Public Health and Healthcare

Abstract: Diphtheria has returned to the WHO African Region as a large, sustained outbreak, yet national immunization indicators for the affected countries look, in aggregate, unremarkable. This narrative review asks why rising case counts coexist with seemingly adequate coverage. We reviewed peer-reviewed outbreak analyses (2022–2026) from Nigeria, Yemen, Guinea, Haiti and South Africa, peer-reviewed studies of zero-dose and under-immunized children, and official WHO African Region communications. Three observations emerge. First, the 2025 resurgence is demographically concentrated: across the Region more than 90% of reported cases occurred in unvaccinated or under-immunized children, and country studies consistently attribute the majority of cases and deaths to zero-dose and late-presenting children. Second, this concentration is invisible to the coverage indicators that surveillance tracks, because district-level DTP3 averages smooth over the pockets—fishing islands, pastoralist zones, peri-urban settlements and conflict areas—where zero-dose prevalence reaches 69–92%. Third, the same children excluded from vaccination are also the least likely to reach diphtheria-antitoxin-capable care, so immunization exclusion and treatment failure are one problem seen from two sides. We argue that outbreak response should pair fine-grained immunization intelligence (who and where remains un- or under-immunized) with district-level treatment-readiness tracking, and report the two together rather than separately.

Abstract: Background/Objectives: Psychosocial support was delivered on a large scale after the 6 February 2023 Kahramanmaraş earthquakes, but survivors have lacked a validated instrument for evaluating the organized services they received. This study developed the Multidimensional Perceived Psychosocial Support Scale for Earthquake Survivors (MPPSS-ES) and examined its psychometric properties. Methods: A 68-item pool covering four domains (Knowledge, Process, Individual Benefit, and Community Benefit) was reduced to 38 items through expert content validity ratings, cognitive interviews (n = 30), and expert committee review. The 38-item form was administered face to face to adults who had received psychosocial support in the affected region (N = 638). The sample was split into a calibration subsample (n = 322) for exploratory factor analysis and a validation subsample (n = 316) for confirmatory factor analysis; measurement invariance, differential item functioning, reliability, and discriminant validity were examined in the full sample. Results: Starting from the four-factor structure of the construct map, the exploratory analyses retained 20 items, each loading on its intended factor. In the validation subsample, the four-factor model showed a high comparative fit index (CFI = 0.976) and Tucker–Lewis index (TLI = 0.972) but a root mean square error of approximation (RMSEA) of 0.103, and standardized loadings ranged from 0.640 to 0.969. The factors were weakly correlated, Knowledge correlated negatively with the other three factors, and a general factor was not supported. Scalar invariance was supported across age group, gender, marital status, and education but was not established for employment status, and no item showed differential item functioning. Cronbach’s α ranged from 0.858 to 0.953 and McDonald’s ω from 0.828 to 0.960. Conclusions: The 20-item MPPSS-ES provides preliminary evidence for a four-subscale profile of survivors’ evaluations of organized psychosocial support. Relations with external measures and stability over time remain to be tested.

Abstract: Renal lesions encompass benign, indeterminate, primary malignant, and secondary neoplastic entities. Ultrasound frequently provides initial detection and triage, whereas CT and MRI provide complementary morphologic and tissue characterization. The Bosniak classification standardizes cystic renal masses but does not provide a unified ordinal framework encompassing solid lesions and aggressive imaging behavior. We propose a preliminary five-category Kidney Imaging Reporting and Data System (KI-RADS) integrating ultrasound, CT, MRI, and the Bosniak classification. KI-RADS 1 includes unequivocally benign lesions; KI-RADS 2 includes benign or low-suspicion lesions, including Bosniak II and IIF cysts; KI-RADS 3 comprises genuinely indeterminate lesions, including Bosniak III cysts and indeterminate solid masses; KI-RADS 4 includes lesions highly suspicious for neoplasia without convincing aggressive features; and KI-RADS 5 requires imaging evidence of aggressive local or systemic behavior. Classification is based on synthesis of relevant imaging findings rather than mandatory performance of every modality, and category assignment does not independently prescribe treatment. This conceptual framework builds on prior calls for a unified KI-RADS and requires prospective validation of reader agreement, pathology correlation, and clinical outcomes before routine implementation.

Abstract: Whole systems approaches have become prominent within physical activity (PA) policy, mostly reported on as individual projects. There is however limited evidence regarding how such approaches can be facilitated at scale by nation-wide agencies. This paper examines Public Health Scotland’s Systems-based Approach to Physical Activity Promotion, designed to support national-level PA strategy development. Using a case study design, three Scottish regions were purposively selected. Data were gathered via: an online survey; interviews with regional PA leads; and key stakeholders focus groups. Analysis combined thematic analysis with Pawson and Tilley’s realistic evaluation framework. The work suggested that whilst previous efforts had often been insufficiently systematic, strong historical foundations of PA partnership working and strategy development provided crucial contemporary support. Despite COVID-19 disrupting ongoing strategic work, participants described the post-pandemic period as a positive ‘reset’ that created opportunities for innovation. The Public Health Scotland framework was valued for offering a structured, practical, and evidence-informed process that balanced centralised systems thinking with local flexibility. Participants also approved of the inclusivity of the workshops, cross-sector collaboration, and the credibility of Public Health Scotland facilitation. Challenges included the complexity of systems concepts, sustaining stakeholder engagement, securing representation from senior decision-makers, and concerns regarding implementation capacity and resources. Our paper suggests that nationally facilitated, systems-informed approaches can effectively support the development of robust local PA strategies. However, strategy production represents only an initial outcome. Sustained implementation support, leadership, and long-term system stewardship are also required to translate aspirations into lasting population-level increases in PA.

Abstract: Pain is conventionally studied within the boundaries of a single substrate — human self-report, animal nociceptive behavior, or engineered damage-avoidance in robotics — with little cross-talk between the resulting formalisms. We previously introduced PainVector, a multidimensional computational framework that represents human pain as a state vector combining self-reported and physiologically inferred intensity with auxiliary dimensions of predictability, controllability, location, memory, and confidence. In this paper we show that the same core computational structure, retained without alteration, extends to substrates that lack self-report entirely, while the operational mapping of individual dimensions — and, for the machine substrate, a small set of substrate-specific extensions — is adapted to the measurable properties of each substrate. We instantiate the framework on two additional substrates: an artificial nociceptive system (the Machine Pain Vector, MPV) and the ASH polymodal nociceptive sensory neuron of Caenorhabditis elegans. The extension rests on a single structural mechanism: substrates without self-report set the self-report weighting term to zero, collapsing the final intensity estimate to the inferred term without any change to the intensity equations. We construct explicit variable-mapping tables for both non-human substrates, grounded in the artificial-nociception and C. elegans literatures, and argue that the formalism's value lies in this demonstrated transportability of form rather than in any claim of shared subjective experience across substrates. We close by discussing a natural extension toward genetically driven inter-individual variability in nociceptive sensitivity, using the C. elegans npr-1 polymorphism as an illustrative case. A supplementary numerical script instantiates the formalism on synthetic, illustrative data for all three substrates to confirm the equations are computable and produce differentiated outputs; this is a worked illustration, not empirical validation, and the variable mappings themselves remain grounded in published literature rather than in jointly validated shared data.

Abstract: Public health emergencies heighten the need for reliable evidence while increasing uncertainty, participant vulnerability, health-system strain, and political pressure. This critical narrative review examines how clinical trials can be accelerated while protecting participants’ dignity, rights, safety, and agency. Drawing on empirical literature, international ethical guidance, and Brazilian legal and regulatory sources, we analyse challenges involving scientific validity, consent, inclusion, adaptive designs, oversight, data governance, and equitable access. We propose the DIGNITY conceptual model: Dignity; Inclusive and locally responsive research; Governance, accountability, and transparency; Necessity and scientific validity; Informed and revisable consent; Timely, risk-proportionate oversight; and Yielding fair and accessible benefits. Brazil provides a regulatory case study through Law No. 14,874/2024, Decree No. 12,651/2025, single ethics review, national ethics governance, post-trial obligations, and risk-, complexity-, and reliance-based regulatory pathways. Regulatory agility requires preparedness, scientific prioritization, local responsiveness, and accountable coordination. DIGNITY is proposed as a normative framework for preparedness and ethical deliberation, requiring empirical evaluation. Procedural adaptations are ethically defensible when they preserve scientific validity, meaningful participant protection, independent oversight, and equitable access to benefits.

Abstract: Background: Hepatic vascular diseases (HVDs)—encompassing portal inflow, sinusoidal microcirculatory, hepatic venous outflow, and hepatic arterial disorders—cause severe portal hypertension, liver failure, and death. Despite major therapeutic advances, national long-term mortality trends and demographic disparities across this spectrum of diseases remain undefined. Methods: In this nationwide, population-based serial cross-sectional study, we analyzed CDC WONDER Multiple Cause of Death records for U.S. decedents aged ≥25 years from 1999 through 2024. HVD-related deaths were identified by any mention of primary vascular lesions across the four vascular compartments (ICD-10 codes: I81, K75.1, I82.0, K76.5, K76.4, and K76.3). Age-adjusted mortality rates (AAMRs), standardized to the 2000 U.S. population, and Joinpoint regression models were used to estimate annual percent change (APC) and average annual percent change (AAPC). Results: Among 22,498 HVD-related deaths, annual fatalities increased 4.7-fold, from 433 in 1999 to 2,025 in 2024, while the AAMR rose from 0.233 to 0.735 per 100,000 (overall AAPC, 4.94% [95% CI, 4.60%–5.24%]). Following a decade of relative stability from 1999 to 2011 (APC, 0.85%), mortality underwent a steep upward inflection during 2011–2024 (APC, 8.87% [95% CI, 8.31%–9.52%]). Portal vein thrombosis (PVT) accounted for 80.8% of all deaths (n = 18,189) and increased rapidly (AAPC, 7.48%); notably, excluding PVT abolished the secular upward trend across the remaining HVDs (AAPC, −0.55% [95% CI, −1.62% to 0.60%]). Concurrent mentions of cirrhosis nearly doubled (19.6% to 35.2%), and co-listing of hepatocellular carcinoma more than tripled (6.5% to 20.1%). Persistent disparities were observed: males had higher mortality than females (rate ratio [RR], 1.52; 95% CI, 1.48–1.56), Hispanic individuals bore the highest racial and ethnic burden (AAMR, 0.434), the West had the highest regional mortality rate (AAMR, 0.460), and nonmetropolitan residents experienced excess mortality compared with metropolitan residents (RR, 1.13; 95% CI, 1.08–1.18). Mortality briefly exceeded pre-pandemic projections only in 2021. Conclusions: Mortality from hepatic vascular diseases in the United States has escalated rapidly since 2011, driven primarily by portal vein thrombosis amid increasing national burdens of cirrhosis and liver cancer. Marked sex, racial and ethnic, and rural–urban disparities highlight the urgent need for targeted vascular surveillance and equitable access to specialized multidisciplinary hepatology and endovascular care.

Abstract: Background: Mobile technologies are increasingly viewed as tools for connecting African populations with healthcare systems, yet whether phone ownership, internet access, and frequency of use are independently related to healthcare contact, after accounting for socioeconomic, demographic, and regional differences, remains unclear. Methods: We analysed pooled cross-sectional data of 44,761 respondents in Round 8 of the Afrobarometer survey across five regions in Africa. The outcome variable was self-reported contact with a public clinic or hospital in the previous 12months. Primary exposures were phone ownership, phone-based internet access, and frequency of phone use. Sequential multivariable logistic regression models assessed their independent relationships before and after adjustment for age, sex, education, religion, rural residence, and African region. A separate model examined whether lived poverty modified the relationship between internet access and healthcare contact using poverty-by-internet-access interaction terms. Results: Overall, 61.1% of respondents reported contact with a public clinic or hospital in the last 12months. Phone ownership was not independently related to contact after full adjustment (AOR=1.054, 95% CI 0.950-1.170; p=.268). Internet access was positively linked with contact after full adjustment (AOR=1.081, 95% CI 1.033-1.131; p< 0.001), despite an inverse relationship before adjustment (AOR=0.850, 95% CI 0.818-0.883). Frequency of use showed the most consistent relationship, with daily users having higher odds of contact than never-users (AOR=1.217, 95% CI 1.091-1.357). Lived poverty was independently related to contact with healthcare facility, with the highest odds among those reporting moderate poverty (AOR=1.709, 95% CI 1.528-1.911), but did not modify the internet access-contact relationship (all interaction p≥.553). Regional disparities were substantial, with lower odds of contact found in Northern Africa than in West Africa (AOR=0.411-0.437 across models). Conclusion: Mobile-phone engagement dimensions showed distinct links with healthcare contact. Frequency of use was most consistently related, while internet access showed a positive connection after covariate and factor adjustment; phone ownership alone was not independently related. The absence of effect modification by lived poverty suggests no detectable heterogeneity in the internet access-contact link across poverty levels. Persistent regional disparities highlight the importance of contextual determinants beyond mobile access.

Abstract: Background & Objectives: Sickle Cell Disease (SCD) affects at least 300,000 babies globally, with 14% born in India. Disease-related stigma is a multidimensional social challenge that varies culturally and severely impacts the quality of life for both patients and caregivers. This study aimed to determine the magnitude of perceived stigma among individuals with Sickle Cell Disease and caregivers and also the factors associated with it. It also aimed to explore the lived experiences of patients and caregivers. Methodology: Community-based mixed methods study of convergent parallel design was conducted in the tribal district Betul of Madhya Pradesh, India. A total of 85 patients and 105 caregivers were sampled for quantitative strand. For qualitative strand, purposive sampling was used and data was saturated after IDI of five patients and five caregivers. Results: Mild stigma was reported by 68.2% of patients and 49.5% of caregivers, whereas severe and very severe stigma was more than twice as common among caregivers (26.7%) compared to patients (11.8%). For patients, high stigma was significantly associated with complication-related hospitalization (p=0.005). High stigma among caregivers was significantly associated with a nuclear family type (p<0.001), blood transfusions in the past year (p<0.001), complication-related hospitalizations (p=0.039), and recent pain crises (p=0.005). Seven themes were identified qualitatively. Conclusion: Overall burden of stigma was more among caregivers than patients. It was associated with frequency of hospitalisation, blood transfusion and pain crisis. Stigma operates as a multilayer, cyclical process driven by knowledge deficits, leading to outcomes ranging from financial insecurity to preventable mortality.

Abstract: Background/Objectives: Bangladesh carries one of the world's highest estimated childhood lead burdens alongside a substantial undernutrition burden, yet no nationally representative study has examined the association of blood lead levels (BLLs) with anthropometric failure. Methods: We analysed data from the 2025 Bangladesh Multiple Indicator Cluster Survey, including 10,495 children aged 12–59 months with BLLs and anthropometric measurements. Venous blood lead, arsenic, cadmium, and mercury were measured alongside anthropometry. Associations of BLLs with height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z-scores were estimated using linear regression; associations with stunting, wasting, underweight, and the Composite Index of Anthropometric Failure (CIAF, comprising six disaggregated failure categories) were estimated using modified Poisson regression yielding adjusted prevalence ratios (APRs). Models considered continuous standardised log-transformed BLLs and elevated BLLs (≥5 µg/dL), with and without adjustment for arsenic, cadmium, mercury, and covariates. Results: The prevalence of stunting, wasting, underweight, and CIAF was 25.9%, 14.1%, 26.6%, and 38.2%, respectively. Elevated blood lead prevalence was 38.6 Higher BLLs were significantly associated with lower HAZ (β=-0.075), WAZ (β=-0.062), and WHZ (β=-0.029), and with higher prevalence of stunting (APR=1.09), wasting (APR=1.08), underweight (APR=1.08), and CIAF (APR=1.07), largely unchanged after adjustment for co-exposure. The association of WHZ was not significant with elevated BLLs. BLLs were associated with several CIAF patterns, most strongly the combined stunting-wasting-underweight category (APR =1.18), with significant associations present across every category involving stunting. In exploratory analyses, elevated BLLs were also significantly associated with household soil lead concentration (APR=1.20), occupational contact with lead-related work (APR=1.08), and child pica behaviour (APR=1.18), and were inversely associated with solid fuel use for cooking (APR=0.78). Elevated BLL prevalence varied substantially by district (range 4.4–93.7%), with higher burden concentrated in the central-eastern region. Conclusions: BLLs are independently associated with impaired growth and specific patterns of CIAF among Bangladeshi children. These findings support prioritising lead-specific source control and integrating growth monitoring with environmental exposure surveillance in national child health programming, and suggest CIAF-based surveillance may capture lead's population-level nutritional burden more fully than single indicators alone. Household soil lead, occupational exposure, and child pica behaviour represent modifiable targets for source-control interventions.

Abstract: Type 2 diabetes mellitus (T2DM) self-management depends on interacting behavioral, clinical, problem-solving, and psychosocial factors that are difficult to represent using rigid categorical models. This study presents FES-T2DSC (Fuzzy Expert System for Type 2 Diabetes Self-Care), an application-specific fuzzy expert system for multidimensional self-care assessment in adults with T2DM. The system comprises four type-1 Mamdani fuzzy inference models—Basic Self-Care, Diabetes Self-Management, Problem-Solving Capacity, and Psychosocial Status—with explicit membership functions and linguistic IF–THEN rules. Development used records from 27 adults with T2DM recruited in an outpatient municipal setting in Veracruz, Mexico; 93 synthetic configurations from the original analysis are retained only as historical descriptive context, not validation evidence. The architecture preserves separate domain-level outputs and makes the encoded rule bases and membership functions inspectable. Quantitative evidence consists of an internal, non-independent archival reanalysis of archived outputs; the currently available FIS files are not established as their generators, and no external clinical validation was performed. FES-T2DSC therefore provides an integrative, rule-based architecture for multidimensional diabetes self-care assessment, while larger independent cohorts, reproducible execution pipelines, and prospective evaluation are required before external performance, generalizability, or clinical utility can be established.

Abstract: Background: The triadic model of assisted telemedicine, in which a trained nurse or caregiver facilitates the clinical encounter between a patient and a remote physician, holds considerable potential for improving access, diagnostic accuracy, and continuity of care. However, the distinctive risk architecture of this three-party model remains poorly characterized. Existing telemedicine risk literature addresses predominantly dyadic consultations, leaving the triadic context without a dedicated, integrative framework. Objective: This study aims to address the absence of a dedicated risk management framework for the triadic telemedicine context by proposing the Risk Management Framework for Triadic Telemedicine (RMFTT)—a structured, domain-specific tool for identifying, assessing, mitigating, and monitoring the principal risks inherent to nurse-facilitated assisted telemedicine. Methods: This conceptual framework development study employs a narrative literature review of PubMed, Scopus, Web of Science, and Google Scholar publications from January 2015 to June 2026, organized across five risk domains: clinical and diagnostic risk, communication risk, legal and liability risk, data privacy and cybersecurity risk, and workforce competency risk. Extracted evidence is synthesized using a structured risk architecture matrix, distinguishing risk type, source, likelihood, and consequence severity within the triadic telemedicine context. Results: The synthesis yields the Risk Management Framework for Triadic Telemedicine (RMFTT), two-axis conceptual model mapping five risk domains against four risk management stages: identification, assessment, mitigation, and monitoring. Each domain is populated with literature-derived risk indicators and corresponding mitigation strategies tailored to the triadic care setting. Conclusions: To our knowledge, no dedicated risk management framework has previously been proposed for the triadic telemedicine context. The RMFTT provides the first structured, domain-specific tool for identifying, assessing, mitigating, and monitoring risk across the five principal dimensions of assisted triadic telemedicine. It offers actionable guidance for clinicians, nurse-facilitators, health system managers, and policymakers, and establishes a foundation for subsequent empirical validation across diverse healthcare settings.

Abstract: COVID-19-related stigma may compound psychological distress, yet evidence from Central Asia remains limited. We conducted an exploratory secondary analysis of baseline data from 399 adults hospitalized with PCR-confirmed COVID-19 in Ulaanbaatar, Mongolia. Two study-specific 12-item indices represented social discrimination/stigma and self-stigma/self-exclusion. We examined score distributions, internal consistency, exploratory internal structure, multivariable correlates, and concurrent associations with PHQ-9, GAD-7, ISI, and PCL-5 scores. Mean scores were 32.14 (SD 6.96) and 29.62 (SD 6.77), with Cronbach's alpha values of 0.903 and 0.891, respectively. The indices were moderately correlated (r = 0.451, 95% CI 0.369-0.526). Parallel analysis suggested two dimensions for the social discrimination/stigma items and one for self-stigma/self-exclusion. In residence-adjusted HC3 models, larger household size was associated with higher self-stigma (B = 0.59, 95% CI 0.18-1.00), although the demographic and clinical models explained little variance. In adjusted sensitivity analyses, self-stigma remained associated with depressive, anxiety, and PTSD symptom burden. Findings are exploratory because original item wording, response anchors, and translation procedures were unavailable; formal cultural adaptation and validation are required before clinical or prevalence use.

Abstract: Pain is a multidimensional clinical phenomenon influenced by biological, psychological, behavioral, and contextual factors. Its assessment remains challenging because pain is a personal experience that cannot be directly observed and because commonly used clinical instruments, such as the Numeric Rating Scale (NRS) and Visual Analog Scale (VAS), primarily reduce pain to a unidimensional scalar value. Physiological signals such as heart rate variability (HRV), electrodermal activity (EDA), and peripheral temperature may provide complementary information, but these signals are themselves nonspecific and require contextual interpretation. We propose PainVector, a computational framework for representing pain as a structured multidimensional state rather than as a single scalar intensity value. The framework integrates self-reported pain, normalized physiological signals, and contextual variables including age, cultural context, and individual pain-expression characteristics. PainVector separates perceived pain from physiologically inferred pain and subsequently combines these components through an explicit fusion mechanism. The framework additionally incorporates temporal and system-level dimensions, including pain duration, predictability, controllability, localization, semantic interpretation, and confidence. A mathematical formulation is provided for signal normalization, contextual modulation, functional weighting, multimodal fusion, temporal prediction, and controllability analysis. A synthetic dataset is used as a proof-of-concept demonstration of the computational structure, while a two-person migraine scenario illustrates how individuals reporting identical NRS values may produce different multidimensional representations when contextual and physiological information are incorporated. PainVector is not proposed as a direct measurement of subjective consciousness, nor as a replacement for clinical pain assessment. Rather, it is designed as a computational representation layer that may support multimodal analysis, longitudinal monitoring, prediction, intervention-response evaluation, and future human–machine pain modeling.

Abstract: Madhya Pradesh bears the highest burden of sickle cell disease (SCD) in India, with four tribal districts—Alirajpur, Anuppur, Chhindwara, and Dindori—accounting for approximately 75% of the existing cases [1]. Sickle cell disease is a genetic blood disease that affects the whole life of an affected patient. Since there is no cure for sickle cell disease, prevention, and holistic care are the mainstay of the sickle cell disease elimination mission. PRERNA - Promoting Resilience in tribal communities by Education and Raising Awareness among New Mothers and Adolescents for Sickle Cell Disease campaign is all about strengthening tribal communities to improve their health and their children’s health through health promotion- education and raising awareness for increasing early detection, genetic counselling, removing stigma, and rapid preventive intervention for management of sickle cell anemia in new mothers, infants, and adolescents. The PRERNA campaign is integrated into the four strategic pillars of “Engage – Educate – Prevent – Build” (EEPB) through systematic dissemination of Social and Behavioural Change Communication (SBCC) strategies to reach the target population. The campaign involves Information, Education, Communication (IEC) and Behaviour Change Communication (BCC) tools, local influencers like tribal heads, teachers, sarpanch and traditional healers, etc., and art and folk forms like Drama, Nukkad Natak, Puppet shows, storytelling for communication dissemination at grass-root level. Social media is another area where we will execute our mass awareness campaign with relative cost-effectiveness. The strategies aim to increase community adaptation by promoting awareness and education of genetics and inheritance for early screening, genetic counseling and management of disease, and spreading the key message that SCD is preventable. The mission of eliminating Sickle Cell Disease can become a reality only when there is public participation, Jan Bhagidari! It is expected that once education and awareness for prevention and management of the disease are translated into practice, this will improve the quality of life, reduce complications, and increase the life expectancy of patients with Sickle Cell Disease. It will also prevent further prevalence of the disease.

Abstract: Background Despite established pharmacological treatments, menstrual and climacteric complaints remain highly prevalent among women in Germany, suggesting that conventional therapies - hormonal contraceptives and hormone replacement therapy - may not fully meet patients’ needs. However, real-world data on the prescription of herbal medicinal products are scarce. Objective To analyze utilization patterns of synthetic therapies and HMPs in real-world gynecological care. Design Repeated cross-sectional observational study. Methods Prescription data were derived from the drug project of the Scientific Institute of Private Health Insurance (WIP), including all prescriptions from 2019 to 2022 for menstrual or climacteric complaints assigned to ATC codes G03A, G03C, G03F or G02CP. Persons under 12 years of age were excluded. In total, 2.8 million prescriptions were analyzed using resource-oriented methodological approaches and descriptive statistics. Key Results Hormone Preparations (G03) accounted for 91.5% of all prescriptions, while gynecological HMPs (G02) represented only 8.5%. Following an initial decline until 2021, the use of hormones nearly returned to baseline, whereas prescriptions of HMPs showed a continuous downward trend. Among women aged 12-25 years, HCs (G03A) predominated (92.2%), with HMPs (G02CP-01; -02; -05; -07) accounting for 7.8%. The proportion of HMPs increased steadily with age and surpassed synthetic hormonal preparations among women aged over 60 years (59.1% vs. 40.8%). For climacteric ailments, HRT medications (G03C, G03F) were predominant across all age groups (>90%), whereas HMPs (G02CP-03; -04; -53) remained below 10%, peaking among women aged 41-65 years (8.8%).

Abstract: Background: Ovarian cancer (OC) pose an escalating global health burden, with marked disparities in incidence, mortality, and survivorship. Social, psychological, and structural determinants, including deprivation, stigma, and access to specialist care, may influence outcomes but are not well represented in existing models of cancer care. We introduce the Tumour, Macroenvironment and Resource (TMR) framework, a novel conceptual model exploring interactions between tumour biology, social determinants, and healthcare resources in OC survivorship and care. Methods: Framework development occurred in three phases. First, a narrative review identified factors influencing OC outcomes across tumour, macroenvironmental, and healthcare resource domains. Second, Multi-Criteria Decision Analysis (MCDA) was used to structure these factors within a preliminary framework and assign indicative domain weightings. Third, two cross-sectional expert opinion surveys were conducted to refine and validate the concept of the framework. The final model was then evaluated in a retrospective pilot cohort to assess the feasibility of collecting predefined TMR variables from routinely available clinical data. Results: The review identified limited evidence addressing broader determinants of health beyond biological prognostic factors. Available studies suggested interactions between tumour characteristics, social determinants, and healthcare infrastructure that may influence outcomes. A preliminary model allocated 50% weighting to tumour factors and 50% to combined macroenvironmental and healthcare resource factors. Expert surveys (n=20 and n=44) achieved consensus and informed development of the final TMR framework. Application to a UK pilot cohort of patients with OC (n=42) demonstrated the feasibility of collecting variables across all TMR domains and identified multiple adverse factors across tumour, macroenvironmental, and resource domains. Conclusions: The TMR framework provides an integrative, hypothesis-generating model for exploring disparities in OC survivorship and care. Further retrospective and prospective validation is required before clinical or prognostic applications can be considered.

Abstract: Background: Several research has revealed that dehydration remains a major cause of preventable illnesses, particularly among children and older adults. Existing tools such as the WHO IMCI, Gorelick, and Clinical Dehydration Scale (CDS) are limited by population focus and absence of quantitative weighting or digital integration. This study developed and prototyped an evidence-based dehydration-risk prediction model derived from meta-analytic data to enable more objective and universal risk estimation. Methods: Building on our recent systematic review and meta-analysis, sixteen (16) clinical and demographic predictors were extracted from validated dehydration scales and pooled diagnostic evidence. Heuristic weights (1-4 points) were assigned according to pooled sensitivity and specificity, yielding a total score of 0–42. The total score was transformed to generate continuous probability estimates using logistic regression. The scoring algorithm was embedded within an interactive R Shiny software prototype that supports real-time computation and visualization. Prototype evaluation involved functional verification and usability testing using simulated patient profiles. Results: High-weight predictors, thirst, inability to drink, and lethargy showed the strongest diagnostic value, while modifiers such as age (≥ 65 years) and comorbidity carried lower weights. The cumulative score was transformed into a continuous dehydration-risk probability using a logistic function, reflecting the nonlinear increase in risk with symptom burden. Prototype evaluation of the MetaDehydrate application using simulated profiles demonstrated functionally correct score computation, consistent probability outputs, sub-second computation latency (< 0.2 s per calculation), and favorable usability feedback. Conclusion: This study presents the design and technical feasibility evaluation of an evidence-informed dehydration risk–scoring algorithm and its implementation as a prototype digital decision-support tool. While no clinical effectiveness was assessed, the findings demonstrate the feasibility of translating pooled diagnostic evidence into a functional, user-interactive application. The tool’s simplicity, limited input requirements, and rapid computation suggest potential utility for future evaluation in community and resource-constrained healthcare settings. Further prospective studies are required to assess effectiveness in real-world and low-resource healthcare settings.

Abstract: Newborn screening for primary immunodeficiencies and spinal muscular atrophy (SMA) enables early identification of infants at risk for severe disorders, facilitating timely treatment and improved outcomes. This study describes the first Greek experience with combined screening for T-cell receptor excision circles (TREC), kappa-deleting recombination excision circles (KREC), and SMN1 using a single dried blood spot (DBS) sample. During 2026, 29.460 newborns were screened using a commercially available in vitro diagnostic kit. TREC and KREC were assessed semi-quantitatively, while SMA screening was based on qualitative detection of the SMN1 exon 7 target. Of these, 2.168 (7,36%) required duplicate retesting, with 481 requiring a second DBS sample. Among the 481 newborns for whom a second DBS card was requested, 469 cards were received. Of these, 446 were classified as negative, 13 remained inconclusive, 4 were referred for genetic/immunological confirmatory evaluation, 2 remained under immunological follow-up, and 4 demonstrated recovery on repeat testing. Confirmatory evaluation identified four clinically significant cases: two with SMA, one with severe T-cell lymphopenia associated with 22q11.2 deletion syndrome, and one with CHARGE syndrome. Several low TREC/KREC results normalized on repeat testing. This experience demonstrates the feasibility of combined screening and highlights the importance of appropriate follow-up and confirmatory evaluation.

Abstract: Personal healthcare expenditure in the United States exhibits substantial heterogeneity driven by non-modifiable demographic factors, modifiable behavioral risks, and regional pricing dynamics. Disentangling the marginal contributions of these overlapping parameters requires multivariable statistical adjustment to inform health economics and payor reimbursement structures. We analyzed an open-access individual-level health insurance claims cohort (n = 1,338). Bivariate explorations were conducted using scatterplots and boxplots across six explanatory covariates: age, body mass index (BMI), number of dependent children, tobacco smoking status, biological sex, and geographic region. To adjust for confounding, we specified an Ordinary Least Squares (OLS) multivariate linear regression model parameterizing individual annual medical charges as a continuous outcome. Geometric dual-plane dynamic surface modeling was constructed to illustrate the non-additive shifts induced by behavioral risk markers. The mean annual healthcare claim was $ 13,270. The OLS regression model demonstrated high explanatory power (R² = 0.751, adjusted R² = 0.749, p < 0.001). Tobacco smoking emerged as the primary contributor to personal health expenditure, accounting for an adjusted mean increase of $ 23,849 (95% CI: $ 23,038 to $ 24,659, p < 0.001) relative to non-smokers. Age (β = $ 257 per year, p < 0.001), BMI (β = $ 339 per kg/m², p < 0.001), and dependent children (β = $ 476 per child, p < 0.001) demonstrated significant positive linear trajectories. Biological sex exhibited no statistically significant association with charges (β = -$ 131 for males, p = 0.693). Regional variation was minor relative to behavioral factors. Behavioral modification, specifically tobacco smoking cessation and obesity mitigation, represents the dominant lever for reducing individual medical expenditure burdens. Unadjusted bivariate visualizations obscure true effect sizes, underscoring the vital necessity of multivariable regression frameworks in actuarial risk stratification and health policy planning.