Megatrends and equity gaps in global digital health: A bibliometric review (2010-2025).

Comparative effectiveness of mineralocorticoid receptor antagonists in cardiovascular, renal and metabolic disease.

Evidence on cardiovascular/renal outcomes associated with GLP-1-based therapies in type 1 diabetes (T1D) is limited. We examined the effects of GLP-1-based therapy on major clinical outcomes and safety, including diabetic ketoacidosis (DKA) and hypoglycemia risk, in adults with T1D in a large real-world cohort. This retrospective cohort study utilised the TriNetX global health research network. Adults with T1D were classified by exposure to GLP-1-based therapies. Propensity score matching (1:1) balanced baseline characteristics for age, sex, demographic characteristics, cardiometabolic risk factors, comorbidities, medication use, and laboratory parameters including lipid profile and glycemic control. Outcomes included all-cause mortality, myocardial infarction, cerebral infarction, heart failure (HF), adapted major adverse cardiovascular events (MACE-all CV clinical outcomes), chronic kidney disease (CKD), and all-cause hospitalisation, plus safety outcomes (hypoglycemia and DKA). Event accrual began 6 months after therapy initiation. After matching, 4088 individuals per group were included. GLP-1-based therapy was associated with lower risks of all-cause mortality (HR 0.67, 95% CI 0.46-0.98), HF (HR 0.38, 95% CI 0.21-0.67), adapted-MACE (HR 0.61, 95% CI 0.40-0.94) and all-cause hospitalisation (HR 0.70, 95% CI 0.51-0.96). No significant differences were observed for myocardial infarction, ischemic stroke, or CKD. DKA incidence was not increased, while hypoglycemia risk was lower with GLP-1 therapy (HR 0.72, 95% CI 0.55-0.95). Less than 10 (0.2%) events of pancreatitis were noted in both groups. In this propensity score-matched real-world cohort of adults with T1D, GLP-1-based therapy was associated with lower risks of all-cause mortality, HF, adapted-MACE, hospitalisation, and hypoglycemia without increased DKA risk. Randomised controlled trials are needed to confirm these findings.

Mycosis fungoides (MF) is a rare extranodal T-cell lymphoma with primary cutaneous involvement. While it is the most common primary skin lymphoma, large-scale real-world data defining survival benchmarks and the prognostic significance of specific nodal sites remain limited. To address this, we conducted a retrospective cohort study using the TriNetX global health research network and identified 25 467 patients with MF. The 5- and 10-year OS for the overall cohort was 83.4% and 74.7%, respectively. Patients with disease limited to the skin had 5- and 10-year OS rates of 86.1% and 78.0%, respectively. Nodal involvement at diagnosis was associated with significantly inferior survival [adjusted HR (aHR) = 1.60; 95% CI: 1.50-1.71; p < 0.001], exhibiting 5- and 10-year OS rates of 74.5% and 63.6%, respectively. Among patients with single-site lymphadenopathy, survival outcomes varied substantially by anatomical site, revealing a potential prognostic hierarchy: patients with inguinal/lower limb involvement exhibited the most favorable outcomes (5-year OS 80.2%), while those with visceral lymphadenopathy had the poorest prognosis (5-year OS 62.9%). In multivariable analysis, elevated LDH (aHR 3.06), lymphocytosis (aHR 1.37), and eosinophilia (aHR 1.29) were strong independent predictors of mortality, among others. To summarize, this study of over 25 000 MF patients represents the largest real-world analysis to date. Data suggest a potential prognostic divergence based on the anatomical site of nodal involvement. Additionally, our findings reinforce the prognostic value of LDH, eosinophils, lymphocytes and the hypopigmented and poikilodermatous variants as independent predictors of mortality, supporting their integration into routine risk stratification.

Despite the increasing discourse around equity, social justice and partnership, global health (GH) research remains shaped by entrenched asymmetries in funding, authorship, data ownership and priority-setting. Solidarity, framed variously as a moral principle or political stance, has been promoted as both corrective and a necessary response to these inequities. Yet, the operationalization of solidarity within research institutes (RIs) (i.e. how leaders interpret, institutionalize and negotiate solidaristic commitments) remains underexplored. This paper draws on findings from a global study of meanings and practices relevant to solidarity among diverse GH stakeholders. In 2024-2025, we conducted exploratory qualitative research using semistructured interviews (N= 75) with a range of GH stakeholders. In this paper, we draw on the 13 interviews conducted with leaders of GH RIs to highlight findings specific to solidarity in and for GH research. Data analysis was conducted using team-based thematic analysis supported by NVIVO 15 (QSR). Thematic analysis of interview transcripts identified five themes in research institute leaders' accounts of how solidarity is or is not enactment in their GH research experience. Each theme describes a requirement or outcome of solidarity-informed research, and includes that such research: (1) generates tangible equitable results or outcomes; (2) accounts for how relationships and impacts unfold over time; (3) operationalizes and depends on less hierarchical ways of working; (4) demands fair distribution of burdens and benefits in research; and (5) requires deep, active listening. This paper provides insight on how solidarity is understood and can be actualized in GH research practice, according to directors in GH RIs who occupy critical roles in structuring and legitimizing GH research agendas. The findings emphasize the need to treat solidarity in and for GH research not as a static ethical ideal, but as a dynamic, relational practice requiring reflexivity, structural reforms and sustained commitment. RIs, as ethical actors, must reconfigure their practices to meaningfully institutionalize solidarity through co-design, authorship, partnership and funding practices. Ultimately, this paper contributes to a growing agenda to reimagine GH research not merely as a technical endeavour but also as a site of political and ethical action.

Effect of bariatric surgery timing on breast cancer incidence: Real-world evidence from TriNetX.

Connections between science and care are common, such as when people access particular therapies through participating in research. However, interactions go far beyond medical treatment per se, with other kinds of advice and support (including direct financial support) also warranting consideration. Such complexities of the science-care relationship are often not fully accounted for by formal ethical and governance processes and approvals. This can result in morally justifiable action, while also engendering uncertainty and unease among research teams. Acts that are ostensibly caring can on occasion and inadvertently also be harmful (e.g. the informal circulation of contested health-related claims or even 'misinformation' by research team members). Here, we argue that the connections between science and care require more dedicated attention from across the research ecosystem. This includes from funders, whose conventions can inappropriately restrict the care that researchers could and should provide. We also indicate the need for further studies by social scientists into how public and global health researchers navigate challenges related to care.

Early and ongoing stakeholder engagement is critical to the development and implementation of scalable behavioral health interventions. Our overarching goal in this implementation research study was to understand and document the process of planning and rolling out Common Elements Treatment Approach (CETA), a transdiagnostic mental health intervention, in Uganda. Guided by the Consolidated Framework for Implementation Research (CFIR) 2.0, we conducted in-depth interviews with multilevel stakeholders (healthcare providers, MOH members, clinic managers, implementing partners, n = 20) to understand and document the process of planning and rolling out CETA in Western Uganda. All interviews were audio recorded, transcribed, and analyzed thematically in Dedoose using a codebook based on CFIR 2.0 domains and constructs. Multilevel stakeholder engagement supported strategic decision making at each stage. Early endorsement of CETA by Uganda’s MOH was instrumental in facilitating program integration. Ministry of Health leadership guided facility selection, while clinic leaders identified trainees positioned to implement CETA. Training incorporated both didactic and participatory methods, including real-time adaptation of intervention content for contextual relevance and identification of “champion” trainees to serve as supervisors as part of the ongoing support supervision infrastructure. During rollout, an incremental implementation strategy facilitated integration into clinic workflows. Ongoing multilevel stakeholder supervision and technical assistance helped CETA deliverers troubleshoot challenges, maintain fidelity, and gain confidence. Together, these processes enabled expansion beyond the initial pilot sites, providing early evidence of stakeholder-perceived feasibility and identifying foundational conditions for scalability. Continued engagement with policymakers, those delivering CETA, and community stakeholders will be essential to refine CETA implementation and support integration into national mental health strategies. By reframing stakeholder engagement as an implementation strategy that builds enduring, locally led infrastructures, this study offers a replicable model for preparing behavioral health interventions for scale-up in low resource settings and advances implementation research in global mental health.

The increasing burden of oral diseases in low- and middle-income countries (LMICs) and limited access to and affordability of oral care disproportionately impact disadvantaged groups. Oral health research has been dominated by professional academic perspectives with limited contribution from the communities involved. The aim of this commentary is to provide a broad overview of the aims and objectives, principles, values, and study design of the CORE programme. The CORE (Community focused Oral health Research for Equity) programme is a multinational research initiative which aims to reduce oral health inequalities and improve access to dental services through collaborations between disadvantaged communities and academic and community partners in Brazil, Colombia, India and Kenya. Public health research interventions will be co-created and tested with local communities through a participatory action research approach and active community engagement and involvement. In addition, the programme aims to strengthen local oral health research capacity and advocacy. The CORE programme is comprised of three elements: (1) Programme management and governance; (2) Research components focused on oral health inequalities, commercial determinants and oral health system reform; (3) Overarching components including (i) community engagement and involvement, (ii) training and capacity building, (iii) monitoring, evaluation and learning. Through a collaborative community-based approach, the CORE programme will undertake high-quality research in LMICs to inform future pro-equity and health system reform policies.

BACKGROUNDMetabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and often coexists with obstructive sleep apnea (OSA). Emerging evidence suggests that OSA may independently accelerate liver injury in MASLD. Despite this the epidemiology and clinical significance of OSA within the population with MASLD remain incompletely understood.AIMTo estimate the prevalence of OSA among MASLD and determine the impact of OSA on hepatic complications.METHODSThis was a large, multicenter, population-based retrospective cohort study conducted using the TriNetX Global Health Research Network from 2010 to 2024. We identified adults with MASLD with International Classification of Diseases, Tenth Revision codes and propensity score matched (PSM) them 1:1 with adults without MASLD. Patients with any record of prior liver disease other than MASLD or OSA (G47.3x) before the MASLD index date were excluded from the study.RESULTSAfter PSM there were 364283 pairs analyzed with balanced covariates. From 2010-2024 OSA incidence and prevalence in MASLD increased more than 400-fold (P < 0.001). MASLD was associated with 54% higher odds of OSA vs matched controls (odds ratio: 1.54), and patients with MASLD developed OSA earlier (median 189 days vs 358 days; P < 0.001). OSA markedly worsened hepatic outcomes. The odds of fibrosis were 1.78-fold higher at 1 year and 2.12-fold higher at 10 years while cirrhosis risk was 50%-55% higher at the 1-year and 10-year follow-ups (P < 0.001). Independent predictors of OSA in MASLD included male sex, obesity, older age, hypertension, and nicotine dependence.CONCLUSIONMASLD was associated with a significantly higher risk of OSA, and coexisting OSA substantially amplified long-term hepatic complications. In addition, MASLD was associated with an earlier onset of OSA, highlighting the need for integrated hepatology-sleep medicine approaches and early identification and treatment of OSA in MASLD cohort may prevent the development of complications such as hepatic fibrosis and cirrhosis.

Military leaders must support health care and research to protect the health and readiness of their forces. Part of this effort entails conducting human subjects research to address current and emerging international health threats. The military is also attentive to the national security interests associated with global health, such as protection from widespread disruption due to disasters and epidemics. While military leaders' global health research objectives relate to the military's strategic goals, including force health protection and national security, it is only through longstanding partnerships with partner nations in several world regions that much of the relevant research is possible. Yet military priorities may differ starkly from those of the collaborating partner nations, raising concerns about the potential for exploitation in global health partnerships. However, in spite of differences in overall strategic priorities, a convergence of stakeholder interests allows for appropriate alignment in the choice of clinical research activities at global health sites supported by the military. These complex collaborative research arrangements depend on negotiating and navigating the selection of research goals and activities to ensure fairness and balancing of priorities among partners, thereby maintaining research infrastructure and capacity. Leaders of military institutions and partner nations must attend to the need for this sustained effort to balance priorities to ensure equity and successful maintenance of these essential relationships.

IntroductionEnsuring the health of agricultural workers, the world’s largest labour force, is key for sustainable food production and progress towards the Sustainable Development Goals (SDGs).MethodsWe conducted an artificial intelligence (AI)-assisted evidence map of research records on global farmer health published from 2015 to 2024. We searched bibliographic databases and screened titles/abstracts using SWIFT-Active Screener, a collaborative review platform that uses machine-learning prioritisation to rank records for human review. We retrieved 32 006 records. After manually screening 8533 records and stopping when the tool estimated ≥94% recall of relevant records, we included 1684 studies. We mapped research output by health topic category (non-communicable diseases (NCDs), communicable diseases, injuries and mental health) country income groups and alignment with SDG 3 targets.ResultsDespite 98% of the agricultural workforce living in low- and middle-income countries (LMICs), 52% of studies originate from high-income countries (HICs). Research focuses on NCDs (29%) and injuries (26%), with LMICs focusing on pesticide poisoning and HIC on accidents. Mental health emerges as a key topic in HICs, with the proportion of publications nearly doubling from 2021 to 2024 but remains underexplored in LMICs. Key gaps with high relevance to farming populations and climate change, such as heat-related illnesses, occupational injuries and musculoskeletal conditions, are not well represented in SDG 3 indicators.ConclusionOur findings highlight urgent needs for a more equitable and comprehensive global research agenda that integrates agricultural worker health into sustainability frameworks beyond the SDG era, ensuring the resilience and well-being of food producers worldwide.

Breaking down barriers: A funder's perspective on achieving equity and inclusivity in infectious disease modelling and epidemiology.

Factor V Leiden (FVL) is a common inherited thrombophilia that increases the risk of venous thromboembolism (VTE). However, its effect on all-cause mortality remains uncertain, and previous studies yielded conflicting results. To assess the association between FVL and all-cause mortality using a large international database, including age- and sex-stratified analyses. Retrospective propensity score-matched cohort study using real-world electronic health records. We analyzed electronic health records from the TriNetX Global Health Research Network, comparing 241,572 patients with FVL to 20,779,115 patients without thrombophilia. One-to-one propensity score matching for age was applied. Incidences of VTE and all-cause mortality were compared over a 19-year follow-up. Subgroup analyses were performed for female patients and three age categories: <20, 20-50, and >50 years. FVL was significantly associated with both VTE (OR: 9.325; 95% CI: 9.109-9.546) and all-cause mortality (OR: 1.423; 95% CI: 1.396-1.451). The mortality risk was particularly elevated in young females (<20 years: OR: 9.681; 20-50 years: OR: 2.345) and attenuated in older females (>50 years: OR: 1.432). Kaplan-Meier analyses showed significantly reduced survival probabilities in FVL-positive patients across all subgroups. This large-scale real-world study indicates that FVL is not only a major risk factor for thrombosis but also associated with increased all-cause mortality-particularly among young women. These findings may have implications for screening and risk stratification in selected populations.

To evaluate whether proliferative diabetic retinopathy (PDR) is associated with an increased risk of nonarteritic anterior ischemic optic neuropathy (NAION) and whether pan-retinal photocoagulation (PRP) alters that risk. A retrospective cohort study was conducted using the TriNetX global health research network. Adults (18 years and older) with ≥3 years of follow-up and no prior NAION were included. In Analysis 1, patients with PDR were compared with those with diabetes mellitus without diabetic retinopathy. In Analysis 2, patients with PDR who underwent PRP were compared with those who did not. Propensity score matching was controlled for demographics and comorbidities. The primary outcome was incident NAION within 3 years. After matching, 30,588 patients were included in each group for Analysis 1. At 3 years, NAION incidence was significantly higher in the PDR cohort than the DM without DR group (0.24% vs 0.09%; HR 2.81, 95% CI 1.80-4.40; P < 0.001). In Analysis 2, 8,126 patients were included in each group. No significant difference in NAION risk was observed between PRP and No PRP cohorts at any time point (3-year incidence: 0.34% vs 0.31%; HR 1.12, 95% CI 0.65-1.92; P = 0.680). PDR is associated with increased NAION risk, suggesting a role for local microvascular changes. PRP does not significantly alter NAION risk, supporting its safety in this context. Further studies with imaging data are warranted to clarify underlying mechanisms.

Tranexamic acid to treat ACE-inhibitor induced angioedema: A comparison outcomes analysis.

Cost-effectiveness of a mTB-Tobacco intervention for smoking cessation in people with tuberculosis: an economic evaluation of a cluster randomised controlled trial.

Patterns of the triple burden of childhood malnutrition in Ecuador by age, sex, ethnicity, and poverty: a cross-sectional population survey

Despite calls for equitable global eye-health research partnerships, there are limited data on authorship trends in research from Sub-Saharan Africa (SSA). Our aims were to determine the magnitude, trends, associated factors, and gender disparities related to inequitable authorship in eye-health research conducted in SSA. This was a cross-sectional analysis of SSA eye-health publications between 2003 and 2022. A systematic literature search was conducted. Data were manually extracted from the 1777 publications that met eligibility screening criteria. Namsor V.2 was used to classify author gender. Outcomes included no locally-affiliated authors and SSA-affiliated female authors. Overall, 1777 publications were included. The percentage of publications with no locally-affiliated authors was 6% overall, 33% in the first author position, and 45% in the last author position. There were no significant trends in the exclusion of locally-affiliated authors between 2003 and 2022 (no authors: p = 0.899; no first authors: p = 0.515; no last authors: p = 0.574). Factors with a higher odds of no locally-affiliated authors at all or in prominent positions included high-income-country-affiliated co-authors, low-income study countries, randomised trials, high-impact research, US/UK journal publishers and funders, and trachoma publications. SSA-affiliated female authors were underrepresented in prominent authorship positions (first authors: p < 0.001; last authors: p < 0.001) and had lower odds of representation with US/UK journal publishers, low-income study countries, and randomised trials. Inequitable authorship practices persist in eye-health research in SSA. Greater commitment towards partnership equity by ophthalmic researchers, journals, and funding organisations is needed.

An ethical framework titled "Research for Health Justice" has been developed that provides global health researchers with guidance on how to design their research to promote health equity and global justice. This study sought to test the framework's guidance by comparing it to the governance and experiences of the "Severe Pre-eclampsia adverse Outcome Triage" (SPOT)-Impact consortium-a transdisciplinary maternal health research consortium. The aim was to identify ways in which the "Research for Health Justice" framework could learn from the consortium's insights and practices and to identify how the SPOT-Impact consortium could more systematically link its governance and research to health equity. We conducted in-depth interviews with investigators, held a validation/reflection session with the consortium, and read core consortium documents. Our analysis identified areas of alignment, where the consortium's practices strongly aligned with the framework's guidance, and we describe how that alignment was achieved. We also identified areas of non-alignment, where the consortium's governance or practices diverged from the framework's guidance or where interviewees defined ethical concepts such that they differed from those of the framework. Based on our findings, we suggest several directions for the revision and expansion of the framework as well as lessons for the SPOT-Impact consortium regarding inclusive priority-setting, sharing resources, and research capacity strengthening.