Introduction Migration significantly impacts the health of international students in host countries. It has been reported in several studies that one of the main challenges for international students is gaining access to healthcare services. This study examined the experiences of international students in Hungarian universities, focusing on their self-reported health status, access to healthcare services, adequacy of services rendered, cultural sensitivity, and quality of care. Method This cross-sectional study gathered responses from 476 students across major universities. However, only 440 were strictly analysed, and 436 in situations where questions under certain parameters were left unanswered. Results Using a structured online survey and CART analysis with chi-squared test as goodness of fit, we examined socio demographic influences on healthcare access and the availability of culturally competent care. Key findings revealed notable health challenges, with 28.3% of students reporting health deterioration after migrating to Hungary. Approximately 63% arrived with limited or no prior information on the healthcare system, and only 35.9% had a full understanding of their entitlements to comprehensive healthcare. Conclusion Despite the Stipendium Hungaricum scholarship’s insurance coverage, 30.9% of students incurred some out-of-pocket expenses, and 4.6% paid entirely for public healthcare. Trust issues also surfaced, with 36.7% placing more confidence in home-country healthcare service providers compared to 20.6% for Hungarian healthcare service providers. Issues of discrimination were implied from the data but not supported in explicit statements. These findings underscore critical policy needs, including enhanced intercultural competence, better language support, and expanded mental health services.

Coccidioidomycosis continues to shape life across California's southern San Joaquin Valley, where thousands fall ill each year. Yet for many, diagnosis marks not the end of uncertainty but the start of another challenge, staying in care. In communities already strained by clinician shortages, distance, and limited insurance coverage, the year-long follow-up recommended after Valley Fever is rarely feasible. Lessons from other rural Latino populations show that continuity can be rebuilt through community-rooted approaches: trusted health workers, mobile clinics, peer education, and simple digital tools that meet patients where they are. Bringing these models into existing county and safety-net systems will require dedicated funding and shared commitment across institutions. Strengthening continuity of care, not only diagnostic capacity, offers the most realistic path to better outcomes for those living in the heart of California's Valley Fever region.

To describe the sociodemographic characteristics of mothers of Haitian origin and the obstetric and neonatal outcomes of their newborns born in French Guiana between 2013 and 2021 in order to identify specific vulnerabilities within this population. A descriptive, population-based study using data from a comprehensive birth cohort including all deliveries in French Guiana from 2013 to 2021. All maternity units in French Guiana, a French overseas territory located in South America. A total of 66 485 live births were recorded during the study period, including 14 065 (21.2%) births to mothers of Haitian origin. Sociodemographic characteristics, antenatal care indicators and neonatal outcomes were compared between mothers of Haitian origin and mothers of other origins. Adjusted odds ratios (aOR) and 95% CI were calculated for key outcomes. Compared with mothers of other origins, Haitian mothers had higher odds of delivering a newborn small for gestational age (aOR=1.41, 95% CI 1.32 to 1.50), neonatal hospitalisation at birth (aOR=1.19, 95% CI 1.11 to 1.28), having an insufficient number of antenatal visits (aOR=1.32, 95% CI 1.26 to 1.38) and lacking health insurance coverage (aOR=2.83, 95% CI 2.52 to 3.17). Conversely, they had a lower risk of adolescent pregnancy (<20 years; aOR=0.24, 95% CI 0.21 to 0.26). The risk of preterm birth did not differ significantly between groups (p=0.24). Mothers of Haitian origin in French Guiana experience distinct social and perinatal vulnerabilities. Strengthening equitable access to healthcare and implementing targeted community-based interventions are essential to improve maternal and neonatal health outcomes in this population.

The US opioid crisis has become a serious public health issue, causing tens of thousands of deaths and tremendous economic loss annually. Acupuncture, as a traditional non-pharmacological method of analgesia, has demonstrated extraordinary value in addressing this crisis. This paper systematically elucidates the causes and impacts of the US opioid crisis and deeply explores the neurobiological mechanisms of acupuncture analgesia, including the activation of the endogenous opioid system, neurotransmitter regulation, and anti-inflammatory and immune modulation via multiple pathways. By analyzing the clinical evidence for acupuncture in the management of acute and chronic pain, opioid dosage reduction, and addiction treatment, we demonstrate the feasibility and efficacy of acupuncture as an alternative to opioid therapy. Research shows that acupuncture can not only effectively relieve various types of pain but also reduce opioid consumption and treat opioid dependence and addiction. However, the promotion of acupuncture in the US still faces multi-faceted challenges, including issues of standardization, limited insurance coverage, and insufficient high-quality evidence. Future efforts should focus on strengthening multidisciplinary research collaboration, improving standardized treatment protocols, and integrating acupuncture into comprehensive pain management systems to provide a safer, more cost-effective, non-pharmacological alternative for resolving the opioid crisis.

Treatment-resistant depression (TRD) remains a major clinical challenge worldwide and across the Gulf Cooperation Council (GCC) countries, where the burden of mental health disorders continues to rise. Conventional TRD therapies, including antidepressants, augmentation strategies, and electroconvulsive therapy (ECT), often result in incomplete remission and are associated with significant adverse effects, highlighting the need for innovative therapeutic approaches. This narrative review explores the mechanisms, clinical evidence, regional adoption, and recent advances of ketamine, esketamine, and rTMS in TRD, while examining barriers to implementation and outlining future directions for care in the GCC. Esketamine adoption is increasing in the GCC, with the United Arab Emirates (UAE) and Qatar leading implementation efforts. In both countries, esketamine and related treatments are currently administered in controlled clinical settings within leading psychiatry clinics. Region-specific governmental strategies, such as Qatar's national mental health initiatives, have further supported the structured introduction of these therapies. rTMS is also being gradually integrated into regional mental health services, with notable expansion through private providers in the UAE and Hamad Medical Corporation (HMC) in Qatar. Despite these advancements, access remains limited due to regulatory challenges, high costs, and infrastructure constraints. Implementation of these therapies may serve as a foundation for future regional mental health policies, although cultural stigma, limited insurance coverage, and workforce shortages continue to pose barriers. Novel therapies for TRD demonstrate clinical efficacy and feasibility in the GCC. Nevertheless, their wider adoption requires addressing accessibility challenges, reducing stigma, and expanding professional training. Strategic investments, policy reforms, and awareness initiatives will be critical to embedding these treatments into mental health systems and transforming TRD care in the region.

The 2025 Kennedy v. Braidwood Supreme Court decision upheld the Affordable Care Act mandate requiring insurance coverage of preventive services with an A/B rating from the U.S. Preventive Services Task Force (USPSTF) without cost-sharing. This ruling preserved access to essential preventive care, including colorectal cancer screening, a leading cause of cancer-related mortality despite the availability of effective, evidence-based screening methods. The recent elimination of out-of-pocket costs for follow-up colonoscopy after positive stool testing resulted in an absolute increase of 1.48% in follow-up procedures, highlighting the impact of financial barriers on the completion of the screening continuum. Yet nonfinancial barriers such as limited transportation, language barriers, and scheduling challenges persist. Patient navigation services addressing these barriers have demonstrated substantial improvements in screening adherence and diagnostic completion but remain inconsistently covered. Recent federal policies about breast and cervical cancer screening have expanded the definition of screening to include follow-up care and navigation services, now requiring coverage of these services by private insurers and Medicaid without cost-sharing. Colorectal cancer screening coverage should similarly expand to include these critical support services. Aligning policy with the realities of patient access will enhance screening uptake, reduce disparities, and strengthen the cost-effectiveness of colorectal cancer prevention efforts.

Obstructive sleep apnea (OSA) is increasingly recognized as a major comorbidity in chronic respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD). The coexistence of OSA with asthma or COPD significantly complicates the clinical course, leading to poorer disease control, more frequent exacerbations, reduced lung function, impaired sleep quality, and increased cardiovascular and overall mortality. In asthma, OSA exacerbates airway inflammation, enhances bronchial hyperresponsiveness, and decreases responsiveness to standard therapies. In COPD, the "overlap syndrome" is associated with profound nocturnal hypoxemia, chronic hypercapnia, pulmonary hypertension, and a markedly elevated risk of hospitalization and death. Underlying mechanisms include chronic airway inflammation, oxidative stress induced by intermittent hypoxia, instability of ventilatory control (high loop gain), structural upper-airway alterations, and the burden of obesity and metabolic dysfunction. These interactions highlight the urgent need for integrated and proactive management strategies. Thus, we propose an Asthma-COPD-OSA Outpatient Unit (ACOSOU)-a care-delivery model, not a disease entity-designed to integrate systematic screening, diagnosis, treatment initiation, and long-term follow-up of OSA in patients with asthma and COPD. Optimal care requires systematic screening in respiratory outpatient settings, appropriate diagnostic pathways using polysomnography or home sleep apnea testing, and individualized treatment approaches. Continuous positive airway pressure (CPAP) remains the cornerstone therapy for OSA-asthma and OSA-COPD overlap, improving gas exchange, reducing exacerbations, and enhancing disease control. Comprehensive management also includes optimization of inhaled therapies, pulmonary rehabilitation, weight reduction, sleep hygiene, and multidisciplinary collaboration. This review proposes an integrated ACOSOU model to streamline screening, diagnosis, CPAP titration, and long-term follow-up. However, implementation in low- and middle-income countries faces challenges including limited trained sleep-medicine personnel, unequal access to diagnostic tools, and high CPAP costs without insurance coverage. Strengthening infrastructure, training, and policy support will be essential to improve outcomes for patients with chronic respiratory diseases and OSA comorbidity.

Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood influenza vaccination in the post-pandemic context. Methods: A single-center cross-sectional survey was conducted between February and March 2025 using convenience sampling among parents of children attending a pediatric immunoallergology center. An anonymous questionnaire collected data on demographics, risk perception, and attitudes. Data from 301 parents were analyzed using descriptive statistics, chi-squared tests, and odds ratios (OR) to identify key predictors of hesitancy. Results: Only 27.6% of parents expressed willingness to vaccinate their children, while 42.5% were opposed and 29.9% hesitant. Statistical analysis revealed no significant association between parental university education and vaccination intent (p &gt; 0.05), indicating that vaccine hesitancy in this specific setting was present across all educational backgrounds. However, the source of information proved to be a critical determinant: consulting a pediatrician significantly increased the odds of acceptance (OR = 6.32; 95% CI: 3.54–11.28), whereas reliance on the internet and social media was a significant predictor of refusal (OR = 0.29; 95% CI: 0.17–0.50). The primary reported barrier was fear of adverse effects (70.4%), which significantly outweighed doubts about efficacy (30.2%). Conclusions: Parental hesitancy in Slovakia is a widespread phenomenon pervasive across all educational backgrounds, driven primarily by safety concerns and digital misinformation. The contrast between the protective influence of pediatricians and the negative impact of digital media underscores that clinical encounters are currently the most effective firewall against hesitancy. Public health strategies must therefore pivot from general education to empowering pediatricians with active, presumptive communication strategies.

ABSTRACT Adults exposed to adverse childhood experiences (ACEs) may have greater risks of experiencing gaps in health insurance coverage. We used data from the 2021 California Health Interview Survey to determine if ACEs exposure was associated with part‐year and year‐round uninsurance among adults ages 26–64. The primary outcome was health insurance coverage at the time of the survey. The primary exposure was the number of ACEs respondents experienced before age 18. Based on a sample of 15,966 eligible respondents, we estimated 6% experienced part‐year uninsurance, 7% experienced year‐round uninsurance, and 70% experienced at least 1 ACE, including 24% exposed to 4 or more ACEs. On multivariable analysis, exposure to 3 versus no ACEs was associated with higher relative risk of part‐year uninsurance (relative risk ratio [RRR]: 1.87; 95% confidence interval [CI]: 1.31, 2.66) or year‐round uninsurance (RRR: 1.83; 95% CI: 1.21, 2.77) rather than having continuous private coverage. We observed no dose‐response gradient in part‐year or year‐round uninsurance with exposure to an increasing number of ACEs, and no association between exposure to 4+ ACEs and risk of uninsurance. Further research is needed to understand what adulthood stressors may increase the risk of coverage disruption.

Migraine is a common neurological disorder that substantially impacts individuals' health and quality of life. This study aimed to estimate the prevalence of migraine and identify factors associated with it among patients attending primary healthcare centers (PHCs) in Saudi Arabia. We conducted a cross-sectional study from March to July 2023, involving 14,239 participants from 48 PHCs within Health Cluster 2 in the Riyadh region of Saudi Arabia. We collected data on participants' sociodemographic characteristics, behavioral risk factors, and existing comorbidities using a validated questionnaire. Migraine status was determined based on participants' self-reported prior physician diagnosis of migraine. To identify factors independently associated with migraine, we used multivariable logistic regression analysis. The adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) were calculated to show the strength of these predictors. The prevalence of migraine was 5.9%. In the multivariable analysis, males had significantly lower odds of migraine compared to females (AOR = 0.69, 95% CI [0.59, 0.80], P < .001). Individuals with insurance coverage had higher odds of migraine (AOR = 2.44, 95% CI [2.11, 2.82], P < .001). Smoking (AOR = 2.44, 95% CI [2.05, 2.92], P < .001), and exercise (AOR = 1.46, 95% CI [1.18, 1.82], P < .001) were associated with higher odds of migraine. Several comorbidities were also significantly associated with migraine: obesity (AOR = 6.08, 95% CI [4.95, 7.47], P < .001), hypercholesterolemia (AOR = 2.59, 95% CI [2.07, 3.25], P < .001), hypertension (AOR = 1.47, 95% CI [1.15, 1.86], P = .002), and heart disease (AOR = 3.25, 95% CI [2.55, 4.15], P < .001). In this Saudi Arabian population, female sex, insurance coverage, smoking, obesity, hypercholesterolemia, hypertension, and heart disease were identified as significant predictors of migraine. These findings highlight the need for targeted preventive strategies and integrated care approaches addressing modifiable risk factors and comorbidities to reduce the burden of migraine.

Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct from coverage-only parity) and to summarize reported effects on telehealth utilization, modality mix, quality/adherence, equity/access, and expenditures. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, and Web of Science for U.S. studies that explicitly modeled state payment parity or stratified results by payment parity vs. coverage-only vs. no parity. We included original quantitative or qualitative studies with a time or geographic comparator and free full-text availability. The primary outcome was telehealth utilization (share or odds of telehealth use); secondary outcomes were modality mix, quality and adherence, equity and access, and spending. Because designs were heterogeneous (interrupted time series [ITS], difference-in-differences [DiD], regression, qualitative), we used structured narrative synthesis. Results: Nine studies met inclusion criteria. In community health centers (CHCs), payment parity was associated with higher telehealth use (42% of visits in parity states vs. 29% without; Δ = +13.0 percentage points; adjusted odds ratio 1.74, 95% CI 1.49–2.03). Among patients with newly diagnosed cancer, adjusted telehealth rates were 23.3% in coverage + payment parity states vs. 19.1% in states without parity, while cross-state practice limits reduced telehealth use (14.9% vs. 17.8%). At the health-system level, parity mandates were linked to a +2.5-percentage-point telemedicine share in 2023, with mental-health (29%) and substance use disorder (SUD) care (21%) showing the highest telemedicine shares. A Medicaid coverage policy bundle increased live-video use by 6.0 points and the proportion “always able to access needed care” by 11.1 points. For hypertension, payment parity improved medication adherence, whereas early emergency department and hospital adoption studies found null associations. Direct spending evidence from open-access sources remained sparse. Conclusions: Across ambulatory settings—especially behavioral health and chronic disease management—state payment parity laws are consistently associated with modest but meaningful increases in telehealth use and some improvements in adherence and perceived access. Effects vary by specialty and are attenuated where cross-state practice limits persist, and the impact of payment parity on overall spending remains understudied.

In the United States, health insurance is strongly associated with healthcare access and health status. How health insurance source, healthcare access, and health status differ by occupation has received less attention. We used responses to the 2022 and 2023 Behavioral Risk Factor Surveillance System to estimate the prevalence of primary health insurance source, healthcare access/unmet healthcare needs, and health status by demographic characteristics and major occupation among respondents employed for wages or self-employed. We generated prevalences and adjusted prevalence ratios (PRs) to examine healthcare access and self-reported health status for workers in each occupation and to understand the impacts of adjustment for demographic characteristics (age, sex, race/Hispanic ethnicity), health insurance source, and household income. Overall, being insured was associated with better healthcare access and self-reported health status. Workers with employer-sponsored insurance or non-group private insurance were least likely to report unmet healthcare needs or to rate their health status as fair or poor. The uninsured were most likely to report unmet healthcare needs. The four occupations with at least 25% of workers uninsured (Farming, Fishing and Forestry; Building and Grounds Cleaning and Maintenance; Food Preparation and Serving; and Construction and Extraction) had statistically significant unadjusted PR elevations for all unmet healthcare need measures and for fair or poor general health. After sequential adjustment for demographic covariates and then primary insurance source, statistically significant elevations remained for being unable to afford needed care and for reporting fair or poor general health in most low-wage occupations. Final adjustment, adding household income, eliminated these remaining elevations for most occupations. Both healthcare access and health status vary by health insurance status and source, which are differentially distributed by occupation. Workers in lower-wage occupations may have trouble affording medical care, even if insured. Affordable, comprehensive health insurance coverage, along with wages adequate to cover needed care, could help ensure the health and continued employability of all workers.

Indigenous women experience distinctive mental health risks that accumulate across the life course under the continuing impacts of colonization, gendered violence, and systemic racism. Drawing on recent mandates from the United Nations Permanent Forum on Indigenous Issues and the World Health Assembly's Resolution 76.16 (2023), as well as community-based exemplars such as Partners In Health's women-led peer models, this policy brief applies the analytical dimensions of the National Collaborating Centre for Healthy Public Policy to synthesize evidence, contextual factors, and feasible policy options. It identifies disproportionate burdens in suicide rates, perinatal depression, caregiver stress, and menopausal symptom severity, alongside a persistent lack of validated Indigenous-specific screening tools and gender-disaggregated data. The brief recommends an integrated, rights-based strategy that funds Indigenous governance of culturally safe mental health services across the life course, builds an Indigenous Women's Mental Health Data Strategy grounded in data sovereignty, embeds traditional knowledge and place-anchored healing in coverage policies, and extends targeted support for caregiving and menopausal transitions. Implementing these measures would operationalize reconciliation commitments, reduce documented inequities, and generate long-term social and economic benefits for communities and health systems alike.

Measuring quality of life (QoL) in breast cancer survivors is a key 'patient-reported outcome' to optimize survivorship care, however, evidence from low- and middle-income countries is limited. Our prospective study aimed to identify QoL trajectory patterns and their determinants in Moroccan breast cancer patients from diagnosis up to one year post-treatment. We recruited 830 stage I-III breast cancer patients registered at the two major oncology centres. QoL was assessed using validated EORTC QLQ-C30 and QLQ-BR23 questionnaires at pre-treatment, after treatment completion, and at one year post-treatment. Trajectory patterns were identified through group-based modelling. Three distinct QoL trajectories were identified: consistently high (36.1%), moderate (56.4%), and low (7.5%). Stage III disease (OR 6.63, 95% CI 2.35-18.71) was significantly associated with patients in the consistently low trajectory group. Being married (OR 0.40, 95% CI 0.19-0.84), receiving treatment at comprehensive cancer centers (OR 0.12, 95% CI: 0.05-0.27), and management according to international guidelines on breast cancer care (OR 0.44, 95% CI 0.24-0.80) reduced the likelihood of being in the consistently low trajectory group. Younger patients (aged < 50) were also more likely to be in the low trajectory pattern. While global health status improved over time (74.8-83.7, p = 0.018), multiple domains showed deterioration, particularly in the low trajectory group. Financial hardship persisted in all groups despite health insurance coverage. We identified three distinct QoL trajectories. Advanced stage of disease increased risk of poor QoL outcomes, while older age, treatment at comprehensive cancer centers, and protocol-appropriate management were protective determinants. Many women survive breast cancer, but we know little about how their quality-of-life changes during and after treatment, especially in countries with fewer resources like Morocco. Our study followed breast cancer patients for over a year after treatment to understand these changes. Our objective was to identify different patterns in how quality of life changes over time for breast cancer survivors and determine what factors influence these patterns. We found three distinct patterns: some women maintained good quality of life (36%), others had moderate levels (56%), and a smaller group consistently struggled with poor quality of life outcomes (7.5%). Younger patients and those with more advanced cancer were more likely to have poor quality of life outcomes. Receiving treatment according to internationally accepted guidelines at comprehensive cancer centers that provide cancer services - from diagnosis through surgery, chemotherapy, radiotherapy, and follow-up all in one location significantly improved quality of life outcomes. Despite most patients having health insurance, many faced financial difficulties throughout treatment and recovery periods. Our findings help identify which patients need extra support and show that comprehensive care centers and appropriate treatment improve quality of life for breast cancer survivors in Morocco.

The purpose of this study was to evaluate the diffusion of surface-guided radiation therapy (SGRT), implementation of quality control and quality assurance strategies, established clinical workflows and user perceptions regarding the benefits and limitations of SGRT in routine practice. From October to December 2024, we surveyed 880 radiotherapy institutions in Japan regarding institutional characteristics, quality assurance/quality control, computed tomography simulation, treatment procedures and general questions regarding SGRT. The survey was distributed via mailing list and through vendors, and administered via Google Forms. A total of 292 institutions responded, corresponding to a response rate of 33%. Ninety-eight institutions reported introducing SGRT, and 50 institutions had introduced it after 2022. The highest usage rate of SGRT in breast treatment was 87%. Approximately half of the institutions performed daily checks of SGRT and radiation isocenter coincidence, as well as static accuracy, whereas 6% did not perform these checks at all. The primary functions of the SGRT system were patient positioning (94%), respiratory management (78%), patient monitoring (76%) and skin marker-less techniques (69%). Many institutions reduced or eliminated skin marking, citing simplified workflows and reduced setup time. Many respondents observed that SGRT implementation reduced both setup and treatment times for breast/chest, abdomen/pelvis and extremity procedures. SGRT has been widely embraced in Japan, offering notable clinical and workflow benefits. However, because participation in this survey was voluntary, the results may overrepresent institutions with greater awareness or adoption of SGRT. Greater standardization, broader insurance coverage and ongoing technological advancements are essential to fully realize its advantages.

This study investigates how socioeconomic status, insurance type, and geography shape access to inpatient synthetic facial implant surgery in the United States. Using HCUP-NIS data from 2016 to 2020 (n=68), the authors show that lower-income patients are more likely to be publicly insured, experience significantly longer hospital stays, and are underrepresented in cosmetic and gender dysphoria-related procedures, while higher-income, urban patients more often self-pay for elective implants clustered in large metropolitan and Pacific regions. Despite low overall complication rates, inpatient admissions are associated with high costs, and rural and low-income patients face pronounced barriers to care, particularly for facial feminization surgery. This work highlights the need for broader outpatient data capture, qualitative research among marginalized groups, and standardized insurance coverage policies to promote equitable, cost-effective access to functional and aesthetic facial implant procedures.

Aim: To identify report and discuss the tools assessing orthodontic treatment need (OTN), - complexity (OTC), -priority (OTP), and Oral Health-Related Quality of Life (OHRQoL in children and adolescents, defining their strengths and weaknesses and to pinpoint research gaps to inform orthodontic practitioners, policy makers, and future research endeavours. Methods: The databases of PubMed, Cochrane, Embase, and Web of Science were searched from inception to January 2025. Epidemiological studies, controlled trials, and comparative studies involving subjects ≤18years old, using different tools to assess OTN, OTC, OTP, and OHRQoL were included. Three authors independently assessed study eligibility, extracted and analysed the data. Results: 15,898 articles were initially identified, from which 171 were finally included for analysis. For OTN, the Index of Orthodontic Treatment Need was the most frequently used, followed by the Dental Aesthetics Index. Both score occlusal traits and do not take into account other factors contributing to overall OTN. The Index of Complexity and Orthodontic Need was the third most used. Several OHRQoL questionnaires were retrieved, identifying Child Perception Questionnaire (CPQ) as most frequently used. Conclusions: A range of assessment tools were identified for OTN and OHRQoL. OTN indexes mainly rate dental malocclusion severity and don't consider patient-specific factors, such as patient perception. A tool assessing OTC that takes into account treatment-specific factors, required skills of the orthodontist, treatment time, and costs is required. Additionally, no tool was found to assess OTN, which is crucial for allocation of public healthcare resources and insurance coverage for orthodontic treatment.

In a context of increasing natural hazards due to climate change, forest insurance is a relevant tool to consider. However, the development of forest insurance schemes varies widely across countries, reflecting differences in forest characteristics, institutional frameworks, and public risk management policies. In this article, we investigate the drivers of this heterogeneity by comparing forest insurance schemes in two contrasting national contexts: France and China. While forest insurance coverage remains relatively limited in France, China has implemented large-scale insurance programs. By examining the design, governance, and role of government intervention in both schemes, we identify the key factors that help explain the differences in insurance uptake across countries. Finally, we discuss innovative insurance products and policy mechanisms that could encourage the adoption of forest insurance.

Background Child malnutrition remains a serious public health challenge in Pakistan. The national health insurance initiative, the Sehat Sahulat Program (SSP), aims to improve access to health care for low-income families. This study examines whether the effectiveness of SSP follows the Law of Diminishing Marginal Returns (LDMR), whereby the marginal health benefits of insurance are greatest for the poorest households and decline with increasing wealth. Methods We analyzed data on 4,499 children under 5 years of age in the Pakistan Demographic and Health Survey 2017–18. To address endogeneity and wealth-based heterogeneity, we employed an IV-Probit model and an IV-Quantile Regression (IV-QR) across wealth quintiles, using community-level internet access and distance to the nearest health facility as instrumental variables. Logistic regression was applied as a baseline model. Results Analysis reveals a strong gradient in the effectiveness of SSP program. Insurance coverage is associated with reduced stunting and marked declines in diarrhea rates among the poorest households. These benefits have diminished in the overall distribution of wealth and have become statistically insignificant for the richest quintile. Econometric tests have confirmed a clear pattern of declining marginal returns. Conclusion The Sehat Sahulat project is a very effective tool for reducing malnutrition among poor children in Pakistan. The observed pattern of diminishing returns suggests that SSP provides the greatest health benefits to the poorest households. These findings support a pro-poor targeting strategy in Pakistan to maximize the program’s impact within resource constraints.

Food and Drug Administration Expert Panel on Infant Formula "Operation Stork Speed" June 2025: Part 3, Marketing of Infant Formulas, Breastfeeding Support, Hypoallergenic Formulas, and Nutrition for Preterm Infants.