Public Health and Healthcare

Abstract: The European Union medical device sector is analysed in several largely separate literatures: regulatory studies of the Medical Device Regulation (MDR) and the In Vitro Diagnostic Regulation (IVDR), innovation research on individual technology classes, commercial market reporting, and health-policy work on adoption and reimbursement. Integration across these dimensions is limited, so the mechanisms by which regulatory change propagates into innovation, market access and healthcare-system outcomes remain poorly specified. This review addresses that gap by proposing and applying a five-stage conceptual framework: Regulation, Evidence, Innovation, Market Access, Healthcare-System Impact, and by using it to structure a reproducible literature synthesis. Four bibliographic databases and a defined set of institutional sources were searched for the period January 2017 to June 2026, with the geographical scope restricted to the EU-27 and the EEA; identified records were screened against explicit criteria and the retained documents were coded against the five framework dimensions. Rather than reporting market values as isolated figures, the synthesis examines relationships between certification duration, evidence intensity, segment growth, market concentration and access conditions. Three findings emerge. First, segment growth in the EU market is ordered by evidence intensity rather than by technological novelty alone: the innovation-intensive segments that grow fastest are also those with the longest and most variable certification paths, median application-to-certificate durations being approximately 17–19 months for in vitro diagnostics and 19–22 months for medical devices, so that regulation operates as a selection mechanism on who can participate rather than as a uniform brake on growth. Second, the innovation consequence of regulatory delay has moved from assertion to estimation: a two-market economic model attributes a measurable loss of EU-directed development effort to the absence of patent-term compensation for conformity assessment, and manufacturer survey evidence records a reallocation of first approvals and launches away from the EU. Third, December 2025 targeted revision of the MDR and IVDR, the first joint clinical assessments of high-risk devices in 2026, and the phased mandatory use of EUDAMED constitute a partial correction whose effects are not yet observable. The framework identifies where regulatory change translates into consequences for manufacturers, providers and patients, and shows that the chain is well evidenced at its regulatory origin and weakest at its healthcare-system terminus.

Abstract: Background: In Israel, fentanyl and pregabalin prescription rates for pain management have increased over the years. However, Health Maintenance Organizations (HMOs) implemented restrictions on opioid prescription in 2022, substantially changing fentanyl availability while pregabalin had no limitations. We aimed to evaluate whether fentanyl and pregabalin misuse between 2021 and 2025 among individuals receiving methadone maintenance treatment (MMT) in Tel Aviv reflected national prescription availability, and to characterize fentanyl misuse groups. Methods: Between February 2021 and December 2025, patients were screened 3-4 times annually for fentanyl and pregabalin, in addition to their routine urine tests. Trends in pregabalin and fentanyl misuse were compared with published national prescription trends. Additionally, methadone doses and serum methadone levels were compared among patients who consistently tested positive for fentanyl, tested negative for fentanyl or Stopped/Started fentanyl use between 2023 and 2025. Results: Pregabalin positivity ranged between 11.2% and 15.9%, with no temporal trend. The fentanyl positivity rate increased from 9.8% in October 2021 to 15.1% in March 2023 and subsequently decreased to 7.5% in March 2025, paralleling the reduction in fentanyl availability following HMO restrictions. The methadone dose of patients testing positive for fentanyl was higher, whether they discontinued or continued fentanyl use, compared with patients who consistently tested negative for fentanyl. Conclusions: Fentanyl misuse among patients receiving MMT decreased following reduced fentanyl availability after HMO restrictions, supporting considering of similar restrictions for pregabalin. However, additional follow-up and studies are warranted. Maintaining an adequate methadone dose may help reduce illicit opioid use and facilitate opioid abstinence.

Abstract: Background: Informal carers provide most long-term care in Europe, and supporting them recently became a political topic. Yet two foundations policy remain unstable: knowing who is considered a carer and what support they need. Objective: To examine how the absence of a consensual definition of the informal carer and the limited operational value of burden measurement hinder designing, targeting and evaluating public support policies. Methods: A critical review of the concepts of burden and informal carers, primary conceptual, psychometric and empirical studies, and policy documents. Results: Definitions of the informal carer converge on non-professional help to a person with long-term needs within a personal relationship, but diverge on several aspects. Prevalence estimates consequently vary across surveys and are partly artefacts of definition. Burden is alternately treated as a stressor, an appraisal or an outcome, and is conflated with stress, strain and burnout. Instruments are numerous, capture mainly subjective strain, have rarely been developed with carers, and seldom demonstrate content validity or responsiveness; none offers thresholds anchored to specific support needs. Policies therefore rely on proxies, typically the care recipient’s dependency level. The French daily carer allowance illustrates this mismatch: nearly 270,000 private-sector employees were eligible, whereas 6,626 entitlements had been opened after 18 months. Conclusions: Conceptual ambiguity is not merely an academic concern: it propagates into identification, targeting and evaluation failures. We propose a definition with explicit reporting of boundaries, separation of objective load, subjective strain and consequences, and the development of COSMIN-compliant, context-specific instruments.

Abstract: Universal health access depends not only on the existence of biomedical innovations but also on the institutional and economic chain that connects research financing to production, regulation, procurement, distribution, and implementation. This essay examines how geopolitical and fiscal conditions can shape that conversion. A structured critical review of 70 multidisciplinary sources was used to integrate evidence on science funding, development assistance for health, global governance, intellectual property, pharmaceutical pricing, vaccine manufacturing, supply security, universal health coverage, the Brazilian Unified Health System (Sistema Único de Saúde, SUS), and the Health Economic-Industrial Complex. The synthesis organizes the science-to-access pathway into interdependent functions spanning priority setting, research and development financing, production or procurement capacity, regulation and negotiation, distribution and implementation, and effective population access. Across these functions, the evidence indicates that scientific capacity is necessary but insufficient: fiscal space, supplier concentration, bargaining power, regulatory and industrial capacity, logistics, and territorial inequalities can alter whether innovation becomes sustainably available. The SUS illustrates how legal universality and large-scale public purchasing can coexist with financing constraints, regional inequalities, and productive dependence. The article therefore proposes that supply security, total implementation cost, absorptive capacity, and distributive effects should be incorporated into the assessment of health innovation from the stage at which scientific priorities are defined. The framework is intended to support context-sensitive analysis rather than a universal policy prescription and identifies a research agenda for empirically testing links among science funding, production strategies, resilience, and equitable access.

Abstract: Falls are among the most common causes of injury, hospitalization, disability, and loss of independence in older adults. Traditional prevention programs focus primarily on reducing fall risk by improving balance, muscle strength, and functional ability, significantly reducing the health consequences of unavoidable falls. The aim of this narrative review is to assess the potential of exercises derived from sports and martial arts as a modern tool for supporting the prevention of falls and injuries in older adults. Available reports on programs incorporating elements of boxing, judo, aikido, tai chi, and self-defence exercises were analysed, with a particular emphasis on dynamic balance training, postural control, cognitive-motor skills, and fall safety education. Current evidence indicates that appropriately modified interventions inspired by martial arts can positively impact postural stability, functional ability, coordination, reaction time, and dual-task performance, which are significant risk factors for falls in older adults. Particular attention was paid to the concept of teaching safe falling, which aims to develop movement patterns that reduce susceptibility to injury during contact with the ground. The INNOAGON (Innovative Agonology) model was also discussed as a concept integrating primary, secondary, and tertiary prevention through motor, cognitive, and behavioural interventions. The results of the analyses suggest that physical activity based on appropriately adapted elements of combat sports can be a valuable complement to contemporary healthy aging programs. Simultaneously, there is a need for multicentre randomized trials and long-term follow-up to assess the impact of such interventions on the incidence of falls, injuries, hospitalizations, and loss of functional independence.

Abstract: Background/Objectives: Multi-dose packaging services aim to simplify complex drug regimens; however, national evaluations of user experience in Saudi Arabia remain limited. This study evaluated patient satisfaction and self-reported medication adherence among active Ez-Pill users across the nationwide network of Nahdi Medical Company in Saudi Arabia. Methods: A national, cross-sectional study was conducted from February to July 2026 utilizing a bilingual online survey administered to a convenience sample of active service users across 14 cities. Two separate multivariable linear regression models were performed to identify demographic, operational, and clinical predictors of self-reported adherence and satisfaction scores. Results: Of 498 distributed surveys, 443 completed responses were analyzed (89.0% response rate; mean age: 53.22 ± 12.36 years; 78.30% male; 43.12% taking ≥ 6 medications). The composite satisfaction score reached 4.55 ± 0.77 out of 5.00, and the self-reported adherence and dosing confidence score reached 4.53 ± 0.79. Service longevity exceeding 1 year was a significant independent positive predictor of both self-reported adherence (B = 0.276, p = .030) and satisfaction (B = 0.278, p = .013). Conclusions: Among surveyed active users, the Ez-Pill compliance aid is associated with high levels of overall satisfaction, self-reported adherence, regimen clarity, and dosing confidence. Given the cross-sectional design and reliance on self-reported data, future longitudinal studies utilizing objective adherence metrics are warranted to confirm clinical effectiveness.

Abstract: Background: Wearable and smartphone sensing can generate longitudinal physiological and behavioral data between conventional clinical encounters, while telemedicine and remote patient monitoring can extend care beyond facility walls. The unresolved translational problem is how to move from repeated signals to proportionate clinical action without converting noisy consumer measurements into diagnoses or overwhelming clinicians with alerts. In Indonesia, this question is increasingly concrete because SATUSEHAT Mobile already supports selected wearable pairing and longitudinal Health Diary data, while SATUSEHAT Platform provides HL7 FHIR-based interoperability.Objective: To develop a two-stage, evidence-gated framework that links low-burden longitudinal health monitoring with triggered targeted assessment, human-supervised clinical triage, and proportionate escalation of care.Methods: We used an evidence-informed conceptual framework-development approach. Source concepts were decomposed into sensing, measurement validity, longitudinal interpretation, trigger logic, remote assessment, triage, escalation, interoperability, governance, and implementation domains. A targeted evidence update through 19 September 2026 prioritized systematic reviews, validation studies, consensus recommendations, current Indonesian digital-health infrastructure, and related conceptual preprints. Proposed functions were classified as near-term capabilities, translational hypotheses, or functions not assumed without prospective validation.Results: RemoteMed360 is specified as a two-stage closed loop. Stage A uses low-burden longitudinal sensing to establish personal trajectories after quality and provenance gating. A trigger may arise from an explicit safety rule, persistent within-person deviation, user concern, multimodal concordance, or clinician request. Stage B activates TRIAGENT as a targeted assessment layer using only validated measurements required by the use case, followed by uncertainty-aware triage support and human clinical review. Responses are graded from continued observation to urgent escalation. A FHIR-oriented interoperability pathway is proposed for validated derived objects, while raw high-frequency data remain outside the clinical exchange layer. An eight-stage validation ladder separates measurement validity, data integrity, longitudinal validity, trigger validity, triage validity, human factors and governance, prospective care-process evaluation, and controlled implementation.Conclusions: RemoteMed360 should be evaluated as a research program for translating longitudinal health signals into proportionate care, not as an autonomous diagnostic or emergency system. Its central testable question is whether a two-stage sensing architecture can improve the timing and appropriateness of remote assessment and escalation while maintaining acceptable false-alert burden, clinician workload, equity, privacy, and safety.

Abstract: Background/Objectives: Psychotherapeutic care in Austria faces the transition introduced by the Psychotherapy Act 2024 (PThG 2024), an aging profession, and a need far exceeding publicly funded provision: potential capacity (≈ 669,000 persons/year) contrasts with ≈ 199,250 publicly (co-)funded patients in 2022. Methods: We developed an FTE-calibrated Monte-Carlo simulation (30,000 iterations per scenario, 2026–2040; anchors: 21 treatment hours/week, 13 units/patient/year) distinguishing potential, accessible and fully funded capacity, treating supervised trainees of both training systems as a separate, survey-anchored capacity line whose capacity rises with insurance funding, including the PThG 2024 transition (Master entry from 2026/27, phase-3 places with a waiting queue, end of the old pathway in 2038) and a robustness matrix across need (5–12%) and treatment intensity (13–40 units/year). Results: At 13 units/year, the expansion scenario closes the median care gap from 2028 and the partial-funding scenario from 2032, largely by funding services delivered by trainees who already treat under supervision; at 30 units/year, even full expansion covers only ≈ 30% of a 9% need. The end of the old pathway in 2038 produces a cliff in workforce growth and trainee capacity; sustaining growth requires about 1,500 Master places per year with matching phase-3 places. Within scenarios, population needs dominate cost uncertainty (Spearman ρ up to 0.79), ahead of the activation rate; exploratory cumulative follow-on costs to 2040 approximate €83/13/1 billion (A/B/C). Conclusions: Activating existing capacity—including trainees' services—is the dominant short-term lever; Master and phase-3 places decide workforce growth after 2038; at clinically adequate treatment intensity, capacity expansion becomes indispensable.

Abstract: Sexual minorities (e.g., lesbian, gay, and bisexual individuals) experience significant health inequalities and report negative identity-related experiences within UK health and social care services. Despite staff training being recommended to improve care for this population, training provision remains inconsistent. This systematic review synthesised UK-focussed guidance documents, training materials, and training evaluations aimed at improving health and social care staff’s work with sexual minority people. We systematically searched nine databases (MEDLINE®, EMBASE, PsycINFO, Social Policy and Practice, CINAHL Plus, ERIC, Applied Social Sciences Index & Abstracts, International Bibliography of the Social Sciences, and Web of Science) and searched supplementary grey literature. Studies of any design, training materials, and guidance documents, published from 2010 onwards were eligible. Screening, data extraction, and quality assessment were conducted independently by two researchers. A narrative synthesis, and content analysis of the guidance documents, was conducted. Study quality was assessed using the QualSyst tool, and guidance documents were appraised using the AGREE II. Thirty-one guidance documents, six training evaluations, and one set of training materials were included. Guidance targeted health and social care staff, services, and commissioners. Consistent recommendations included using neutral language, avoiding assumptions about sexual orientation, recognising the diversity of sexual minority identities, explicitly including sexual minorities in policies, addressing prejudice and discrimination, providing staff training, having visible signs of inclusivity, and routinely collecting and monitoring sexual orientation data. Training evaluations suggested that training can improve staff competence in working with sexual minorities. This review provides the most comprehensive synthesis to date of UK guidance and training relating to health and social care provision for sexual minority service users. It identifies a consistent set of practical, largely low-cost actions that organisations and staff can prioritise to create safe and inclusive services.

Abstract: Background: Telehealth has expanded remote access to ADHD care, yet a prescription issued remotely must still be filled at a pharmacy—and whether telehealth resolves these downstream fulfillment barriers remains unclear. Federal regulatory distinctions between Schedule II controlled stimulants and non-controlled ADHD pharmacotherapies create structurally divergent procurement experiences, particularly under ongoing nationwide stimulant shortages. This study examined whether prescription fulfillment difficulty differs by medication regulatory classification among adults using telehealth for ADHD care, and identified social determinants of health (SDOH) associated with access difficulty. Methods: Data were drawn from Round 2 of the NCHS Rapid Surveys System (RSS-2; October–November 2023). The analytic sample comprised 141 adults with a current ADHD diagnosis who reported pharmacotherapy use and telehealth utilization for ADHD care, classified as controlled-exposed (n = 95) or non-controlled-exposed (n = 46) by medication regulatory class. Chi-square tests, multivariable logistic regression, and five machine learning algorithms were applied across 19 SDOH variables. Results: Prescription access difficulty was substantially more prevalent among controlled-exposed than non-controlled-exposed participants (75.8% vs. 45.7%, p < 0.001). Multivariable logistic regression identified controlled medication exposure (coefficient = 2.155, p < 0.001), difficulty paying medical bills (coefficient = 1.409, p = 0.034), and income (coefficient = 0.145, p = 0.042) as significant correlates. Random forest permutation importance ranked controlled medication exposure and having a usual place for care as the two strongest predictors. Notably, all 13 participants reporting non-prescribed online medication purchases also reported access difficulty through formal channels, a pattern consistent with displacement toward unregulated supply chains. Conclusions: Prescription fulfillment barriers were strongly stratified by medication regulatory classification, with financial strain further compounding access difficulty. As federal telemedicine flexibilities approach their December 31, 2026, expiration, regulatory deliberations should weigh downstream fulfillment constraints, including the Schedule II refill prohibition under shortage conditions, alongside upstream telehealth access.

Abstract: Background: Although a protective vaccine is available, diphtheria reemerged in Somalia starting in mid-2023 with outbreak reported throughout the country in 2025. In response, the Federal Ministry of Health (FMoH) developed a diphtheria outbreak response plan in 2025, launching a vaccination campaign with the first round conducted in 2025 and a second round in early 2026. The vaccination campaign was a mass public health push to rapidly deliver Pentavalent and Td vaccines to children in Somalia regardless of past vaccination status, to stop the diphtheria outbreak. During the campaign, under 5 children received Pentavalent vaccines, while 5-15 years olds received Diphtheria and Tetanus (Td). This study aims to evaluate the post-campaign coverage of diphtheria vaccines in the three most stable states in Somalia, namely the Benadir region, Puntland, and Galmudug states. Methods: The post-campaign coverage survey (PCCS) was conducted from May 18th to July 21st, 2026, in Benadir, Galmudug, and Puntland states. A two-stage cluster sampling design was employed, whereby 362 clusters were randomly selected from a national sampling frame covering all accessible districts, villages, and nomadic areas across the three states. The sample size was calculated according to the WHO 2018 manual, resulting in the selection of 120 clusters and 1,335 households from each state, culminating in a total of 4,093 interviews and covered 9184 children. Surveys were carried out by 152 trained personnel equipped with the KoboCollect app for digital data collection. Ethical approval was obtained from the Somali National University Ethical Committee. Results: Among the children, 49.7% were aged 0 to <5 years, and 50.3% were aged 5 to 15 years. Weighted data indicated that 84.1% of children aged 0 to 15 years across the three states received at least one dose of the diphtheria vaccine during the campaign (95% CI: 80.4% to 87.2%). Among those vaccinated, only 25% of children under 5 years of age and 36% of children aged 5 to 15 years received two doses. Vaccination coverage varied significantly by state: Puntland reported the highest coverage at 93.9%, while Galmudug had the lowest at 75.4% (95% CI: 69.2–80.7%), and Benadir showed intermediate coverage at 80.3% (95% CI: 74.5–85.1%). Geographically, internally displaced persons (IDPs) and nomadic populations had the lowest coverage rates, at 71.9% (95% CI: 55.0–84.2%) and 72.6% (95% CI: 57.9–83.7%) respectively. The primary reason for children not being vaccinated was a lack of awareness about the vaccination campaign. Conclusion: Post-campaign vaccination coverage is notably lower in Galmudug, the most fragile of the three states in terms of security. This indicates that even among Somalia’s relatively stable states, vaccination coverage tends to reflect the security situation of each state. Furthermore, despite the campaign has achieved a relatively high overall vaccination rate of 84.1% in the three states, specific groups—particularly nomadic populations and IDPs remain underserved. Efforts must be intensified to improve accessibility and ensure equitable and comprehensive vaccine coverage for all children throughout Somalia.

Abstract: Background. Research shows that children in court-involved families receive low levels of therapy, which might be associated with restrictions on publication of effective therapies. Method. The article reviews mechanisms used to ensure ethical practices are used both when developing innovative mental health interventions and when publishing innovations. Research is regulated as prior approval is required before a proposal is implement, while therapy is monitored as complains can be made after therapy is provided. Three guidelines for developing innovative therapies are reviewed: the combined scientist-practitioner and levels-of-evidence models; the practice of registering health practitioners; and monitoring of assessment and treatment reports by family-oriented courts. The COPE guidelines were developed to help publishers ensure that only human research based on ethical approaches is published. Result. The article notes confusion will result if the COPE regulatory guidelines for research are extended to publication of innovative therapies. Conclusion. The article proposes that publishers accept responsibility for monitoring ethicality when publishing innovative single case studies involving mental health therapy and recognise established mechanisms to ensure ethicality. Use of a standardised consent form is proposed.

Abstract: Patient-facing generative AI can enter healthcare from outside organizational boundaries, but patient use does not automatically translate into organizational change. This Perspective develops a cross-level framework for explaining when such changes become consequential for healthcare delivery and organizations. It distinguishes technical AI affordances from effective patient capability, identifies two patient-mediated routes into care—care-seeking/utilization and AI-mediated patient inputs—and separates delivery-level change from persistent mismatch and organizational recognition. Organizational responses may then be formal, decentralized, both or neither. As a conditional extension, the framework distinguishes the existence of system-level patterns of healthcare delivery from causal attribution to organizational change. By making stopping points explicit, the framework is designed to prevent evidence at the patient or encounter level from being overextended into unsupported organizational or system-level claims.

Abstract: Background: Most medication use occurs at home, after a consultation ends. Patients may need to recall why each medicine matters, how and when to take it, follow changing dose schedules, and recall observations for the next consultation. These tasks are often distributed across separate sources and tools. Methods: We describe the design, implemented functions, and intended-use boundaries of Medil AI, a multilingual Android and iOS treatment-support platform. Needs identified from clinical experience and the literature were mapped to application workflows, documented from interface screens and public guides (version 4.17; September 2026). Reporting was guided by mERA and iCHECK-DH. Results: Medil AI connects source-linked medicine information from official sources in 12 countries (United States, Canada, Israel, France, United Kingdom, Germany, Spain, Russia, Japan, South Korea, Singapore, and Argentina); translation into 20 languages; prescription capture; medication reminders; and dose recording. Health measurements can be synchronized through Health Connect on Android and HealthKit on iOS, and recorded by camera-assisted capture of values displayed by home-monitoring devices, including blood pressure, pulse, weight, temperature, and oxygen saturation. Detected values are saved after confirmation in the medical diary alongside medication-use records for follow-up. The application supports implementation of prescribed dose sequences for selected medications, including semaglutide (Ozempic, Rybelsus, Wegovy), tirzepatide (Mounjaro, Zepbound), liraglutide (Victoza, Saxenda), and varenicline (Chantix and generic products). Conclusions: A continuous patient journey from prescription to understanding, daily implementation, and the next consultation has been implemented in one application. Independent evaluation of usability, recognition accuracy, medication comprehension, adherence, and clinical effects is warranted.

Abstract: To aim for health equity, this essay posits the necessity of lifelong health literacy education for all individuals. A fundamental aspect of this endeavour involves prioritizing wisdom, characterized by intellectual and emotional intelligence, and encapsulated by the principles of realism, benevolence, and creativity. To elucidate the multifaceted, theoretical and practical concept of wisdom, it is essential, first, to cultivate intellectual intelligence. This entails comprehending the world objectively, based on verifiable evidence and rational, logical reasoning, rather than on perceived desires. This necessitates humility in search of truth and a clear-eyed acceptance of reality. Furthermore, wisdom incorporates emotional intelligence, which involves the capacity to manage one's own emotions and those of others, thereby preventing emotions from dictating one’s responses. Emotional intelligence thus encompasses social awareness (particularly empathy) and effective relationship management, promoting respectful interactions and collaborative problem-solving to foster dignity and health for all. Another defining characteristic of wisdom is creativity, which involves critical thinking, curiosity, and innovation across art, science, and literature. Crucially, it involves appreciating the beauty and wonders of the world, identifying and avoiding potential pitfalls or “traps”, such as psychological biases, sociocultural pressures, ecological challenges, evolutionary traps, and AI-delegation traps (i.e., over-reliance on artificial intelligence). Ultimately, this essay contends that genuine health literacy—the ability to appropriately access, understand, appraise, and utilize health information and services—can only be achieved through the integration of these principles of wisdom. This holistic approach is crucial for reducing preventable health disparities and advancing the overarching goal of health equity.

Abstract: The end of the Sustainable Development Goal (SDG) era presents an opportunity to reconsider how the global development agenda is defined, governed and implemented. For Small Island Developing States, including Pacific Island countries and territories, this is particularly important. Although the SDGs have provided a valuable common framework for development, their implementation has also exposed persistent limitations: fragmented sectoral approaches, externally driven priorities, short-term financing, and measures of progress that inadequately reflect structural vulnerability and the realities of small island systems. This essay argues that Pacific Island states should not simply adapt to the framework that succeeds the SDGs, but collectively seek to shape it. The Blue Pacific narrative, supported by established regional institutions and frameworks and decades of collective diplomacy, provides a platform through which Pacific states can articulate a coherent position in post-2030 negotiations. Central to this position should be recognition of climate change as a system-wide determinant of development rather than a discrete sectoral issue; greater use of vulnerability, rather than income alone, to determine access to development and climate finance; investment in resilient and integrated public systems; and stronger country ownership of development priorities, implementation and measures of progress. As geopolitical interest in the Pacific intensifies, these principles are also important for ensuring that development agendas reflect Pacific priorities rather than those of external actors. The post-2030 transition therefore represents a strategic opportunity for Pacific states to translate regional solidarity and the Blue Pacific narrative into greater influence over global development governance. Rather than remaining recipients of frameworks designed elsewhere, Pacific states are well positioned to help define the principles, priorities and architecture of the next global development agenda.

Abstract: Rapid interruption of ebolavirus transmission depends on surveillance that converts alerts into investigation, classification, sampling and care while sustaining contact follow-up, active case finding, laboratory processing and border screening. By 25 August 2026, the Democratic Republic of the Congo (DRC) had reported 5,713 confirmed cases and 2,744 confirmed deaths across 58 health zones in six provinces. A retrospective descriptive ecological analysis was conducted using the national situation-report series from the 2026 Bundibugyo virus disease outbreak in the DRC, with chronology and operational context triangulated against official WHO and Africa CDC reports. Of 103 expected report positions through 25 August 2026, 96 (93.2%) were available, yielding 2,375 source-derived records. Strict source-linkability rules were applied without imputation. Median cumulative alert-investigation coverage was 88.5% (IQR 79.9–94.2; n=97), sampling coverage 66.7% (IQR 54.5–74.6; n=5), validation yield 26.0% (IQR 20.2–74.2; n=35), contact follow-up 78.2% (IQR 67.3–82.9; n=90), and point-of-entry/point-of-control screening approximately 98.0% (IQR 96.0–98.8; n=32). Reported completion within 44 source-defined compatible laboratory specimen cohorts ranged from 89% to 100%; these observations should not be interpreted as independent measures of overall laboratory throughput. Most process indicators were cumulative status measures reported at successive dates and should not be interpreted as independent daily performance. Under the primary national-first date-level hierarchy, 71 qualifying reporting observations were identified. Contact follow-up was the lowest measured process in 55 observations (77.5%), followed by alert investigation in 12 (16.9%), sampling in three (4.2%) and point-of-entry/point-of-control screening in one (1.4%); laboratory processing was not uniquely lowest in any observation, and no ties occurred. Contact follow-up remained dominant in the province-first sensitivity analysis (67/94; 71.3%). Active case finding was documented early and later incorporated into routine health-zone surveillance, but implementation gaps occurred in some high-risk areas and population-level coverage could not be quantified. Official reports documented logistical constraints, insecurity, community resistance and limited trust that disrupted field access, alert investigation, specimen collection and transport, and contact follow-up. Public reporting did not consistently link validated or sampled alerts to same-cohort Ebola treatment centre transfer. Contact follow-up emerged as the dominant recurrent measurable bottleneck. Strengthening contact follow-up, active case-finding capacity, field logistics, community trust and safe access, together with cohort-linked reporting from alert through sampling, isolation and referral, should strengthen early detection, accelerate diagnosis and care, and help limit continued community transmission.

Abstract: Syndromic management transformed sexually transmitted infection (STI) care in settings where laboratory diagnosis was unavailable, enabling standardized treatment at the first consultation. Its historical contribution remains substantial. Yet continued reliance on symptom-based algorithms now creates a global health contradiction. We propose the STI diagnostic–antimicrobial resistance (AMR) paradox: the same strategy can miss true infections, especially asymptomatic infections, while exposing people without the targeted infection to unnecessary or poorly targeted antimicrobials. The resulting combination of persistent transmission, avoidable antimicrobial exposure and weak pathogen-specific surveillance threatens both STI control and antimicrobial stewardship. The appropriate policy response is not the abrupt abandonment of syndromic care, nor indiscriminate molecular screening. It is a progressive transition to diagnostic stewardship: testing the right populations for the right pathogens, through technologies suited to the level of care, and ensuring that results guide treatment, partner services, surveillance and procurement. We propose a four-stage diagnostic continuum, from optimized syndromic care to targeted rapid testing, near-patient molecular diagnosis and integrated pathogen and resistance surveillance. Implementation should be evaluated through clinical appropriateness, feasibility, acceptability, fidelity, turnaround time, cost, equity and sustainability, rather than analytical accuracy alone. STI diagnostics should therefore be treated as health-system interventions and public goods that connect sexual health, universal health coverage, surveillance and AMR policy. National programmes, funders and implementers should prioritize context-specific implementation research and gradual, equity-centred integration into routine services.

Abstract: Background/Objectives: Evidence-based maternity care practices are critical for supporting breastfeeding initiation, exclusivity, and continuation, and these practices are operationalized through the Baby-Friendly Hospital Initiative (BFHI) Ten Steps to Successful Breastfeeding. This study examined longitudinal trajectories of evidence-based maternity care practices by Baby-Friendly designation status among U.S. hospitals. Methods: Hospital-level data from the Centers for Disease Control and Prevention’s Maternity Practices in Infant Nutrition and Care (mPINC) surveys from 2018, 2020, 2022, and 2024 were analyzed. Hospitals completing at least two surveys were included in the analysis, categorized as having sustained designation, adopted designation late, lost designation, or never been designated. Longitudinal mixed-effects models estimated changes in total and domain-specific mPINC scores over time. Results: Among 2,304 hospitals, 400 sustained Baby-Friendly designation, 190 adopted designation late, 160 lost designation, and 1,554 were never designated. Hospitals with sustained designation maintained consistently high total mPINC scores from 2018 to 2024. Late adopters improved substantially, increasing 8.9 points (95% CI: 7.0,10.9), whereas hospitals that lost designation declined from 88.1 to 84.7, a change of −3.4 points (95% CI: −5.6, −1.3). Declines among hospitals that lost designation were most evident in immediate postpartum care, feeding practices, and institutional management domains. Never-designated hospitals’ scores improved modestly but remained below those of the sustained Baby-Friendly hospitals across survey years and domains. Conclusions: Sustained Baby-Friendly designation was associated with stable, high implementation of evidence-based maternity practices, whereas loss of designation was associated with measurable declines in key breastfeeding-supportive domains. Maintaining or regaining designation may protect equitable access to critical breastfeeding support services across communities.

Abstract: The care for the disabled is a societal concern for many nations. This study documents a simulation to support the discussion related to the financial sustainability of this care. The simulation relies on Eurostat data and 1,120 observations provided by 769 unique respondents who participated in the Survey of Health, Ageing, and Retirement in Europe (SHARE) in 2020 and 2022. A Poisson panel estimator is used to obtain the effects of gender, age, income, and nationality on the amount of disability benefits and pensions. The simulation procedure integrates these coefficients as well as accounts for the forecasted population change, income growth, and disability prevalence change occurring in the period 2026 up to 2036. The results suggest the occurrence of a notable increase in the annual total amount of disability benefits and pensions in the upcoming decade for women 85+ in the Baltic States. For men, a remarkable increase is suggested for the 55-to-64-year-olds in Latvia and Lithuania. To conclude, the results may provide some valuable insight to policymakers and institutions to ensure the long-term care for the disabled in the Baltic States.