BACKGROUNDIntestinal obstruction (IO) in pregnancy, though rare (1:1500-1:66000), carries high maternal (6%-10%) and fetal mortality (26%). Adhesions from prior surgery are the leading cause. Diagnosis is often delayed due to symptom overlap with normal pregnancy, increasing risks of perforation and sepsis.CASE SUMMARYA 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation, feculent vomiting, and abdominal distension. She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma. The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings. Interventions included conservative measures (nasogastric tube decompression, enemas) followed by emergency laparotomy with bowel resection/anastomosis. Despite surgical management, the patient succumbed to septic shock.CONCLUSIONHigh clinical suspicion, expedited cross-sectional imaging (computed tomography/Magnetic resonance imaging), and emergent surgery are critical to reduce mortality.

The growing demand for precision and consistency in the forging industry has heightened the need for predictive simulation tools. While extensive research has focused on parameters such as flow stress, die wear, billet fracture, and residual stresses, the phenomenon of billet buckling, especially during cold upset forging, remains underexplored. Most existing models address only elastic buckling for slender billets using classical approaches like Euler and Rankine-Gordon formulae, which are not suitable for inelastic deformation in shorter billets. This study presents a numerical model developed to analyze inelastic buckling during cold forging and to determine associated stresses and deflection characteristics. The model was validated through finite element simulations across a range of billet geometries (10–40 mm diameter, 120 mm length), materials (aluminum, stainless steel, and copper), and friction coefficients (µ = 0.12, 0.16, and 0.35). Stress distributions were evaluated against die stroke, with particular emphasis on the influence of strain hardening and geometry. The results showed that billet geometry and strain-hardening exponent significantly affect buckling behavior, whereas friction had a secondary effect, mainly altering overall stress levels. A nonlinear regression approach incorporating material properties, geometric parameters, and friction was used to formulate the numerical model. The developed model effectively estimated buckling stresses across various conditions but could not precisely predict buckling points based on stress differentials. This work contributes a novel framework for integrating material, geometric, and process variables into stress prediction during forging, advancing defect control strategies in industrial metal forming.

Abstract While clinical medicine essentially concentrates on the human body and its parts, public health focuses on the health of human populations and their social and environmental determinants. Integrated approaches to health extend the focus of attention to humans in their socio-cultural and ecological environment and their mutual interdependencies, paying attention to inter-species interdependencies. Since the beginning of the 21st century, ecosystem approaches to health (EcoHealth), One Health and Planetary Health have emerged as integrated approaches that relate to and expand public health and related fields. In this article, we aim at clarifying their respective definitions, philosophical foundations and methodological positions. This clarification is important because the way we define integrated approaches to health shapes research, teaching methods and their translation into policy and practice. Key methods and case studies are summarized and compared. Among the three integrated approaches, EcoHealth and Planetary Health operate largely in academic networks and non-governmental organizations (NGOs). One Health is currently operationalized at the level of international organizations, regional organizations and national governments. Integrated approaches to health require urgent adoption and implementation, as they are pivotal for complex problem-solving regarding challenges such as pandemic prevention, climate change, biodiversity loss and antimicrobial resistance. One Health impact statement In this article, we compare the different paradigms of EcoHealth, One Health and Planetary Health as leading integrated approaches to health. We examine how they are shaping public health and closely related disciplines, how they relate to each other and how they possibly converge (Winkler et al ., 2025 ). Compared to public health, integrated approaches to health extend the focus of attention from humans only (anthropocentric perspective) to humans in their socio-cultural and ecological environment, paying attention to inter-species interdependencies. All integrated approaches claim that they are open to epistemic diversity whenever they engage in inter- and transdisciplinary processes, including with indigenous knowledge systems. Integrated approaches to health emphasize systems thinking that recognizes the interconnectedness of ecosystems, human and animal health, and societal factors. They aim to co-create transformational knowledge through participatory transdisciplinary processes between researchers, communities and authorities. Between and within these approaches, variable levels of attention are given to social equity and ecological sustainability.

The field of psychiatry has experienced an incredible development within the last three decades as it is no longer an institution/medically based profession but rather is more inclusive of community care with emphasis on human rights and cultural sensitivity. Globally, neuroscience, psychopharmacology and psychotherapy developments have increased treatment options, whereas advocacy has reduced stigma and helped in patient autonomy. However, there are still challenges that comprise a widening treatment gap, workforce shortages, and inequities in access, particularly in low- and middle-income countries. In Kenya, psychiatry has transitioned from its historical monopoly by Mathari National Teaching and Referral Hospital to more widespread decentralization, policy reforms and integration into the general health systems. Nonetheless, a paucity of resources, unequal investment across counties, and entrenched stigma continue to hinder progress. The next three decades will require context-specific, culturally based strategies, which take into consideration utilization of digital innovations, integrating mental and physical health care, equity and inclusivity. The future of psychiatry is not only in the scientific breakthroughs but the ability to develop strong structures that address the local realities and at the same time connect with the global innovation.

IntroductionCOVID-19 pandemic restrictions accelerated the use of mHealth interventions to maintain continuity of care for youth living with HIV (YLH). Evaluation of mHealth implementation during the pandemic can inform optimization of use among healthcare workers (HCWs) beyond emergencies. This study identified key influences on perceived acceptability, feasibility, and reach of phone delivery of an HIV care transition intervention, the Adolescent Transition Package (ATP), a booklet detailing themes on HIV disclosure and transition readiness, and relevant assessment tools, to support care transition for Kenyan YLH.MethodsWe conducted 50 semi-structured interviews with a purposively selected subset of frontline (HCWs) from intervention sites participating in the Adolescent Transition to Adult Care for Adolescents living with HIV (ATTACH) study evaluating the ATP between June 2020 and January 2021. In this hybrid effectiveness-implementation cluster randomized trial, we nested a mixed methods study. We conducted and recorded interviews, and transcribed verbatim. Applying the Consolidated Framework for Implementation Research (CFIR), we conducted a directed content analysis to evaluate determinants of acceptability, feasibility and reach of ATP phone delivery. We also documented all attempted and completed calls, including call characteristics such as duration, and summarized these data using descriptive statistics.ResultsOut of 1,444 call attempts, 82% successfully reached YLH being contacted. Providers successfully discussed the ATP during 79% of calls where YLH were reached. Determinants influencing perceived acceptability, feasibility, and reach of phone delivery of the ATP were concentrated in intervention characteristics, inner and outer setting CFIR domains. Overall, HCWs felt phone calls were acceptable and feasible for reaching most youth. However, limited ability to assess client comprehension and inability to share ATP booklet pictures in real-time negatively influenced acceptability. Within the inner setting, few phones at the clinic, missing or inaccurate contact information, the composition and organization of clinic teams, and HCW self-efficacy drove perceptions of feasibility. HCWs’ recognition of limited phone ownership and incomplete disclosure to others in the home environment were recognized outer setting barriers to reach and acceptability. In contrast, the ease of implementation, convenience, and flexibility afforded by calls positively influenced perceived acceptability and feasibility, and reach. Views on implementing calls beyond the pandemic were mixed, HCW noting that long-term access to clinic phones would be essential for sustained feasibility.ConclusionDelivery of the ATP by phone was an acceptable and feasible strategy to reach YLH during COVID-19. Phone call feasibility was limited by low phone ownership but enhanced when there were strong collaborations and communication between clinic staff. Acceptability of the phone call strategy was driven by its ease, efficiency and capacity to reach many YLH but challenged by the inability to assess and ensure client comprehension. Future mHealth initiatives may improve the implementation of calls by addressing phone access, comprehension and privacy-related constraints to maximize benefits.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13305-4.

Background:Cleft lip and palate (CLP) is a common congenital malformation. It results in substantial healthcare utilization and financial burden on families and healthcare services. Research shows that comprehensive cleft care (CCC) leads to better outcomes. To date, little is known about the barriers to CCC in sub-Saharan Africa. Understanding these and their possible solutions is paramount when engaging national policymakers on achieving equity in healthcare. Therefore, the aim of this study was to identify the barriers sub-Saharan African healthcare professionals face in implementing CCC and their potential solutions.Methods:A questionnaire was sent to healthcare professionals representing the Pan African Congress for CLP, Operation Smile, and Smile Train foundations regarding the most important barriers and potential solutions to CCC.Results:A total of 119 professionals participated; 76.5% were men, and 56.3% were surgeons. Most respondents worked in Nigeria or Ethiopia. The most commonly reported barriers were long travel distances and financial constraints, followed by limited public awareness. The most critical improvement identified was financial support for establishing multidisciplinary teams (MDTs). The absence or inadequate function of MDTs was largely attributed to a shortage of trained professionals.Conclusions:Patients’ inability to reach hospitals due to travel distance, especially for follow-ups, was the most important barrier. Action to increase geographic accessibility of hospitals is needed. Healthcare professionals overwhelmingly supported establishing MDTs and providing financial aid to patients as the most effective solutions for CCC. To enable MDTs to reach their full potential, a budget for employing and educating healthcare professionals to increase trained staff is needed.

BackgroundThere is a dearth of information on the extent of marketing of ultra-processed foods on traditional media such as radio in low- and middle-income countries (LMICs). Consumption of ultra-processed foods is associated with nutrition-related noncommunicable diseases such as overweight/obesity, type 2 diabetes, and cardiovascular diseases. This study aimed to examine the marketing of ultra-processed foods on the most widely accessed radio stations across three counties in Kenya.MethodsThis was a cross-sectional quantitative study conducted in three counties: Nairobi, Mombasa, and Baringo counties in the period between December 2021 to February 2022. We purposively selected 5 radio stations based on their popularity in different counties according to the Communications Authority of Kenya ratings. Using stratified sampling, we selected 8 recording days: 4 weekdays and 4 weekend days for three months. The recorded data were coded using a structured questionnaire. The key variables included the food and non-food and beverage products advertised on the radio stations, categorization of the food, non-food beverage products, time slots of the advertisements, promotional strategies, and premium offers.ResultsOf the 1499 advertisements on the radio, 15.7% (n = 235) were food and beverage products. The most advertised food categories were sugar-sweetened beverages (44.7%) and alcoholic drinks (23.4%). Ultra-processed foods (UPFs) accounted for 58.3% of the non-alcoholic food and beverage product advertisements on the radio. There was a significantly higher level of UPFs during the weekdays (58.3%) compared to weekend days (39.0%) (p < 0.001), school holiday seasons (73.4%) compared to non-school holiday seasons (46.5%) (p < 0.001), and in urban areas (70.1%) compared to rural areas (34.5%) (p < 0.001).ConclusionsWe observed a high level of UPF marketing across both rural and urban settings, with higher proportions recorded in urban areas and during school holiday periods. To support healthier food environments, there is a need for regulatory action targeting radio advertising of unhealthy foods. This may include restrictions during peak child listening hours, regulation of persuasive content, and clear identification of sponsored food promotions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40795-025-01164-5.

Background:Although the golden ratio (1.62) is frequently proposed for ideal umbilical positioning, aesthetic judgments vary across cultures and individual preferences. This survey examined shape and ratio preferences among Kenyan adults, exploring whether local norms (1.69) or the golden ratio (1.62) better match subjective ideals.Methods:We conducted a cross-sectional online survey with 440 participants recruited from a Kenyan referral hospital. Five umbilical shapes (oval, vertical, T-shaped, horizontal, and distorted/protruded) were digitally positioned at 1.62 or 1.69. Respondents selected their preferred position, identified most/least attractive shapes, and indicated separate choices for masculine versus feminine figures. Statistical analyses were done using χ² tests and logistic regressions.Results:The gender distribution was balanced, with 48.9% men and 51.1% women. Overall, 55% favored 1.62 for oval, vertical, T-shaped, and horizontal shapes, whereas distorted was often chosen at 1.69 (52.5%). The vertical shape was ranked the most attractive overall (39.8%), especially for feminine figures (55.9%). Men showed significantly greater preference than women for distorted shapes (odds ratio = 2.89; P = 0.010). Oval and T-shaped were equally popular for masculine figures (29.1% each).Conclusions:Kenyan preferences lean toward the classic golden ratio in certain shapes, but not universally. Distorted navels garnered significant support at the local 1.69 ratio, underscoring that patient desires do not strictly align with a single numeric standard. This preference-based study complements morphometric data from a companion article, highlighting the interplay between objective norms and subjective ideals in Kenyan abdominal aesthetics.