a cohort of 188 cases of TP53-mutated myeloid disease to determine how diagnoses and outcomes differ between the 2 classifications. Overall, 120 (64%) cases were classified differently by the ICC and WHO5, including 24 of 80 (30%) cases with <20% blasts. These cases were discrepantly categorized primarily because of inclusion of complex karyotype (CK) as a surrogate for biallelic TP53 inactivation only in the ICC. However, there were no significant differences in clinicopathologic characteristics or overall survival between cases categorized as TP53-mutated disease by both classifications and those with a single TP53 mutation and CK, suggesting that CK reliably identifies TP53-mutated cases with biallelic TP53 inactivation. Most cases of acute myeloid leukemia (AML; 96/102 [94%]) were discrepantly diagnosed between the ICC and WHO5 because of the introduction of AML with mutated TP53 as a distinct category only in the ICC. Nearly all of these were instead diagnosed as AML, myelodysplasia related (AML-MR) by WHO5. However, when compared with a separate cohort of patients with AML-MR without TP53 mutations, patients with TP53-mutated AML showed a distinct genetic profile and significantly worse overall survival, supporting the inclusion of AML with mutated TP53 as a distinct disease category. Overall, our results show that a significant percentage of TP53-mutated myeloid disease is classified differently by the ICC and WHO5 and highlight areas to address in future classification systems., (© 2025 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Meningiomas are the most frequent primary intracranial tumors. Hence, they constitute a major share of diagnostic specimens in neuropathology practice. The 2021 WHO Classification of Central Nervous System Tumors ("CNS5") has introduced the first molecular grading parameters for meningioma with oncogenic variants in the TERT promoter and homozygous deletion of CDKN2A/B as markers for CNS WHO grade 3. However, after the publication of the new classification volume, clarifications were requested, not only on novel but also on long-standing questions in meningioma grading that were beyond the scope of the WHO "blue book." In addition, more recent research into possible new molecular grading parameters could not yet be implemented in the 2021 classification but constitutes a compelling body of literature. Hence, the consortium to inform molecular and practical approaches to CNS tumor taxonomy-not official WHO (cIMPACT-NOW) Steering Committee convened a working group to provide such clarification and assess the evidence of possible novel molecular criteria. As a result, this cIMPACT-NOW update provides guidance for more standardized morphological evaluation and interpretation, most prominently pertaining to brain invasion, identifies scenarios in which advanced molecular testing is recommended, proposes to assign CNS WHO grade 2 for cases with CNS WHO grade 1 morphology but chromosomal arm 1p deletion in combination with 22q deletion and/or NF2 oncogenic variants, and discusses areas in which the current evidence is not yet sufficient to result in new recommendations., (Published by Oxford University Press on behalf of the Society for Neuro-Oncology 2024.)

Background: To describe the implementation of the ICOPE program in France using a digital tool in order to: (1) describe the characteristics of people completing the screener, identifying differences across assessors (healthcare professionals (HCPs), non-HCPs, or self-assessment); (2) describe the characteristics of follow-up and assessments for people with abnormal screening test; and (3) describe the recommendations in the intervention care plans for people with a decline in intrinsic capacity., Methods: A descriptive study, presenting the results at initial screening, as well as at assessment when needed, and the recommendations issued during Step 3. We compared these results based on whether the participant was enrolled by an HCP, by a non-HCP, or by self-assessment., Results: A total of 27 082 participants were enrolled. 67.9% were registered by HCPs. 90.8% participants screened positive at Step 1. Participants who completed the self-assessment were significantly younger (70.9 years vs 76.4 for HCPs or 77.9 for non-HCPs, p < .01) and less frequently had alerts in Step 1 (83.8% vs 90.8% for HCPs or 94.8% for non-HCPs). Step 2 in-depth assessments were carried out for 8.9% of the participants. In Step 2, only the SPPB showed significantly better motor abilities in individuals enrolled through self-assessment (median and IQR: 11 (10-12) vs 10 (8-12) for HCPs and 10 (7-12) for non-HCPs). Prevention care plans were proposed, mainly physical activity (n = 833, 33.7%) and nutrition counseling (n = 1 233, 51.7%)., Conclusions: This study highlights the major role of HCPs in the implementation of the ICOPE program. Self-assessment enables the enrollment of more robust seniors, allowing for an early detection and treatment., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The problem caused by viral hepatitis is a major public health challenge faced in the past decade, and the global goal of eliminating viral hepatitis by 2030 is still far away. With the use of hepatitis B vaccine and the launch of new drugs, there are more means to control viral hepatitis and more technologies to prevent, diagnose and treat it. While improving the coverage of vaccine use, drugs for treating hepatitis B are not only becoming more effective, but also decreasing in price. The objective of this article was to explore the urgent issues that need to be addressed in global viral hepatitis with the increasing availability of vaccines and antiviral drugs., Main Text: The updated World Health Organization guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection (2024 edition) and Chinese guidelines for the prevention and treatment of chronic hepatitis B (version 2022) simplify clinical algorithms for the diagnosis, treatment, and monitoring of hepatitis B, expand treatment eligibility criteria, and provide alternative treatment options, which will cover a higher proportion of all hepatitis B surface antigen positive populations. These actions promote the global goal of eliminating the public health hazards of viral hepatitis by 2030. Among the countries that have made remarkable progress in eliminating viral hepatitis policies, the key strategy is to simplify the diagnosis and treatment plan. Furthermore, the World Health Organization has identified 38 priority countries for viral hepatitis. Expand access to viral hepatitis services in these countries., Conclusions: Regions and countries with the high burden of viral hepatitis still need to take urgent action regarding the new measures proposed by the WHO to achieve the 2030 targets. First, countries must establish a complete public health system aligned with the World Health Organization's strategy. Second, provide effective, people-oriented services and public prevention strategies. Third, prioritize the implementation of health strategies in the 38 identified priority countries. Finally, use complete and measurable data to monitor progress., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The author declares no competing interests., (© 2025. The Author(s).)

Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts., Objective: This paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs., Methods: A DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings., Unlabelled: Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health., Conclusions: Country experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact., (© Rosemary K Muliokela, Kuwani Banda, Abdulaziz Mohammed Hussen, Sarai Bvulani Malumo, Andrew Kashoka, Angel Mwiche, Innocent Chiboma, Maria Barreix, Muyereka Nyirenda, Zvanaka Sithole, Natschja Ratanaprayul, Berhanu Fikadie Endehabtu, Hanna Abayneh Telake, Adane Weldeab, William J M Probert, Ӧzge Tunçalp, Ernest Maya, Mulatu Woldetsadik, Binyam Tilahun, Chris Guure, Kafui Senya, Lale Say, Tigest Tamrat. Originally published in JMIR Medical Informatics (https://medinform.jmir.org).)

On 20 January, President Trump announced the withdrawal of the United States from the World Health Organization (WHO). President Trump shares many of the same concerns about WHO as previous administrations, including improved transparency, financial oversight, and accountability. He also believes that China has exerted undue influence on WHO-a charge that WHO adamantly denies. But the US cannot influence WHO if it is not at the table. WHO will remain at the center of global health governance, but this withdrawal will limit US leadership to protect public health and challenge WHO coordination in facing global challenges.

The introduction of the Sustainable Development Goals by the United Nations has set a global target for achieving Universal Health Coverage, requiring resilient health systems capable of addressing public health emergencies and ensuring health security. Public health surveillance, crucial for detecting and responding to infectious disease outbreaks, is key to building health system resilience. Due to the high levels of mobility and political instability in the Middle East and North Africa (MENA) region, unique challenges arise in cross-border health surveillance. This review aims to highlight the importance of cross-border public health surveillance in strengthening health systems across MENA to achieve equitable health outcomes.A mixed-methods approach was utilized, combining a systematic literature review with semi-structured in-depth interviews (IDIs) involving 28 stakeholders from seven MENA countries. The literature review adhered to PRISMA guidelines, while the IDIs provided qualitative insights into current surveillance practices and challenges. Findings from the literature review and IDIs were triangulated and analyzed using the WHO Health Systems Strengthening (HSS) Building Blocks Framework to identify key challenges and recommendations for improving cross-border surveillance.Results indicate that existing cross-border surveillance systems in MENA face challenges in data collection, analysis, and sharing, with disparities across countries based on income levels and political contexts. Key challenges include delayed and incomplete data sharing, insufficient funding across sectors, inadequate training, inconsistent data definitions, and limited integration of health data for mobile populations. Recommendations emphasize strengthened governance and leadership to facilitate regional cooperation and information sharing, sustainable financing for implementing a One Health approach, utilizing innovative information systems, workforce development to enhance data collection and analysis, and secure supply chains for medicines and vaccines and equitable service delivery for all mobile populations.In conclusion, the WHO HSS Building Block Framework provides a comprehensive approach to assessing and improving cross-border public health surveillance and enhancing health security and equity in MENA. Strengthening cross-border surveillance systems may help MENA countries meet IHR requirements, achieve greater health security, and advance health equity among all types of mobile populations. Despite limitations, the study offers critical insights for improving cross-border surveillance strategies in the region., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the University of California San Francisco Human Research Protection Program Institutional Review Board (IRB, study number: 22–37958). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. The participants were invited to participate by email, accepted participation by email and provided verbal informed consent for participation and recording. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The COVID-19 pandemic represents one of the most challenging public health emergencies in recent world history, causing about 7.07 million deaths globally by September 24, 2024. Accurate, timely, and consistent data are critical for early response to situations like the COVID-19 pandemic., Objective: This study aimed to evaluate consistency of daily reported COVID-19 cases in 191 countries from the Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE) and the World Health Organization (WHO) dashboards during 2020-2022., Methods: We retrieved data concerning new daily COVID-19 cases in 191 countries covered by both data sources from January 22, 2020, to December 31, 2022. The ratios of numbers of daily reported cases from the 2 sources were calculated to measure data consistency. We performed simple linear regression to examine significant changes in the ratio of numbers of daily reported cases during the study period., Results: Of 191 WHO member countries, only 60 displayed excellent data consistency in the number of daily reported COVID-19 cases between the WHO and JHU CSSE dashboards (mean ratio 0.9-1.1). Data consistency changed greatly across the 191 countries from 2020 to 2022 and differed across 4 types of countries, categorized by income. Data inconsistency between the 2 data sources generally decreased slightly over time, both for the 191 countries combined and within the 4 types of income-defined countries. The absolute relative difference between the 2 data sources increased in 84 countries, particularly for Malta (R2=0.25), Montenegro (R2=0.30), and the United States (R2=0.29), but it decreased significantly in 40 countries., Conclusions: The inconsistency between the 2 data sources warrants further research. Construction of public health surveillance and data collection systems for public health emergencies like the COVID-19 pandemic should be strengthened in the future., (© Han Liu, Huiying Zong, Yang Yang, David C Schwebel, Bin Xie, Peishan Ning, Zhenzhen Rao, Li Li, Guoqing Hu. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Meningiomas, the most common primary intracranial neoplasms, account for more than one-third of primary CNS tumors. While traditionally viewed as benign, meningiomas can be associated with considerable morbidity, and specific meningioma subgroups display more aggressive behavior with higher recurrence rates. The risk stratification for recurrence has been primarily associated with the World Health Organization (WHO) histopathologic grade and extent of resection. However, a growing body of literature has highlighted the value of molecular characteristics in assessing recurrence risk. While maintaining the previous classification system, the 5th edition of the 2021 WHO Classification of Central Nervous System tumors (CNS5) book expands upon the molecular information in meningiomas to help guide management. The WHO CNS5 stratifies meningioma into 3 grades (1-3) based on histopathology criteria and molecular profile. The telomerase reverse transcriptase promoter mutations and cyclin-dependent kinase inhibitor 2A/B ( CDKN2A / B) deletions now signify a grade 3 meningioma with increased recurrence risk. Tumor location also correlates with underlying mutations. Cerebral convexity and most spinal meningiomas carry a 22q deletion and/or NF2 mutations, while skull base meningiomas have AKT1 , TRAF7 , SMO , and/or PIK3CA mutations. MRI is the primary imaging technique for diagnosing and treatment-planning of meningiomas, while DOTATATE PET imaging offers supplementary information beyond anatomic imaging. Herein, we review the evolving molecular landscape of meningiomas, emphasizing imaging/genetic biomarkers and treatment strategies relevant to neuroradiologists., (© 2025 by American Journal of Neuroradiology.)

Intro: The article tests the hypothesis that we can draw practical knowledge from the experience of service providers operating in the past. The research questions were formulated: can the historical example of the organization of medical care in the Polish Children's Hospital named after Karol and Maria be used as a viable example today? Is it relevant for contemporary practitioners? And do we still use the knowledge of predecessors? The authors decided to use the interwar Hospital and an operating paediatric ward of the Child-Friendly Hospital for a comparative analysis., Methods: The model of the European Regional Office of the World Health Organization for integrated delivery of health services was adopted as the analysis framework. We based the analysis on descriptive methods, starting with a literature review of routine activities of the Karol and Maria Hospital (historical example) and a paediatric hospital in Poland (contemporary example), then we conducted a comparative transversal study concerning the extent to which integrated care occurs in the WHO model. Finally, the elements of the process evaluation were used in the work., Results: The research model used enabled us to provide answers to the research questions formulated. The comparative study of a historical hospital and a contemporary one has shown that some problems and ways of solving them constantly reappear in the discussion on the management of evidence-based medical care. Sourcing good practices from the past can be a good research method for current practitioners., Conclusion: It seems that while the technical aspects of integrated care initiated in the past are developing perfectly, the approach to the evidence-based medicine is waiting to be developed again., (© 2024 John Wiley & Sons Ltd.)

The 5th Edition of the "WHO Classification of Tumours: Urinary and Male Genital Tumours" introduces several significant updates to the classification of testicular tumours. These updates include revised terminology for special germ cell tumour subtypes (neuroectodermal and neuroendocrine tumours) of the testis. Additionally, the signet-ring stromal tumour and myoid gonadal stromal tumour have been introduced as distinct entities within the sex-cord stromal tumours. Moreover, new combined sections have been created for lymphatic neoplasms and soft tissue tumours of the urinary and male genital tract., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: A. Fichtner, M. Zielke und F. Bremmer geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Electronic health record (EHR) systems are powerful tools that enhance healthcare quality. They improve efficiency, enable data exchange, and ensure authorized access to patient information. In 2022, the World Health Organization Regional Office for Europe (WHO EURO) conducted a survey to assess the digital health capabilities of the 53 Member States. This article provides a sub-regional analysis of the status of EHR systems and major barriers to their implementation, their readiness for information sharing, and the access and re-use of EHR data. Generally, EHR implementation and national data exchange are at an advanced stage in the region, though achievements and challenges vary across subregions. While more Member States in the Eastern, Western, and Southern Europe subregions reported having centralized national EHR systems, the situation is more diverse in Northern Europe and the Asian subregions, where both centralized and decentralized EHR systems are in use. Significant barriers to EHR implementation, including funding, technical capacity, competing priorities, and lack of interoperability standards are frequently cited, while others like demand, knowledge or acceptance challenges are not reported as significant. Significant barriers were reported the most by the Central Asia subregion, while barriers had least significance in Western Europe. Five out of the six subregions reported a wide adoption of national strategies and have dedicated agencies to ensure interoperability and secure data exchange. However, only 29 Member States have established legal requirements for healthcare providers to adopt EHR systems that conform to national standards for both clinical terminology and electronic messaging, with this being most notable in Western, Eastern, and Northern Europe, and the lowest percentage of Member States in Central Asia. All Member States of the six sub regions have passed privacy and data protection legislation. The use of EHR data is widely regulated, with only five remaining Member States of WHO Europe to develop EHR legislation distributed across subregions (Southern Europe, Western and Central Asia). Looking ahead, Member States are encouraged to define national legislation governing EHR systems and their use, while ensuring the interconnectivity of the local and regional EHR systems. Sustainable funding should be allocated to the development and maintenance of these systems. Efforts should also focus on creating comprehensive roadmaps for the full implementation of health data standards, addressing interoperability at local and regional levels, and developing quality management systems for testing and certification. Additionally, monitoring and evaluation should be conducted to assess whether EHRs are contributing to national health objectives. Finally, engaging patients and intersectoral partners will be key to developing a more patient-centered approach, ensuring that EHR systems meet patient needs and expectations., 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. This publication has been produced with the financial assistance of the European Union. The contents of this publication can in no way be taken to reflect the views of the European Union., (Copyright © 2024. Published by Elsevier B.V.)

Background and Objectives: Isocitrate dehydrogenase (IDH)-mutant astrocytomas central nervous system World Health Organization grade 2 and 3 show heterogeneous appearance on MRI. In the premolecular era, the discrepancy between T1 hypointense and T2 hyperintense tumor volume in absolute values has been proposed as a marker for diffuse tumor growth. We set out to investigate if a ratio of T1 to T2 tumor volume (T1/T2 ratio) is associated with resectability and overall survival (OS) in patients with IDH-mutant astrocytomas., Methods: Patient data from 2 centers (Sahlgrenska University Hospital, Center A; LMU University Hospital, Center B) were collected retrospectively. Inclusion criteria were as follows: pre and postoperative MRI scans available for volumetric analysis (I), diagnosis of an IDH-mutant astrocytoma between 2003 and 2021 (II), and tumor resection at initial diagnosis (III). Tumor volumes were manually segmented. The T1/T2 ratio was calculated and correlated with extent of resection, residual T2 tumor volume, and OS., Results: The study comprised 134 patients with 65 patients included from Center A and 69 patients from Center B. The median OS was 134 months and did not differ between the cohorts ( P = .29). Overall, the median T1/T2 ratio was 0.79 (range 0.15-1.0). Tumors displaying a T1/T2 ratio of 0.33 or lower showed significantly larger residual tumor volumes postoperatively (median 17.9 cm 3 vs 4.6 cm 3 , P = .03). The median extent of resection in these patients was 65% vs 90% ( P = .03). The ratio itself did not correlate with OS. In multivariable analyses, larger postoperative tumor volumes were associated with shorter survival times (hazard ratio 1.02, 95% CI 1.01-1.03, P < .01)., Conclusion: The T1/T2 ratio might be a good indicator for diffuse tumor growth on MRI and is associated with resectability in patients with IDH-mutant astrocytoma. This ratio might aid to identify patients in which an oncologically relevant tumor volume reduction cannot be safely achieved., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Calibration of thromboplastins is required for accurate calculation of the international normalised ratio (INR). Accurate INR results are required for optimal dosing of vitamin K antagonists. Decreases in vitamin K antagonist usage have made the recruitment of sample sets for international sensitivity index (ISI) calibrations more difficult. A possible solution to this would be to allow the use of frozen-thawed samples in place of fresh plasmas in the calibration of secondary standards., Objectives: We investigated the effect of freezing and thawing samples before usage in ISI calibrations of secondary standards., Methods: Multiple reagent/instruments were tested to identify the degree of difference between a fresh sample ISI calibration and one performed on frozen-thawed samples. Where possible, the two ISI calibrations were performed on the same sample set. Alternatively, a separate set of samples from different patients was used., Results: The difference in ISI values was <3% for those datasets where the same samples were used, and <6% for those datasets where two sample sets were used. Additionally, other parameters required for a valid ISI calibration showed only minor differences-some calibrations showed fewer outliers in the frozen-thawed datasets. Mean normal prothrombin time for the international reference thromboplastins was <3.5% different across four different calibrations (two for rabbit thromboplastin and two for recombinant human thromboplastin)., Conclusions: This modification to the WHO guidelines would facilitate the recruitment of test plasmas in advance of calibration solving the problem of requiring availability of fresh patient samples with a range of INRs in a 5-h window., Trial Registration: Not a part of any clinical trial., (© 2024 John Wiley & Sons Ltd.)

A recent report presented to the WHO has highlighted significant opportunities for the implementation of 3Rs approaches (i.e. Replacement, Reduction and Refinement of animal tests) within their manuals, guidelines and recommendations for vaccines and biotherapeutics. The report is the culmination of a three-year project led by the UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) and co-funded by the Bill & Melinda Gates Foundation. The aim was to review the extent to which animal-based testing methods are currently described in these internationally recognised guidance documents and recommend opportunities for applying the 3Rs. International stakeholders have been engaged throughout the project to gauge opportunities and barriers to adoption of 3Rs approaches and how these vary globally, to inform the recommendations in the report. This paper summarises the output from a series of international stakeholder workshops held between March 2022 and September 2023., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Human African trypanosomiasis is a neglected tropical disease that is usually fatal without treatment. WHO has revised its rhodesiense human African trypanosomiasis treatment guidelines on the basis of an independent systematic literature review and following the GRADE methodology. This Review reports on the decision-making process and summarises the new recommendations and their potential implications for health-care professionals and policy makers. Due to data scarcity, all recommendations are conditional and based on very low certainty of evidence. Fexinidazole replaces suramin and melarsoprol as the first-line therapy in individuals aged 6 years and older with a bodyweight of 20 kg or more. As fexinidazole is effective in both stages of rhodesiense human African trypanosomiasis, a lumbar puncture for staging is no longer required. In settings in which first-choice drugs are not readily available, immediate interim treatment with pentamidine is suggested. The introduction of oral fexinidazole represents an advancement in the management of rhodesiense human African trypanosomiasis considering the life-threatening adverse reactions individuals can have to melarsoprol. However, children below the age or weight limits remain ineligible for treatment with fexinidazole., Competing Interests: Declaration of interests JS reports that the Instituto de Higiene e Medicina Tropical–Lisbon was a partner in the European & Developing Countries Clinical Trials Partnership (EDCTP2) HAT-r-ACC project (for a clinical trial on fexinidazole in rhodesiense human African trypanosomiasis [HAT]; NCT03974178), coordinated by the Drugs for Neglected Diseases initiative (DNDi), and funded by the EDCTP. JS had a non-remunerated role in training the clinical investigators of the field teams. LB was a member of the data and safety monitoring board for the clinical trial on fexinidazole in rhodesiense HAT. PPS was employed as an advisor at the DNDi until 2021. MPB participated in the scientific advisory committee of the DNDi that dealt with the fexinidazole trials, among other projects. VL reports that the Institut de Recherche pour le Développement was a partner in the HAT-r-ACC project (for a clinical trial on fexinidazole in rhodesiense HAT [NCT03974178]), coordinated by the DNDi. VL was responsible for training project health staff in the diagnosis of HAT (two trainings, one in Malawi and one in Uganda, in 2019). AE chaired the data and safety monitoring board for the clinical trial on fexinidazole in rhodesiense HAT. AE also participated in the scientific advisory committee of the DNDi. All other authors declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The latest edition of the WHO classification of urinary and male genital tumours was published in 2022. The revision was based on the newest scientific literature. This article summarizes the updated recommendations regarding the classification of histomorphologically defined tumours., Results and Conclusions: The current edition of the WHO classification made some adjustments on the classification of histomorphologically defined tumour types. Papillary renal cell carcinoma is no longer categorized into two subtypes. Also, the new classification recognized the benign nature of clear cell papillary tumours, which are no longer regarded as carcinomas. Finally, several emerging renal tumours were introduced., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: A. Hartmann gibt folgende Interessenkonflikte an: Honorare von Abbvie, AstraZeneca, Biontech, BMS, Boehringer Ingelheim, Cepheid, Diaceutics, Ipsen, Janssen, Lilly, MSD, Nanostring, Novartis, Roche, 3DHistotech; Beratungsgebühren von Abbvie, AstraZeneca, Biontech, BMS, Boehringer Ingelheim, Cepheid, Diaceutics, Gilead, Illumina, Ipsen, Janssen, Lilly, MSD, Nanostring, Novartis, Qiagen, QUIP GmbH, Roche, 3DHistotech; Forschungsförderung von AstraZeneca, Biontech, Cepheid, Gilead, Illumina, Janssen, Nanostring, Qiagen, QUIP GmbH, Roche. C. Stöhr, A. Fiegl, C. Bercebal und A. Agaimy geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: The Janus kinase (JAK) inhibitors are treatment options for autoimmune diseases. Numerous safety concerns have been raised. The European Medicines Agency updated the product information of tofacitinib to include the risk of fractures-but not for other JAK inhibitors. We conducted a global pharmacovigilance analysis of previously investigated JAK inhibitors to investigate a potential class effect., Methods: Individual case safety reports (ICSRs) for all licensed JAK inhibitors were identified from the global WHO pharmacovigilance database. The primary outcome of interest was a bone fracture. Disproportionality analyses using reporting odds ratios (RORs) were conducted., Results: We identified 122,037 ICSRs for tofacitinib, 27,786 ICSRs for upadacitinib, 14,616 ICSRs for baricitinib, 830 for filgotinib, and 350 for abrocitinib. Among the ICSRs, we identified 2198 (1.8%), 634 (2.3%), and 144 (1.0%) reports, where a bone fracture was reported for tofacitinib, upadacitinib, and baricitinib, respectively. Few reports were available for the newest drugs filgotinib (10) and abrocitinib (1). JAK inhibitors were associated with increased reporting for fracture: tofacitinib (ROR 3.34, 95% confidence interval [CI] 3.20-3.48), upadacitinib (ROR 4.23, 95% CI 3.80-4.48), baricitinib (ROR 1.80, 95% CI 1.52-2.11) and filgotinib (ROR 2.24, 95% CI 1.11-3.94). Patients with bone fractures were more often female, older and had a higher number of co-reported medications. They were more likely to use glucocorticoids, opioids, and bisphosphonates., Conclusion: The results from this pharmacovigilance analysis, based on a spontaneous reporting database associated with inherent limitations, suggest a potential risk of fractures with JAK inhibitors, indicating that a class effect cannot be ruled out., Competing Interests: Declarations. Funding: Open access funding provided by Swiss Federal Institute of Technology Zurich. Conflict of interest: Andreas Clausen received travel funding during the project from Novo Nordisk and Nordea. Stefan Weiler is a member of the Human Medicine Expert Committee of Swissmedic. The views expressed in this article are the personal views of the authors and may not be understood or quoted as being made on behalf of or reflecting the position of the competent authority or one of its committees or working parties. While the authors used data from VigiBase, the World Health Organization (WHO) global database of individual case report forms, as a source of information, the conclusions do not represent the opinion of the Uppsala Monitoring Centre (UMC) or the World Health Organization. The remaining authors have no competing interests to declare. Ethics approval: The study was conducted in accordance with the principles of the Declaration of Helsinki. VigiBase®, the WHO global database of individual case safety reports (ICSRs), is the source of the information; the information comes from a variety of sources, and the probability that the suspected adverse effect is drug related is not the same in all cases; the information does not represent the opinion of the Uppsala Monitoring Centre (UMC) or the World Health Organization (WHO). According to WHO policy and UMC guidelines, reports sent from the WHO Programme for International Drug Monitoring member countries to VigiBase® are anonymized. Identifiable data are not available. Consent to participate: Patient consent was waived as VigiBase® database contains anonymized data that cannot allow patients’ identification. Consent to publish: Not applicable. Data availability: The authors do not have the authority to share the study data. Access to VigiBase and VigiLyze is handled directly by the Uppsala Monitoring Centre ( https://who-umc.org/ ). Code availability: The code will be made available upon reasonable request to the corresponding author. Author contributions: Andreas Clausen: Methodology; Formal analysis; Investigation; Interpretation of results; Writing original draft; Literature review and implementation of the study. Stefan Weiler: Conceptualization; Supervision; Interpretation of results. Adrian Martinez-De la Torre: Formal analysis, Interpretation of results, Writing original revision; Methodology; Contributed to the design and implementation of the study; Interpretation of results. Andrea Burden: Methodology; Contributed to the design and implementation of the study; Interpretation of results. All authors reviewed and contributed critically to the manuscript. All authors read and approved the final version., (© 2024. The Author(s).)

A recently published report from the UK National Centre for the Replacement, Refinement, and Reduction of Animals in Research (NC3Rs) has highlighted significant opportunities for the broader inclusion of 3Rs approaches (i.e. Replacement, Reduction and Refinement of animal tests) within World Health Organization (WHO) manuals, guidelines and recommendations for vaccines and biotherapeutics. The report is the culmination of a three-year project, co-funded by the Bill & Melinda Gates Foundation, to review the extent to which animal-based testing methods are described in WHO manuals, guidelines and recommendations. The aim was to identify where recommendations did not incorporate current non-animal testing strategies and/or 3Rs principles in biologicals quality control and batch release testing. The inclusion of such methods in WHO guidance documents would improve their adoption by regulators and help to accelerate the safe release of these products to the communities who need them most. The final report was presented to the WHO's Expert Committee on Biological Standardization (ECBS) in October 2023 for their consideration and response. The project findings and recommendations described in the report are summarised in this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study's objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala., Methods: We conducted a single-arm pilot implementation trial over six months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrolment and retention data. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rates. When baseline data were available, we analyzed secondary outcomes as the net change from baseline or using an interrupted time series approach., Results: The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. Monthly treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P < 0.001) and 3.5 (95% CI: -1.6 to 8.7; P = 0.17) patients per month for hypertension and diabetes, respectively., Conclusions: Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings., Competing Interests: DF and IAW have received consultant fees from the World Health Organization. IAW and LFA have received consultant fees from the Pan American Health Organization. MDH has pending patents for heart failure polypills, has received travel support from the World Heart Federation and has consulted for PwC Switzerland. George Health Enterprises Pty Ltd (GH) and its subsidiary, George Medicines Pty Ltd, have received investment funds to develop fixed-dose combination products, including combinations of blood pressure-lowering drugs. George Health Enterprises Pty Ltd is the social enterprise arm of The George Institute for Global Health., (Copyright: © 2025 The Author(s).)

Background: Socio-economic inequalities significantly impact paediatric cancer survival. The review aims to elucidate the facilitators and barriers influencing the availability and accessibility of essential medicines for childhood cancer (EMCC) in low- and lower-middle-income countries (LLMICs)., Methods: This systematic review was conducted adhering to the PRISMA guidelines. Peer- reviewed primary studies, national/regional reports, and policy documents published in the English language were included through a thorough literature search using three electronic databases: MEDLINE, EMBASE, and CINAHL. Review questions were framed according to the ECLIPS framework. Children under 19 years of age living in LLMICs diagnosed with any malignancy were the client group. The quality of the included studies was assessed using the mixed methods appraisal tool. Data is presented as a narrative synthesis. Enablers and barriers were discussed based on the World Health Organization (WHO) health system building blocks., Results: Out of the 29 articles retrieved for full-text screening, the final synthesis included nine articles. Six were based on quantitative, two on mixed-method research, and one was a review article. These studies represented 26 LLMICs from several continents (Africa, Asia, and America). The alignment of the National Essential Medicine Lists (NEMLs) with the World Health Organization Essential Medicine List for Children (WHO EMC) varied from 40%- 60%. Overall stock out rate ranged from 17 to 100%. Stock out rate was higher in the public sector than in the private sector. International partnerships, policy changes, and financing strategies are some of the key enablers identified. Barriers included inadequate global drug production, high drug costs, weak regulatory enforcement, poor supply chain management, and insufficient health information systems., Conclusion: The findings of our review revealed the failure of LLMICs to meet the WHO- recommended target of 80% availability for EMCCs. The availability and accessibility of EMCC in LLMICs are hindered by multiple systemic barriers despite several enabling strategies. Addressing these challenges requires coordinated global efforts and local initiatives to ensure equitable access to childhood cancer treatments in LLMICs., Prospero Registration Number: CRD42022334156., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The incidence of thyroid cancer has shown marked increases globally over recent decades. This study investigated how the incidence of papillary thyroid carcinoma (PTC) subtypes and World Health Organisation (WHO) endocrine tumour classification changes have affected overall thyroid cancer incidence recorded in Australia. Using incidence data from the Australian Institute of Health and Welfare cancer registry (spanning 1982 to 2019), this descriptive epidemiological study employed joinpoint regression analysis to assess temporal trends in thyroid carcinoma incidence, focusing on PTC. Results were then compared with WHO endocrine tumour classification changes over the same period. The results showed increasing trends for the classic PTC subtype over the entire 38-year period and for thyroid microcarcinomas post-2003, while a declining trend for the follicular variant of PTC was observed commencing in 2015. Examination of PTC incidence also revealed distinct changes in trends that align with the WHO classification of papillary microcarcinoma as a subtype in 2004 and the reclassification of some encapsulated follicular variant of PTCs to non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) in 2016/17. Even when taking these WHO classification changes into account, significant increases in PTC over the last three decades are observed. These findings underscore the shifts in classification driven by improving diagnostic clarity influencing thyroid carcinoma incidence patterns. However, thyroid carcinoma cases in Australia have dramatically increased over the last three decades independent of WHO classification changes, suggesting a genuine increase rather than simply being a direct consequence of improved reporting and diagnostics., Competing Interests: Declarations. Ethics approval and consent to participate: Griffith University, Office for Research, Human Research Ethics approved Ethical Clearance (GU Ref No: 2024/007). Consent for publication: All authors consent for publication. Competing Interests: The authors declare no competing interests., (© 2025. The Author(s).)

For more than a decade, the WHO Eastern Mediterranean Region (EMR) has faced multiple protracted crises that have plunged nearly half of its 22 countries and territories into severe turmoil. The political conflicts, escalating hostilities and natural disasters have shattered communities, triggered disease outbreaks and placed immense strain on the health systems. In 2022 and 2023 alone, 5 of the world's 10 deadliest natural disasters occurred in the region, often as a result of extreme weather-related events., (Copyright: © Authors 2025; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: The World Health Organization (WHO) recommended cryptococcal antigen (CrAg) screening for people presenting with advanced HIV disease (AHD) and for those with positive CrAg without evidence of meningitis to initiate preemptive antifungal medication. Data on the implementation of WHO recommendations regarding CrAg screening is limited. We estimated pooled prevalence of CrAg screening uptake, cryptococcal antigenemia, lumbar puncture, cryptococcal meningitis and initiation of preemptive antifungal medication from available eligible published studies conducted in Africa., Methods: PubMed, Cochrane Library and Embase were searched for articles published between January 2011 and December 2023. CrAg uptake was defined as percentage of eligible people (CD4 ≤ 200 cells/mm3 or WHO stage III/IV) who received cryptococcal antigen testing. Stratified analysis to compare uptake and cryptococcal antigenemia between studies that involved multiple vs single sites was performed. Using random effects models, we computed the pooled estimate of CrAg screening uptake, cryptococcal antigenemia, lumbar puncture, cryptococcal meningitis, preemptive antifungals treatment and 95% confidence intervals (CIs)., Results: Ten studies with 18,820 individuals with AHD were analyzed. Overall, the pooled estimate of CrAg screening uptake was 57.1% (95% CI: 41.4-72.7). CrAg screening uptake was significantly lower among studies that involved multiple sites compared to those that involved single site, (47.3% vs 73.3%; p<0.001). Overall, the pooled prevalence of cryptococcal antigenemia was 9.6% (95% CI:6.4-12.9). Cryptococcal antigenemia was significantly lower among studies that involved multiple sites compared to those that involved single site, (9.1% vs 10.4%; p<0.001). Among those who tested positive for CrAg, 84.6% (95% CI: 54.1-99.0) received preemptive antifungal treatment, though nearly 25% did not undergo lumbar puncture, highlighting gaps in diagnostic follow-up. Six studies evaluated CrAg positive patients with lumbar puncture and the overall prevalence of lumbar puncture was 74.9% (48.0-94.8). The overall prevalence of cryptococcal meningitis was 58.1% (46.6-69.6)., Conclusions: Not screening for CrAg among people with AHD and failure to initiate antifungal medications among eligible patients with cryptococcal antigenemia presents a significant missed opportunity. Emphasis on improving CrAg screening is critical given its proven cost-effective benefits., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Ally 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.)

Background: Excessive prescription of antibiotics in infants increases the risk of short-term and lifelong morbidity and mortality. Nonetheless, the use of antibiotics in neonatal intensive care units (NICUs) is significantly high. This is primarily because neonatologists are concerned about the fragile immune systems of newborns, their vulnerability to serious infectious diseases, and the challenge of accurately distinguishing between infectious and non-infectious conditions., Method: A five-month cross-sectional prospective study was conducted in southwestern Iran's largest neonatal intensive care unit. This study aimed to evaluate the dose and duration of antibiotic therapy and identify the prescribing pattern of antibiotics based on the Access, Watch, and Reserve (AWaRe) classification recommended by the World Health Organization (WHO)., Results: Out of 502 examined patient files, antibiotics were prescribed for 483 neonates. The most common drug combinations were ampicillin and amikacin. The mean number and duration of antibiotic administration were 2.14 drugs and 7.78 days, respectively. 84.3% of infants received antibiotics for ten days or less. The mean course of antibiotic prescription for newborns was 1.1, and 83.1% of prescribed antibiotics were from the Access Group., Conclusion: The antibiotic prescription rate was high in our study's department. Most neonates received two antibiotics in one course from the Access group., Competing Interests: Declarations. Ethics approval and consent to participate: The research was conducted with the approval of the Pediatrics Department and the Research Vice-Chancellor of Ahvaz University of Medical Sciences and in accordance with the World Medical Association Declaration of Helsinki. The data for this study was obtained from the patient’s hospital records immediately following their discharge. No diagnostic or therapeutic interventions were conducted during their hospital stays, and all patients’ personal information was kept entirely confidential. Written informed consent was obtained from the legal guardians before the neonate was enrolled. The Medical Ethics Committee of Ahvaz Jundishapur University of Medical Sciences provided the code IR.AJUMS.REC.1403.011 to authorize the initiation of this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

High-burden cholera outbreaks, spreading beyond the traditional cholera-endemic countries, have been reported since 2021 in the WHO African region. Member states in the region have committed to the global goal of cholera elimination by 2030. To track progress towards this goal, WHO-African countries adopted a regional cholera prevention and control framework in 2018. This study reports on 27 countries' 5-year achievements in implementing the cholera regional framework for cholera prevention, and control. Data collected through a web-based self-assessment tool were analysed and visualised through Power BI. Data were provided by national teams of experts on cholera based on the milestones of the framework. Countries' specific progress and regional progress were calculated. The overall regional progress was 53%, ranging from 19% in Mauritania to 76% in Ethiopia. Out of the 27 countries, 3 had made good progress while 14 had fair and 10 had insufficient progress. At the regional level, 4 milestones were on track, 7 were fair and 10 had insufficient progress. Cholera hot spot mapping had the highest score at 85%, while development of investment cases for cholera control scored the lowest at 14%. Although appreciable progress was noted in some milestones, the progress against critical milestones, including for water, sanitation and hygiene, that form the bedrock of cholera control, was insufficient. Effective implementation of the cholera prevention and control framework anchored on strong government commitment and ownership is essential to curb the current trend of cholera outbreaks and improve the likelihood of cholera elimination by 2030 in Africa., Competing Interests: Competing interests: None declared., (© World Health Organization 2025. Licensee BMJ.)

The World Health Organization (WHO) highlights the importance of improving the design of public health interventions and policies by applying principles from the behavioral sciences. These sciences play a crucial role in modifying behaviors and addressing a wide range of health challenges, from pandemics and chronic diseases to the climate crisis. This article examines the transformative impact of behavioral sciences on public health promotion, focusing on the factors that influence decision-making and intervention strategies based on the six principles developed by the WHO Technical Advisory Group. Additionally, it addresses the significant shortage of Spanish-language literature on this topic, reviewing contributions from influential scientists and key theoretical models. The WHO's recommendations for the effective implementation of these interventions in public health are also discussed. This work not only fills a critical gap in the Spanish-language literature but also provides practical tools to improve public health in Spanish-speaking countries., Competing Interests: None of the authors declares a conflict of interest., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

The World Health Organization ExpandNet framework for scaling up contains key recommendations to support the scaling of health interventions globally. Despite being widely used, it is not known how the framework informs intervention scale-up nor how 'successful' scale-up is defined. Using data from the Scaling Up InTErventions' study, this paper assessed adoption of framework components using an international sample of scaled-up physical activity and nutrition interventions, and explored individuals' definitions of scale-up 'success'. An online survey with academic, community, and government representatives involved in scaling physical activity and nutrition interventions globally. Survey questions (n = 27) corresponded to 32 components of the ExpandNet framework, reflecting four core areas: (i) intervention; (ii) user organization; (iii) resource team; and (iv) scale-up strategy. Data were analysed descriptively and qualitative free-text survey responses coded thematically. In total, 62 survey responses were obtained [academia (n = 32), community (n = 20), and government (n = 10)], corresponding to 35 scaled-up interventions. Only 8% of participants reported all 32 framework components during scale-up. Four core elements (containing eight themes) underpinned successful scale-up: (i) scaling inputs (e.g., sustained partner buy-in); (ii) scaling outputs (e.g., sustained, quality implementation); (iii) scaling outcomes (e.g., increased and equitable reach, improved organization and system capacity) and; (iv) scaling context (e.g., partner mental models, and a context-specific construct). There is no universal definition of successful scale-up. We propose core elements of 'successful scale-up' that could be used as criteria for scale-up planning and evaluation, and are applicable to other areas of public health., (© The Author(s) 2025. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Introduction: Reports of suicidality associated with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been reported to the European Medicines Agency (EMA) and the United States Food and Drug Administration (FDA). We previously reported an increased reporting odds ratio (ROR) of some measures of suicidality with semaglutide and liraglutide using the FDA Adverse Event Reporting System (FAERS). Notwithstanding the increased ROR, causality between GLP-1 RAs exposure and any aspect of suicidality is not established., Research Design and Methods: The analysis herein aims to extend a previous analysis of the FAERS by evaluating the ROR for suicidality reported to the World Health Organization (WHO) Pharmacovigilance Database (VigiBase). We aimed to characterize the ROR of suicidality associated with GLP-1 RAs, as extrapolated from spontaneous reports. As per our previous report, the ROR was considered significant when the lower limit of the 95 % confidence (CI) was >1.0., Results: We searched VigiBase reports from inception to January 2024. The RORs for suicidal ideation were significantly increased for semaglutide (5.82), liraglutide (4.03) and tirzepatide (2.25). For "depression/suicidal", the ROR was significantly increased for semaglutide (14.74) and liraglutide (5.86); and for suicidal behaviour, the ROR was significantly increased for semaglutide (6.52) and liraglutide (3.90). However, for suicide attempts, the ROR was significantly decreased for semaglutide (0.11), dulaglutide (0.075), exenatide (0.047) and liraglutide (0.15). For completed suicide, the ROR was also significantly decreased for semaglutide (0.01), dulaglutide (0.003), exenatide (0.002) and liraglutide (0.008)., Conclusion: Unlike our previous report with FAERS, a mixed pattern of ROR emerged in the WHO VigiBase with respect to suicidality and exposure to select GLP-RAs. Causation between GLP-1 RA exposure and suicidality (either increased or decreased) cannot be ascertained from ROR data., Competing Interests: Declaration of competing interest Dr. Roger S. McIntyre has received research grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; speaker/consultation fees from Lundbeck, Janssen, Alkermes, Neumora Therapeutics, Boehringer Ingelheim, Sage, Biogen, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Viatris, Abbvie, Atai Life Sciences. Dr. Roger S. McIntyre is a CEO of Braxia Scientific Corp. Dr. Rodrigo B. Mansur has received research grant support from the Canadian Institutes of Health Research (CIHR), the Physicians’ Services Incorporated (PSI) Foundation and the Baszucki Brain Research Fund; and support from an Academic Scholars Award from the Department of Psychiatry, University of Toronto. Dr. Joshua D. Rosenblat has received research grant support from the Canadian Institute of Health Research (CIHR), Physician Services Inc (PSI) Foundation, Labatt Brain Health Network, Brain and Cognition Discovery Foundation (BCDF), Canadian Cancer Society, Canadian Psychiatric Association, Academic Scholars Award, American Psychiatric Association, American Society of Psychopharmacology, University of Toronto, University Health Network Centre for Mental Health, Joseph M. West Family Memorial Fund and Timeposters Fellowship and industry funding for speaker/consultation/research fees from iGan, Boehringer Ingelheim, Janssen, Allergan, Lundbeck, Sunovion and COMPASS. Dr. Taeho Greg Rhee serves as a review committee member for Patient-Centered Outcomes Research Institute (PCORI) and Substance Abuse and Mental Health Services Administration (SAMHSA) and has received honoraria payments from PCORI and SAMHSA. Dr. Rhee has also served as a stakeholder/consultant for PCORI and received consulting fees from PCORI. Dr. Rhee serves as an advisory committee member for International Alliance of Mental Health Research Funders (IAMHRF). Dr. Rhee is currently a co-Editor-in-Chief of Mental Health Science and has received honorarium payments annually from the publisher, John Wiley & Sons, Inc. Kayla M. Teopiz has received fees from Braxia Scientific Corp., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Laboratories play a central role in managing public health emergencies. The COVID-19 pandemic imposed unique challenges on global laboratory systems, including testing protocol uncertainties, supply shortages, rapid need for information dissemination, and disruptions to traditional training methods. In response, the WHO established the Public Health Laboratories (PHL) knowledge sharing webinar series whose goals were to respond to the increased demand in up-to-date and reliable information, which WHO is in a unique position to provide. It also aimed to enhance peer-to-peer exchanges across laboratories. This article outlines the PHL webinar series delivery format and presents how the webinar series was received and perceived by participants and how it evolved to support the response to other health emergencies. Contents of the knowledge sharing sessions, as well as attendance, participants' satisfaction and application of learning were monitored over time using registration forms, satisfaction polls, an annual survey and focus group discussions. From May 2020 to December 2023, 48 sessions attracted 58,688 registrations from 204 countries and territories. Thirty-five sessions featured presentations of WHO guidance, tools or documents and 39 sessions featured country experience sharing. Initially focused on COVID-19, the series became a tool to rapidly disseminate guidance and best practices during new health emergencies and to address cross-cutting topics relevant to the laboratory workforce. Feedback data shows participants found the webinars very useful (86% respondents), reporting knowledge gains in biosafety, quality management, and laboratory practices. The series facilitated knowledge application, with foreseen changes in workplace procedures and training activities (43% respondents). Barriers such as resource limitations, additional training needs, and connectivity issues were frequently identified. Evidence that this knowledge was subsequently applied by participants, such as through changes in workflow, onwards training events and procedural changes further reinforces the efficacy with which the series was able support the laboratory workforce globally in addressing challenges of the COVID-19 pandemic and other health emergencies. The series utilized sessions on cross-cutting topics to run routinely and to keep a high level of engagement with laboratory professionals globally. This enabled it to act as an adaptable tool that was leveraged effectively and quickly during health emergencies for just-in-time learning., Competing Interests: The authors declare 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 © 2025 Barnadas, Stevens, Milhano, Barbosa de Lima, Struminger, Burke and Cognat.)

This study aimed to describe the severity of abortion-related complications, factors associated with complications, the types of management and the experience of care in Brazil. A cross-sectional study in twenty hospitals (10 in Federal District, 3 in Rondônia and 7 in Maranhão). For 3 months, all women treated for abortion/miscarriage had their data collected. The severity of complications was defined according to World Health Organization criteria. Women with hemorrhage, infection or organs injury were invited to answer an interview about experience of care. Statistical analysis was performed using chi-square test and Poisson regression models. Among 1,683 women included, 82.5% had mild complications, 13.6% had moderate complications, 3.2% had potentially life-threatening conditions (PLTC) and 0.7% had severe maternal outcomes (SMO). Most women (94.2%) required uterine evacuation. Among these, 91.5% required surgical evacuation (with or without the use of uterotonics) and 8.5% used only uterotonics. The most frequent surgical evacuation method was curettage (66.9%), followed by manual vacuum aspiration (MVA) (32.3%). Factors associated with PLTC/SMO vs mild complications were having a gestational age ≥ 13 weeks (pravlence ratio - PR = 3.09; 95% confidence interval - 95%CI: 1.42-6.72), having been treated in Maranhão (PR = 0.27; 95%CI: 0.12-0.63) and in Rondônia (PR = 0.64; 95%CI: 0.20-0.99). Factors associated with moderate vs. mild complications were expulsion of products of conception before arrival to health facility (PR = 2.55; 95%CI: 1.64-3.96) and having been treated in Maranhão (PR = 0.58; 95%CI: 0.38-0.87). Most women who responded to the interview were treated kindly (95.6%), however, 66.7% felt stressed and 10.1% reported that their preferences were not respected during hospitalization. Nine out of ten women treated in Brazilian public hospitals due to abortion-related complications undergo some surgical procedure, the most common of which is uterine curettage. Approximately four in every hundred women experience severe complications. It is essential to ensure the supply of equipment for MVA and to encourage continuing medical education programs to increase the awareness of healthcare professionals about safer treatments for uterine evacuation.

Lithuania ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2010 and started deinstitutionalization in 2014. This reform covers segregated social care institutions where persons with mental health conditions, psychosocial, and/or intellectual disabilities live. It aims to move away from institutional care and towards community-based services. Mental healthcare services are also a part of the complex picture, undergoing its own reform since 2022. This study aims to assess the human rights conditions and standards of care in Lithuanian psychiatric and social care facilities in the context of deinstitutionalization. Data collection assessments were conducted in psychiatric hospitals and psychiatric units in general hospitals, segregated social care homes, and community-based group living homes. Independent experts collected data through documentation review, observation, and semistructured interviews with service users and staff. The study followed the World Health Organization's QualityRights Toolkit methodology. In all assessed facilities, regardless of their type, the human rights of service users are often undermined, especially the right to exercise legal capacity, personal liberty and security, freedom from seclusion and restraints, and the right to live independently and be included in the community. The study reveals shortcomings in the implementation of the UNCRPD and Lithuania's attempts at deinstitutionalization. It points to key practical gaps and areas, including the vital need for better collaboration between the social and mental healthcare systems. The Lithuanian government needs to address these issues to make reforms more effective, safeguard human rights, and ensure the quality of mental health and social care services., (© The Author(s) 2025. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Purpose: The first 1000 days of life are critical for long-term health outcomes, and there is increasing concern about the suitability of commercial food products for infants, toddlers, and children. This study evaluates the compliance of UK commercial baby food products with WHO Nutrient and Promotion Profile Model (NPPM) guidelines., Methods: Between February and April 2023, data on 469 baby food products marketed for infants and children under 36 months were collected from the online platforms of four major UK supermarkets. Nutritional composition and labelling information were assessed using the NPPM criteria. Quantitative analyses were performed using IBM SPSS, presenting data as means with 95% confidence intervals., Results: While 75% of products met the minimum energy content criteria, compliance with total sugar content and protein requirements was 59% and 94%, respectively. Overall, only 45% of products adhered to NPPM nutritional standards. Promotional assessments revealed that no products met the requirements for appropriate nutrient, health, or marketing claims. Furthermore, only 5% of products included adequate statements in support of breastfeeding., Conclusion: This study highlights the need for stricter nutritional and promotional standards in the UK baby food industry to foster healthier early dietary habits. Regulatory measures are essential to align commercial baby food products with WHO recommendations, reducing inappropriate claims and improving nutritional quality., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: Not applicable., (© 2025. The Author(s).)

Background: Health system and environmental factors play a significant role in achieving the World Health Organization (WHO) End Tuberculosis (TB) targets. However, quantitative measures are scarce or non-existent at a global level. We aimed to measure the progress made towards meeting the global End TB milestones from 2015 to 2020 and identify health system and environmental factors contributing to the success., Methods: We obtained data from ten different online data repositories and used principal component analysis to create domain-specific health system performance measures. We used radar charts and dumbbell plots to show the country's progress in ending TB with their health systems. Lastly, we used a linear regression model to identify key health systems and environmental predictors of the percent reduction in TB incidence and mortality., Results: There was a high variation in TB incidence and mortality reduction between countries and WHO regions. Of all countries included, 75 (39.3%) achieved more than a 20% reduction in TB incidence between 2015 and 2020. However, only 31 (16.2%) reached a 35% reduction in TB mortality. The European Region achieved the highest incidence reduction, exceeding the 2020 milestone with a 25% reduction. The African Region also made notable progress, achieving an 18% mortality reduction despite its relatively poor health systems. Health system factors, such as TB financing, TB-specific health service delivery, access to medicine, and governance, were significantly associated with TB mortality reduction between 2015 and 2020. Environmental factors, such as average annual temperature and air particulate matter concentration, were found to have a significant negative effect on TB incidence and mortality reduction., Conclusions: Weak health systems were identified as major barriers to achieving the End TB milestones in most high-burden countries. Hence, strengthening health systems with a special focus on TB financing, service delivery, and access to medicine in these countries should be prioritised to achieve global TB mortality reduction targets. Countries should follow WHO's air quality guidelines and rapidly reduce carbon dioxide and other greenhouse gas emissions to mitigate the impact of environmental factors., Competing Interests: Disclosure of interests: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclosed no relevant interests., (Copyright © 2025 by the Journal of Global Health. All rights reserved.)

Background and Objectives: The tobacco industry (TI) has undermined tobacco control policy for decades. The WHO Framework Convention on Tobacco Control Article 5.3 implementation guidelines provide guidance for preventing TI interference. Government officials responsible for policy implementation must understand these guidelines to manage TI tactics. This study assessed awareness, attitudes and practices of Article 5.3 guidelines among members of District Level Coordination Committees (DLCC) in Karnataka mandated with overseeing tobacco control activity., Method: A semistructured questionnaire survey of awareness, attitudes and adherence to Article 5.3 guidelines among 102 DLCC members carried out between January and July 2019., Result: Responses were received from 82 members, comprising 51 (62%) from health and 31 (38%) from non-health departments. Our study demonstrates a lack of understanding of Article 5.3 and its guidelines, even among those actively involved in tobacco control at the district level. Nearly 80% of respondents were aware that corporate social responsibility (CSR) by tobacco companies is an indirect form of promoting tobacco. However, 44% of members felt that CSR funding from the TI should be used to combat tobacco-related harm. A higher proportion (12%) of health respondents agreed that subsidies should be provided to tobacco agriculture compared with non-health (3%)., Conclusion: Awareness of international guidance designed to prevent the TI influence on health policy among policymakers in this Indian state is low. Respondents from non-health departments were less aware of TI CSR. Those in health departments were more receptive towards taking a TI role in the future ., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: In 2022, the WHO and International Consensus Classification (ICC) published diagnostic criteria for myelodysplastic neoplasms (MDSs). We examined the influence of the revised diagnostic criteria on classifying MDSs in a large population., Methods: We retrieved an open-source pre-existing dataset from cBioPortal and included 2,454 patients with MDS in this study. Patients were reclassified based on the new diagnostic 2022 WHO and ICC criteria. Survival analysis was performed using Cox regression to validate the new criteria and to assess risk factors., Results: Based on the 2022 WHO criteria, 1.4% of patients were reclassified as having AML. The 2022 WHO criteria provide a superior prognostic/diagnostic model to the 2017 WHO criteria (Akaike information criterion, 14,152 vs. 14,516; concordance index, 0.705 vs. 0.681). For classifying MDS with low blast counts and SF3B1 mutation, a variant allele frequency cut-off of 5% (2022 WHO criteria) and the absence of RUNX1 co-mutation (2022 ICC criteria) are diagnostically relevant. For classifying MDSs with mutated TP53 , a blast count cut-off of 10% (2022 ICC criteria) and multi-hit TP53 (2022 WHO criteria) are independent risk factors in cases with ≥ 10% blasts., Conclusions: Our findings support the refinements of the new WHO criteria. We recommend the complementary use of the new WHO and ICC criteria in classifying SF3B1- and TP53 -mutated MDSs for better survival prediction.

The World Health Organization's International Classification of Functioning, Disability and Health (ICF), the international standard for the description of functioning and disability, completely ignores a specific form of accessible communication despite its potential to improve functioning and reduce disability: Easy Language, a form of standard language with substantially reduced linguistic complexity. Starting with a proposal for how and where Easy Language could be appropriately integrated into the ICF, the commentary then outlines the various benefits and opportunities for social policy that could be associated with doing so. It also notes several potential challenges involved in this process. If used correctly, the integration of Easy Language into the ICF could prove useful for both professional users of the ICF and Easy Language target groups., 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 Inc. All rights reserved.)

Introduction: Poison Centers are vital to prevent and manage exposures to chemicals, toxins, and ionizing radiation. However, many countries still lack sufficient poison information center services. Within the World Health Organization's Eastern Mediterranean Regional Office (EMRO) region, we were not able to identify a formal assessment of its toxicological resources. We sought to assess the clinical toxicological resources in the EMRO region and the attitudes, needs, and perspective of the workforce in that region.  METHODS: This was a two part survey study. First, we developed a poison center questionnaire and scoring system based on the World Health Organization's Guidelines for Establishing a Poison Center; this instrument was administered by phone to poison center directors and faculty in the EMRO region. Questions assessed for the presence or absence of important poison center capabilities listed in the WHO guidelines, and points were assigned based on response. Secondly, we administered an electronic workforce survey to clinical toxicology professionals in the region; participant eligibility for the workforce survey was based on the membership roster of MENATOX., Results: Out of 22 EMRO countries, 16 countries have an established poison center, and 14 of 16 participated in the poison center survey.  The results reflected a wide variability in capabilities among countries. Areas such as call centers, clinical toxicology units, laboratory services, and data management were relatively lacking while some other areas including toxicovigilance, chemical incidents and emergencies, antidotes/antivenoms, poisoning information sources, and the availability of free services were relatively stronger. Twenty-seven out of 32 workforce respondents were physicians. Results from that survey highlighted a desire for more support from government and better compensation., Conclusions: Our study identified areas of need for the EMRO region. The poison center survey results reflect large disparities among countries with some areas being stronger than others. The workforce survey highlighted issues such as compensation and government recognition. Overall, a formal assessment of individual poison centers can provide benchmarks to drive improvement of services, but further research is needed to identify and characterize country-specific needs., Competing Interests: Declaration. Conflict of Interest: Regarding MENATOX, the Middle East and North Africa Clinical Toxicology Association: Author Z.K. is a former president of the association and author B.A. is the current president. MENATOX did not provide funding for this project., (© 2024. American College of Medical Toxicology.)

Globally, there has not been a standardised approach to ensure that the growing number of people who are not licensed clinicians but are delivering psychological interventions and mental health services have the competencies to deliver those interventions and services safely. Therefore, WHO and UNICEF developed Ensuring Quality in Psychosocial and Mental Health Care (EQUIP). EQUIP is a free resource with a digital platform that can be used to guide competency assessment. We describe EQUIP's 5-year development (2018-23) and the rationale supporting its contents and use. Development phases included establishing consensus for competency-based strategies; selecting foundational competencies; evaluating feasibility of assessments, role plays, and technology; piloting EQUIP when training non-specialists; and public dissemination and ongoing adaptations to increase scalability. From the public launch in March, 2022, through to March, 2024, EQUIP's digital platform has been used in 794 training programmes in 36 countries with 3760 trainees resulting in 10 001 competency assessments., Competing Interests: Declaration of interests AW was employed by US Agency for International Development (USAID) from 2017 to 2019, and JTG began employment at USAID in 2024. All other authors declare no competing interests., (Copyright © 2024 World Health Organization. Published by Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

The World Health Organisation's International Health Regulations were amended in May 2024, with a number of implications for countries to amend their legal and institutional frameworks. This perspective highlights two key areas of focus in the amendments-the importance of multisectoral coordination and subnational work - and explores their links to health security challenges and to concrete country experiences. National legal and institutional frameworks constitute a key enabling mechanism for effective public health systems capable of preventing, detecting, and responding promptly to public health events and emergencies, and the recent IHR amendments provide a new impetus for WHO Member States to make these changes., (© 2024 John Wiley & Sons Ltd.)

Context: Palliative care is an essential health service, with over 56.8 million people needing it yearly, particularly in low- and middle-income countries. The World Health Assembly has recognized palliative care as an ethical responsibility and called for comprehensive primary health care. The World Health Organization has published a technical report titled "Assessing the Development of Palliative Care Worldwide," as a crucial first step in addressing palliative care. The report includes 14 indicators to help decision-makers identify service provision gaps and inform health priorities, piloted by WHO's ATLANTES in Benin, Morocco, and Uruguay as part of a global assessment., Objectives: To describe, for the three countries, the primary outcomes and lessons learned to enable replication in further countries., Methods: A step-by-step description of the assessment project, a summary of the main results obtained through evaluations, and a description of how the selected countries effectively implemented the WHO indicators through a six-step process, including a phase of action plan design. We advocated a 'Do-it-yourself' approach., Results: The summary data from three country reports reveals national development at a national level. A SWOT analysis involving consultants and program managers was conducted. A stakeholder guide was developed, providing trigger questions and practical recommendations for assessing development using specific indicators. Full information can be found in the specific published reports., Conclusion: The WHO approach has proven effective in identifying health system deficiencies and disseminating information about palliative care evaluation processes. The report provides a 'Do-it-yourself' approach, encouraging self-management without expert guidance., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Bartonella is a vector-borne zoonotic pathogen, which could also be transmitted directly and cause a variety of clinical illnesses. This study aimed to investigate the prevalence of Bartonella in countries in the WHO Eastern Mediterranean Region (WHO-EMR) region. We searched using the keywords Bartonella and the name of each country in the WHO-EMR in databases such as PubMed, ISI (Web of Science), Scopus, and Google Scholar, with a publication date range of 1990-2022 and limited to English articles. We evaluated the quality of the studies using the STROBE 6-item checklist and used the random effects model to integrate the findings of the included studies. A total of 45 papers out of 240 were included in the analysis. The results showed the prevalence of Bartonella infection among endocarditis patients was 3.8% (95% CI: 0.2-7.4) and the seroprevalence of Bartonella among other people was 27.5% (95% CI: 13.5-41.5). The overall prevalence of Bartonella spp. among animals, as determined by molecular, serological, and culture methods, was 11.9% (95% CI: 5.7-18.2), 38.9% (95% CI: 27.5-50.2), and 1.7% (95% CI: 0.5-2.9), respectively. Furthermore, the prevalence of Bartonella spp. in ectoparasites was 3.9% (95% CI: 3.5-5.2), with fleas (6.2%) showing a higher prevalence compared to lice (4.9%) and ticks (1.0%). The detection of Bartonella in all animal and ectoparasites species and human populations in the WHO-EMR with prevalence ranging from 0.3% to 23% is concerning, emphasizes the importance of conducting more comprehensive studies to gain a deeper understanding of the spread of Bartonella in these areas., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Public Health Association.)

Hepatitis C virus (HCV) is predominantly transmitted through parenteral exposures to infectious blood or body fluids. In 2019, approximately 58 million people worldwide were infected with HCV, and 290,000 deaths occurred due to hepatitis C-related conditions, despite hepatitis C being curable. There are substantial barriers to elimination, including the lack of widespread point-of-care diagnostics, cost of treatment, stigma associated with hepatitis C, and challenges in reaching marginalized populations, such as people who inject drugs. The World Health Organization (WHO) has set goals to eliminate hepatitis C by 2030. Several countries, including Australia, Egypt, Georgia, and Rwanda, have made remarkable progress toward hepatitis C elimination. In the United States, the Biden-Harris administration recently issued a plan for the national elimination of hepatitis C. Global progress has been uneven, however, and will need to accelerate considerably to reach the WHO's 2030 goals. Nevertheless, the global elimination of hepatitis C is within reach and should remain a high public health priority.

Objective: Vaccine-associated erythema multiforme (EM) remains under-researched, impacting global vaccine safety evaluations. This study examines the global and regional burden of EM and its association with specific vaccines to optimize vaccination strategies., Subject and Methods: We analyzed data from the WHO pharmacovigilance database on vaccine-associated EM from 1967 to 2023 (n = 131,255,418 reports). Reporting frequencies, reported odds ratios (RORs), and information components (IC) were calculated for 16 vaccines across 170 countries., Results: We identified 6,355 cases (males, n = 3,182 [50.07%]) of vaccine-associated EM from a total of 46,378 reports of all-cause EM. While vaccine-associated EM has been consistently reported, there has been a notable increase in reported incidence particularly in 2010 and 2020. Measles, mumps, and rubella vaccines had the highest association with vaccine-associated EM reports (ROR: 8.75 [95% confidence interval, 8.11-9.44]; IC, 3.10 [IC0.25, 2.97]), followed by hepatitis B (8.54 [7.66-9.51]; 3.06 [2.88]), hepatitis A (8.11 [7.01-9.39]; 2.98 [2.74]), typhoid (6.50 [4.75-8.90]; 2.60 [2.07]), encephalitis (5.86 [4.35-7.91]; 2.47 [1.96]), diphtheria, tetanus toxoids, pertussis, polio, and Hemophilus influenza type b (5.70 [5.42-5.99]; 2.46 [2.38]), pneumococcal (5.56 [5.11-6.06]; 2.45 [2.31]), rotavirus (4.96 [4.21-5.84]; 2.29 [2.01]), varicella-zoster (4.44 [3.99-4.95]; 2.13 [1.95]). Vaccine-associated EM reports were more strongly correlated with younger age groups and males. The overall fatality rate of vaccine-associated EM was 0.04%., Conclusions: The rise in vaccine-associated EM across multiple vaccines, especially in younger populations, highlights the need for closer monitoring and more informed vaccination practices to mitigate adverse reactions., Objective: Vaccine-associated erythema multiforme (EM) remains under-researched, impacting global vaccine safety evaluations. This study examines the global and regional burden of EM and its association with specific vaccines to optimize vaccination strategies., Subject and Methods: We analyzed data from the WHO pharmacovigilance database on vaccine-associated EM from 1967 to 2023 (n = 131,255,418 reports). Reporting frequencies, reported odds ratios (RORs), and information components (IC) were calculated for 16 vaccines across 170 countries., Results: We identified 6,355 cases (males, n = 3,182 [50.07%]) of vaccine-associated EM from a total of 46,378 reports of all-cause EM. While vaccine-associated EM has been consistently reported, there has been a notable increase in reported incidence particularly in 2010 and 2020. Measles, mumps, and rubella vaccines had the highest association with vaccine-associated EM reports (ROR: 8.75 [95% confidence interval, 8.11-9.44]; IC, 3.10 [IC0.25, 2.97]), followed by hepatitis B (8.54 [7.66-9.51]; 3.06 [2.88]), hepatitis A (8.11 [7.01-9.39]; 2.98 [2.74]), typhoid (6.50 [4.75-8.90]; 2.60 [2.07]), encephalitis (5.86 [4.35-7.91]; 2.47 [1.96]), diphtheria, tetanus toxoids, pertussis, polio, and Hemophilus influenza type b (5.70 [5.42-5.99]; 2.46 [2.38]), pneumococcal (5.56 [5.11-6.06]; 2.45 [2.31]), rotavirus (4.96 [4.21-5.84]; 2.29 [2.01]), varicella-zoster (4.44 [3.99-4.95]; 2.13 [1.95]). Vaccine-associated EM reports were more strongly correlated with younger age groups and males. The overall fatality rate of vaccine-associated EM was 0.04%., Conclusions: The rise in vaccine-associated EM across multiple vaccines, especially in younger populations, highlights the need for closer monitoring and more informed vaccination practices to mitigate adverse reactions., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Intrahepatic cholangiocarcinoma (iCCA) has been subclassified by its gross morphology into the mass-forming (MF), periductal-infiltrating (PI), and intraductal growth (IG) types and their combinations. This classification correlates well with clinical features; for example, MF-iCCA has less lymph-node metastasis and a better prognosis than PI-iCCA. According to the recently accumulated evidence from histological investigations, the WHO classification endorsed a subclassification scheme in which iCCA cases are classified into small- and large-duct types. Small-duct iCCA is considered to originate from septal or smaller bile ducts and is characterized by less frequent lymph-node metastasis, a favorable prognosis, and an MF appearance. Large-duct iCCA arises around the second branch of the biliary tree and has more aggressive biology and distinct genetic abnormalities. According to the practice guidelines for iCCA from the Liver Cancer Study Group of Japan and the National Comprehensive Cancer Network, upfront surgery is recommended for iCCA without distant metastasis regardless of the morphological subtype, based on clinical experience. In consideration of the biological heterogeneity of iCCA, the treatment strategy for iCCA needs to be reconsidered based on the WHO subtypes., Competing Interests: Declarations. Conflict of interest: We have no conflicts of interest to declare. There was no grant or financial support for this study. Ethical approval: Because this is a literature review article, IRB approval was not required., (© 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)