Global Approach Research Articles

Health Impacts of E-Cigarettes: A Comprehensive Review of the Evidence and Public Health Implications

Electronic cigarettes, also known as e-cigarettes or Electronic Nicotine Delivery Systems (ENDS), have quickly become a well-liked substitute for conventional tobacco products, especially among teenagers and young people. Despite being marketed as a smoking cessation assistance and harm reduction tool, their safety profile is still being investigated. The health implications of e-cigarette use on the respiratory, cardiovascular, and neurological systems, as well as possible carcinogenic consequences, are examined in this thorough literature analysis. Airway inflammation, elevated cardiovascular risk markers, mental health comorbidities, and biomarkers of DNA damage are only a few of the detrimental health impacts that are now supported by data. The long-term safety of vaping is still unknown, despite some research suggesting lower exposure to dangerous chemicals as compared to combustible tobacco. The necessity of balanced public health measures is emphasized, and global regulatory approaches are also covered. This review concludes by highlighting the significance of prudent regulation and ongoing research to inform clinical and policy decisions on the use of e-cigarettes.

Advancing herbal medicine safety: the need for a global pharmacovigilance approach.

Herbal and traditional medicines (H&TMs) form a significant part of healthcare practices worldwide, often perceived as safe alternatives to conventional treatments. However, this perception has led to challenges in ensuring the safety and efficacy of these products, highlighting the critical importance of pharmacovigilance for herbal medicines. Over the past two decades, concerted efforts have been made globally to establish robust regulatory frameworks, leading to the emergence of phytovigilance systems. This review provides a comprehensive overview of the pharmacovigilance mechanisms in various countries, emphasizing recent developments, persistent challenges, and international perspectives in the field. The study underscores the need for systematic monitoring of adverse events (AEs) associated with herbal medicines to safeguard patient health. A key focus is placed on comparing the processes and mechanisms employed by different nations in building up safety monitoring systems, identifying gaps in knowledge and practices, and evaluating stakeholder awareness and involvement. The findings highlight the necessity of harmonizing global regulations under the guidance of the World Health Organization (WHO) to ensure uniformity and efficacy in reporting systems. This article advocates for a collaborative international approach, inclusive of all regulatory agencies, to enhance the safety of herbal therapies. By proposing comprehensive, standardized guidelines, it aims to bridge existing gaps and strengthen the pharmacovigilance infrastructure for herbal medicines globally, paving the way for improved patient safety and trust in traditional medical practices.

Outpatient acute kidney disease detection by national and institutional health data

BackgroundThe development of diagnostic definitions for acute kidney disease in outpatients (AKDOPT) remains an unattained goal because of consensus gaps and data silos in health-care systems.MethodsOur team developed the Acute Kidney Injury Detection System (AKIDS) to screen for undiagnosed AKDOPT using National Health Insurance MediCloud data and institutional electronic medical records. The criteria for AKDOPT were a >50% change in maximum and minimum serum creatinine levels or a >35% change in corresponding estimated glomerular filtration rate values within the 180 days before an appointed outpatient visit. In this retrospective cohort study, the associations between AKDOPT and composite kidney outcome (CKO; e.g., end-stage kidney disease, a >40% drop in estimated glomerular filtration rate, or a 2-fold or more increase in serum creatinine), all-cause mortality, and de novo non-dialysis chronic kidney disease (CKD-ND) were evaluated using multivariable Cox proportional hazards models.ResultsOf 79,838 eligible adult patients screened by the AKIDS, 12,510 (15.7%) have AKDOPT. The adjusted absolute risk increases for 1-year incident CKO, mortality, and de novo CKD-ND for patients with AKDOPT relative to those without are 79.0 (95% confidence interval 78.9–79.1), 25.3 (25.2–25.3), and 54.8 (54.7–54.9) per 1000 patients, respectively. The adjusted hazard ratios for 1-year CKO, mortality, and de novo CKD-ND are 16.2 (14.2–18.5), 2.6 (2.4–2.9), and 3.5 (3.1–3.9), respectively.ConclusionsBy integrating the national-local data using the AKIDS, this study comprehensively characterizes a previously unrecognized phenotype, AKDOPT, illustrating the potential of healthcare big data in transforming global approaches to AKD patterns and prevention.

Sub-national landscape on the years of life lost due to COVID-19 pandemic in the major cities of Southern Philippines.

In Southern Philippines, 5 697 COVID-19 deaths were reported in the major cities from March 2020 to June 2022. The pandemic's impact, despite the relatively modest death toll, was examined by analysing the Years of Life Lost (YLL) derived from disease surveillance datasets. The individual YLLs were calculated using the global disease burden approach applying 7% discounting rate and adjusting for sex, age-at-death, and the individual's city-location. The YLLs were then aggregated on a monthly basis. Descriptive analytics were used to characterise the dynamic nature over time of the YLLs. A total of 51 749.07 YLLs due to COVID-19 were estimated, i.e. 9.09 YLLs per death or 969.49 YLLs per 100 000 population. The monthly YLL ranged from 68.55 to 7 641.12. On average, the age-at-death is 59.68years with males having younger age-at-death than females. Notably, the weekly COVID-19 incidences and deaths in Southern Philippines showed synchronous peaks. The average age-at-death in Southern Philippines is at least 10years younger than both international age-at-death estimates and the Philippine life expectancy. The synchronous weekly peaks may highlight distinct pandemic dynamics for a low- and middle-income country. The YLL due to COVID-19 in Southern Philippines, at a sub-national level, is comparable to some country-level estimates, highlighting the impact of the pandemic on this island region alone.

Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement.

Obesity rates have surged since 1990 worldwide. This rise is paralleled by increases in pathological processes affecting organs such as the heart, liver, and kidneys, here termed systemic metabolic disorders (SMDs). For clinical management of SMD, the European Atherosclerosis Society proposes a pathophysiology-based system comprising three stages: Stage 1, where metabolic abnormalities such as dysfunctional adiposity and dyslipidaemia occur without detectable organ damage; Stage 2, which involves early organ damage manifested as Type 2 diabetes, asymptomatic diastolic dysfunction, metabolic-associated steatohepatitis (MASH), and chronic kidney disease (CKD); and Stage 3, characterized by more advanced organ damage affecting multiple organs. Various forms of high-risk obesity, driven by maintained positive energy balance, are the most common cause of SMD, leading to ectopic lipid accumulation and insulin resistance. This progression affects various organs, promoting comorbidities such as hypertension and atherogenic dyslipidaemia. Genetic factors influence SMD susceptibility, and ethnic disparities in SMD are attributable to genetic and socioeconomic factors. Key SMD features include insulin resistance, inflammation, pre-diabetes, Type 2 diabetes, MASH, hypertension, CKD, atherogenic dyslipidaemia, and heart failure. Management strategies involve lifestyle changes, pharmacotherapy, and metabolic surgery in severe cases, with emerging treatments focusing on genetic approaches. The staging system provides a structured approach to understanding and addressing the multi-faceted nature of SMD, which is crucial for improving health outcomes. Categorization of SMD abnormalities by presence and progression is aimed to improve awareness of a multi-system trait and encourage a tailored and global approach to treatment, ultimately aiming to reduce the burden of obesity-related comorbidities.

Leveraging Ottawa Charter strategies to enhance COVID-19 vaccination: A systematic review of global health promotion approaches

Background: Despite global vaccination efforts, many countries struggled to achieve sufficient COVID-19 vaccination coverage. The use of Ottawa Charter health promotion strategies in vaccination programs not only enhances coverage but also fosters sustainable public health outcomes. This systematic review aims to identify actionable strategies to improve vaccination efforts. Methods: This systematic review involved a comprehensive literature search across PubMed, Scopus, Web of Science, and Embase, targeting studies published between January 2020 and August 2024. The search focused on government-led health promotion strategies for enhancing COVID-19 vaccination rates. Strategies were categorized five main areas of the Ottawa Charter for health promotion. Results: A total of 22 health promotion strategies were identified globally, categorized into five key areas based on the Ottawa Charter for health promotion. Notable strategies included engaging community, addressing misinformation, expanding vaccination sites, and providing culturally tailored communication. Conclusion: The findings underscore the significance of utilizing the Ottawa Charter framework to design inclusive and adaptable public health strategies that ensure equitable vaccination coverage globally.

Transforming Healthcare in India: The Role of Artificial Intelligence and Regulatory Frameworks for Sustainable Growth

ABSTRACTArtificial intelligence (AI) has quickly emerged as a game changer in healthcare, providing innovative ways to improve patient care, enhance processes, and reduce expenses. AI could solve important healthcare issues in India, including increasing service demand, a lack of trained medical personnel, and notable geographical differences, especially in rural areas. AI can aid in addressing this gap by offering scalable, affordable regulatory framework that enhance diagnosis, treatment planning, and suitable resource allocation. This paper examines the impact of AI on healthcare, considering its benefits, challenges, and ethical implications for improving the healthcare delivery system. The paper also explores global regulatory frameworks and their implications for AI in healthcare, focusing on the roles of the United States, United Kingdom, European Union, India, and other prominent organizations. Additionally, the paper explores the opportunity to develop a robust AI policy framework for healthcare in India, drawing from global approaches. The study emphasizes ethical, interoperable AI and outlines a roadmap for India's healthcare sector‐integrating risk‐based regulations, enhanced digital infrastructure, ethical AI policies, and private entrepreneurship via public–private partnerships—to position India as a leader in AI‐driven healthcare regulation. As India continues to invest in digital health infrastructure, a comprehensive, ethically sound regulatory framework will be crucial in ensuring that AI‐powered healthcare is accessible, affordable, and inclusive for all citizens. By learning from global best practices and focusing on equitable healthcare, India can lead the way in AI‐driven healthcare innovation.

Crisis-ready telecom: Global approaches to emergency management in telecommunications

Crisis-ready telecom: Global approaches to emergency management in telecommunications

Management of Risk Factors in Oil and Gas EPC Projects: Global Approaches with Special Reference to India

Management of risk factors is a critical approach in the oil and gas projects related to Engineering, Procurement, and Construction (EPC). The objectives of the study are to understand the risk factors and risk management strategies in oil and gas EPC projects globally and in India. This is a narrative review based study and the sources of data are secondary. The conceptual frameworks of various research studies have been carefully analyzed. The study reflected the complexities of the risk factors such as unskilled human resource, lack of coordination among the stakeholders and non-technical risks. Risk-based engineering management execution in oil and gas EPC projects needs a systematic and integrated approach, leveraging advanced tools and techniques to ensure successful project outcomes.

Implikasi Hukum Perubahan Kedua Undang-Undang Informasi dan Transaksi Elektronik: Menyeimbangkan Kebebasan Berpendapat dan Partisipasi Publik dalam Demokrasi Digital

This study examines the legal implications of the second amendment to the Electronic Information and Transactions Law (UU ITE) through Law No. 1 of 2024 on public participation in cyberspace, particularly in the context of general elections (PEMILU). Over time, the UU ITE has often been regarded as ambiguous and repressive, potentially hindering freedom of expression. Provisions such as Articles 27A and 27B, while intended to replace previously criticized "rubber articles," continue to face criticism for perpetuating a chilling effect. This situation raises concerns about the declining quality of public participation in digital democracy processes. However, studies on the impact of the second amendment to the UU ITE on freedom of expression in the 2024 elections, as well as comparative analyses of more proportional international regulations, remain limited, necessitating further research. This study employs a descriptive qualitative approach to analyze the implications of the amendments to the UU ITE on freedom of expression and public participation in elections. The findings reveal that the unclear regulations in the UU ITE may lead to legal uncertainty, marginalize certain groups, and create inequality in access to information. Reforming the UU ITE is essential to ensure that the regulations align with democratic principles, protect freedom of expression, and promote inclusive public participation. The novelty of this study lies in its specific analysis of the revised provisions in Law No. 1 of 2024 and their impact on freedom of expression in the 2024 elections, incorporating a global comparative approach to propose a more just and...

Urban, Architectural, and Socioeconomic Factors Contributing to the Concentration of Potential Arbovirus Vectors and Arbovirosis in Urban Environments from a One Health Perspective: A Systematic Review

Today, urbanisation and environmental changes are increasingly influencing the social and biological landscape of our planet. This systematic review aims to assess the relationship between urban–architectural and socioeconomic factors and vector concentrations in the urban environment. Following the Preferred Reporting Methodology for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, Scopus, and Cochrane libraries were screened for studies conducted in urban contexts and those involving only arboviruses and potential exposure to arboviral vectors in urban environments, published from the beginning to 22 April 2025. Out of a total of 171 identified studies, 132 were selected for further analysis. Of these, 14 studies were eligible. The included studies reported different ways of measuring vector density and different considerations of the urban–architectural or socio-demographic factors related to it. The studies were set in different urban contexts: Asia, Central and South America, Africa and Oceania. Among the vector species, Aedes aegypti was the most analysed, often with Aedes albopictus. Socioeconomic status emerges as a determining factor. Low-income areas experience higher mosquito densities due to overcrowding, sub-optimal infrastructure, and environmental neglect. This review highlights the importance of implementing a standardised and effective global approach in urban health planning.

Promoting Equity in Public Health: Addressing Inequality and Social Disparities.

Health inequalities remain a global issue, deeply rooted in social, economic, and environmental determinants that shape health outcomes. This editorial examines these disparities and critiques the World Health Organization's (WHO) health definition to address the historical and systemic injustices that perpetuate health inequities. This paper synthesizes research and expert perspectives on the fundamental causes of health inequities, focusing on social determinants such as income inequality, environmental hazards, and systemic discrimination. Findings highlight significant disparities in healthcare access and outcomes, particularly among marginalized populations affected by factors like income, race, and geographic location. This underscores the need for tailored, equity-centered approaches to healthcare. A coordinated global approach that addresses both environmental and social determinants of health is essential to create equitable and resilient health systems.

Beauty and truth. The aesthetic practice of news and the media prosumer

The rationality of modern aesthetics is not limited to art but extends to news. However, an ideological approach to news aesthetics remains, at best, unfulfilled. By applying a global South approach, this paper offers an alternative understanding of how television platforms employ aesthetic value. It first offers an ideological description of news aesthetics—that is, the conversion of an incident into a media event by the creation of popular appeal, and its mythification in society. By situating the media prosumer in this ecosystem, it exposes the bond between presented beauty and absented truth, arguing that this conflicted relationship marks the essence of news aesthetics. This theory-building paper explores the relationship between aesthetics and the production of news. Based on this premise, four features of news aesthetics are propounded. Using a case study, it illustrates how these features operate in tandem to suture a media prosumer’s truth that may be quite different from reality.

A global optimization approach to automated indexing of fiber diffraction patterns

Accurate determination of cell parameters from two-dimensional wide-angle X-ray diffraction patterns of oriented polymer crystals is critical for structural analysis. This process, known as indexing, can be challenging due to the complexity of the diffraction patterns. Here, we introduce a method that synergistically combines genetic algorithms with gradient-based optimization techniques to progressively refine diffraction pattern matching. This approach is implemented in an automated computational tool named PolymCrystIndex. The method's versatility allows it to be applied to various crystal systems, including orthorhombic, monoclinic and triclinic, as demonstrated by its successful testing on experimental data from different polymers. PolymCrystIndex will provide a fast and reliable solution for indexing fiber patterns and obtaining accurate cell parameters, advancing the field of polymer crystallography.

RISK PERCEPTION AND RESPONSE TO NATURAL HAZARDS WITHIN SCIENCE CURRICULUM

Natural hazards pose global risks making it essential to incorporate risk perception and response strategies into science curricula. This study analyzed the distribution of risk perception and response indicators for natural hazards—including earthquakes, tsunamis, typhoons, landslides, floods, droughts, volcanoes, wildfires, storms, and extreme temperatures (heat waves, cold waves)—in lower secondary science curricula: the Cambridge Lower Secondary Curriculum 2020 (UK), Indonesia Merdeka Curriculum 2022, South Korea Curriculum 2022, and Singapore Lower Secondary Express and Normal (Academic) Curriculum 2021. A descriptive qualitative content analysis was conducted by analyzing curriculum documents to evaluate risk perception and response indicators distribution. The findings show that the distribution of risk perception and response to natural hazards in specific science curricula does not align with the geographic characteristics of the respective regions. Furthermore, risk perception is given greater emphasis than response strategies, creating an imbalance in the lower secondary science curriculum. This study suggests the need to modify the explanation of risk perception and response to natural hazards in the science curriculum, which emphasizes a global approach that broadens understanding beyond local hazards to prepare individuals for risks they may encounter while moving, traveling, or living in other countries. Keywords: natural hazards, risk perception, risk response, science curriculum, secondary school

Reclassifying NOBOX variants in primary ovarian insufficiency cases with a corrected gene model and a novel quantitative framework.

How updated expression and genomic data combined with a disease/disorder-specific classification system can be used to correct a gene model for a better evaluation of the pathogenicity of variants found in patients? By combining available genomic and transcriptomic data from several species and a quantitative classification framework with primary ovarian insufficiency (POI)-adjusted parameters, we correct the human NOBOX (newborn ovary homeobox) gene model and provide a reclassification of variants previously reported in POI cases. The NOBOX gene, encoding a gonad-specific transcription factor with a crucial role in early folliculogenesis and considered a major gene involved in POI, is currently described as being expressed as four transcripts, the longest one considered canonical. All the variants identified in POI cases have been evaluated according to this canonical transcript, and the various functional tests have been performed using the corresponding predicted protein. We refined and corrected the NOBOX gene model using available genomic and RNAseq data in human and 16 other mammalian species. Expression data were selected for tissue specificity, strand specificity, and coverage. The analysis of RNAseq data from different ovarian fetal stages allows for a time-course description of NOBOX isoforms. Literature was scanned to retrieve NOBOX variants reported in POI cases, and NOBOX variants present in ClinVar and GnomAD 4 databases were also retrieved. Strand-specific RNAseq data from human fetal ovaries and human adult testes were analysed to infer the correct human NOBOX gene isoforms. The conservation of the gene structure was verified by combining the aligned genomic sequences from 17 mammalian species covering a wide phylogenetic range and the relevant RNAseq data. As changing a gene model implies a reclassification of variants, we set up a quantitative framework with updated variant frequencies from GnomAD4 and POI-adjusted parameters following the American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines. Using this framework, we reclassified 44 NOBOX variants reported in POI patients and families, 117 NOBOX variants reported in ClinVar, and 2613 NOBOX variants present in GnomAD4. The corrected NOBOX gene model proposes the invalidation of two transcripts, including the canonical one. The two correct isoforms were present in fetal ovarian samples, and only one was detected in adult testes. Only 14 variants remained as possibly causative for POI. Furthermore, this re-evaluation strongly suggests that NOBOX biallelic variants are the most likely cause of POI. Large tables are provided as supplementary data sets on the Zenodo repository. The proposed gene model is robust but relies on available transcriptomic data covering a range of time points and tissues. Our scoring system was manually adjusted and other laboratories can implement it with different parameters. For the NOBOX variants that cannot be considered pathogenic or causative anymore, the genome/exome sequencing data of the corresponding patients should be reanalysed. Furthermore, the functional studies performed using the obsolete coding sequence should be reconsidered. The corrected gene model should be taken into account when evaluating novel NOBOX variants identified in POI patients. Our results highlight the importance of the careful assessment of the most updated expression data for validating a gene model, enabling a correct evaluation of the pathogenicity of variants found in patients. The proposed quantitative framework developed here can be used for the classification of variants in other genes underlying POI. Furthermore, the global approach based on quantitatively adjusting the ACMG/AMP guidelines could be extended to other inherited pathologies. This project was not funded. All the authors have no conflict of interest to disclose.

Metabolic Syndrome and Liver Disease: Re-Appraisal of Screening, Diagnosis, and Treatment Through the Paradigm Shift from NAFLD to MASLD.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), encompasses a spectrum of liver diseases characterized by hepatic steatosis, the presence of at least one cardiometabolic risk factor, and no other apparent cause. Metabolic syndrome (MetS) is a cluster of clinical conditions associated with increased risk of cardiovascular disease, type 2 diabetes, and overall morbidity and mortality. This narrative review summarizes the changes in the management of people with MetS and NAFLD/MASLD from screening to therapeutic strategies that have occurred in the last decades. Specifically, we underline the clinical importance of considering the different impacts of simple steatosis and advanced fibrosis and provide an up-to-date overview on non-invasive diagnostic tests (i.e., imaging and serum biomarkers), which now offer acceptable accuracy and are globally more accessible. Early detection of MetS and MASLD is a top priority as it allows for timely interventions, primarily through lifestyle modification. The liver and cardiovascular benefits of a global and multidimensional approach are not negligible. Therefore, a holistic approach to both conditions, MetS and related chronic liver disease, should be applied to improve overall health and longevity.

The continuing evolution of antibiotic resistance in Neisseria gonorrhoeae: past, present and future threats to effective treatment.

Gonorrhoea constitutes a global public health threat. Although a range of antibiotics have been available to treat gonococcal infections for more than 80 years, Neisseria gonorrhoeae has shown remarkable versatility in its ability to develop resistance to successive classes of drugs. As a result, national and international treatment guidelines have had to be regularly updated to take account of increases in the prevalence of gonococcal strains resistant to recommended antibiotics. Even when particular antibiotics are no longer empirically used to treat gonorrhoea, N. gonorrhoeae often retains resistance, with strains becoming MDR over time. Future efforts to ensure gonorrhoea remains a treatable infection will require a multidisciplinary global approach including efforts to provide widely available and affordable diagnostic testing, robust international surveillance of resistance, and the development of new antibiotics coupled with enhanced antimicrobial stewardship to ensure optimal use of both new and older antimicrobial agents.

The Role of U.S. Environmental Diplomacy in International Wildfire Management and Sustainable Grassland Burning Practices

The increasing frequency and intensity of wildfires worldwide highlight the need for robust international collaboration in wildfire prevention and sustainable grassland burning practices. The United States, as a global leader in environmental diplomacy, plays a critical role in shaping policies, facilitating technological exchange, and supporting capacity-building efforts for wildfire management. This study examines the impact of U.S. environmental diplomacy on international wildfire response strategies, with a particular focus on bilateral and multilateral agreements, knowledge-sharing initiatives, and financial aid programs. Additionally, the research explores how U.S.-led innovations in fire danger prediction models, remote sensing technologies, and controlled burning techniques contribute to sustainable land management practices globally. By analyzing case studies of U.S. partnerships with wildfire-prone regions, such as Australia, Canada, and the Mediterranean, this study highlights best practices and areas for improvement in diplomatic efforts. The findings suggest that strengthening international cooperation through policy harmonization, data-sharing frameworks, and joint research initiatives can enhance wildfire resilience and promote sustainable grassland burning as a tool for ecosystem management. This research highlights the significance of environmental diplomacy in addressing transboundary fire risks and fostering a more coordinated global approach to wildfire prevention.

Le Quy Don as a Representative of the Enlightenment Age in Vietnam

Based on the global history approaches, the article analyzes activities and intellectual heritage of Le Quy Don, a Vietnamese scholar and encyclopedist of the 18th century. Conceptual aspects and substantial issues of the most notable works compiled by Le Quy Don are explored in the context of the global Enlightenment concept suggested by Sebastian Conrad and compared with defining manifestations of the Enlightenment in various countries in the West and the East. As a result of the research, the author concludes that Le Quy Don’s activities for the accumulation, systematization and spreading of knowledge, his ideas and contribution to the social development of Vietnam make him not only an outstanding light-bringer in Vietnam history but also one of the prominent figures of the Enlightenment era which is understood as a universal phenomenon of global history.