BACKGROUNDPublic Health Intelligence (PHI) aims to detect health threats early for a timely and effective response. The PHI team at the Robert Koch Institute (RKI) uses the Epidemic Intelligence from Open Sources (EIOS) system in combination with other sources for detecting signals of international public health threats relevant to Germany. However, while EIOS is increasingly used for PHI worldwide, it is rarely evaluated.AIMWe designed and conducted an attribute-based evaluation to assess EIOS's performance for international PHI in 2023 and to identify areas for improvement.METHODSWe adapted surveillance system attributes and designed attribute-specific data collection methods. We conducted a mixed-method evaluation combining prospective and retrospective operational data collection with feedback from PHI officers.RESULTSDuring 2 weeks in July 2023, the PHI team reported 20 signals: 16 detected using EIOS and four from other sources. Increasing the number of EIOS sources increased timeliness and sensitivity slightly but caused a 35-fold increase in articles to screen (35,546 vs 1,138). The team found EIOS flexible and simple for signal detection but identified challenges in simplicity of signal documenting and reporting and in completeness of EIOS sources screened by the team.CONCLUSIONThe current use of EIOS proved sensitive and timely. However, PHI must balance sensitivity, timeliness and resource requirements. To maintain this balance, we strongly recommend regular evaluations of the use of EIOS for PHI. Our evaluation offers practical guidance for other PHI teams. We recommend integrating EIOS with an event management system to facilitate signal documentation and reporting.

Recent outbreaks of the Zika virus (ZIKV) worldwide have underscored its growing epidemiological significance, leading to its recognition as an international health concern. The steady annual rise in ZIKV cases has transformed it into a major challenge for global public health systems. Despite ongoing efforts, the development of effective therapeutic agents against the virus remains difficult. Among the promising avenues for treatment are natural products, particularly those derived from medicinal and aromatic plants. These substances act as reservoirs of beneficial chemical compounds that can contribute to developing effective therapies. This work used computer methods to examine 26 bioactive molecules derived from plants as potential Zika inhibitors. Baicalin, epicatechin gallate, epigallocatechin gallate, isoquercetin, and sophoroflavenone are plant-derived bioactive molecules that have demonstrated significant stability at the active site of the receptor examined (PDB code: 5TFR). They provided intense binding energies and were also stabilized at the active site of the target receptor by standard hydrogen bonds. These results were validated by molecular dynamics simulation at 500ns. The molecules chosen to meet essential therapeutic criteria, such as those of Lipinski, have good ADMET characteristics and are not toxic. As a result, they have excellent pharmacokinetic properties and appreciable bioavailability. The findings of this research strongly suggest that these five molecules could be potential inhibitors of anti-Zika action in the future.

To document the development and implementation of a WHO Framework Convention on Tobacco Control (FCTC)-guided law in Ethiopia. We analyzed 15 publicly available documents including news articles and government documents. We triangulated findings by interviewing three tobacco control advocates, two academic researchers, and four government officials. We used a thematic framework analysis to analyze the data and documented this through a retrospective policy analysis. Local and international health advocacy groups supported regulation development through capacity building workshops. The National Tobacco Enterprise/Japan Tobacco International used standard industry arguments to weaken draft regulations but government officials, supported by health advocacy messages promoting Ethiopia's WHO FCTC obligations, rejected these arguments. Key barriers to implementation included industry interference, lack of funding and resources, monitoring and evaluation system issues, government system coordination issues, and a lack in organizational knowledge. Key facilitators included financial mechanisms and health advocacy support and government and inter-governmental support which contributed to increased monitoring, education efforts, and technical support. The tobacco industry remains the biggest barrier to FCTC implementation continuing to advertise at the point-of-sale, fuel illicit tobacco trade, and push the sale of single cigarette sticks near schools. Other barriers include a shortage of funding/resources, a lack of strict enforcement, and an absence of local regulations. Financial and technical support and leveraging the FCTC as a legal instrument can help uphold strong regulations. More efforts are needed to educate government authorities and establish local regulations to protect policy implementation.

Anesthesia is increasingly acknowledged as a neglected priority in global health, and pediatric anesthesia is especially important due to the high proportion of children in the least developed countries with a large unmet burden of surgical disease. Pediatric anesthesiologists involved in global health may encounter several common "error traps" that could either lead to missed opportunities to build on recent advancements in global anesthesia or potentially cause harm. We present a number of these "traps" based on the literature and our experience from both sides of global health partnerships in East and Southern Africa, India, and the Caribbean. These error traps include failing to appreciate the public health "big picture"; failing to consider a health-systems approach, prioritizing quantity-based outcomes at the expense of quality, having priorities driven by partners in the "Global North"; failing to make programs sustainable, failing to invest in the retention of anesthesia providers, not realizing that not all global health is international health, and unethical practices. Our goal is to spark debate on ongoing controversies and to inform pediatric anesthesiologists who are working or considering a career in this field.

Sustainable value generation from digital health investments: lessons from EU-funded projects preceding the European health data space.

Traditional medicine is increasingly promoted worldwide as a tool to achieve universal access to healthcare. Herbal medicines have formed the basis of healthcare throughout the world and are still widely used, playing a major role in the international health market. However, several factors influence the potential quality of phytotherapy. The diversity of herbal medicines, their various uses and preparation methods, the pluralism in access to these treatments, and the variability in the chemical composition of raw materials depending on their environment are all critical elements. This study compares the regulatory frameworks and quality control practices for plant-based health products in six countries: Benin, Burkina Faso, Guinea, Mali, Peru and France. It also provides an overview of the market in these countries. To do so, we compiled and highlighted key information from WHO guidelines, national legal documents, public databases on product registration and markets, and conducted interviews with health organisation experts. The main findings indicate that West African countries face challenges related to regulatory enforcement and limited industrial and research capacity. In contrast, Peru experienced an initial surge in production following regulation in 1997 and gained international recognition for Amazonian plants, but saw a decline after the 2009 U.S.-Peru Free Trade Agreement due to more stringent standards. France, while notable for its pharmacopoeia, struggles to implement quality control given the high volume of dietary supplements available. Based on these comparative insights, the paper recommends a multidimensional approach: promoting stakeholder training in good practices, developing robust pharmacopoeias, facilitating dialogue between traditional and allopathic medicines, and building shared infrastructures for research and quality control. These strategies, informed by successful practices across countries, aim to support the safe and equitable development of herbal health products worldwide.

From recruitment to retention of young doctors: A comparative analysis of policies in Poland and the United Kingdom.

Health Performance in North America: An International Comparative Review of Canada and the USA with Implications for Women's Health Equity.

In recent years, the international health discourse has increasingly focused on achieving universal health coverage (UHC) through the provision of health insurance. Low- and middle-income countries (LMICs), such as Zambia, have adopted national health insurance schemes to improve health service delivery among their citizens. This study explored the role of Zambia's National Health Insurance Scheme (NHIS) in strengthening the delivery of health services to the elderly at the district level in Zambia. The study employed a qualitative case approach, and purposive sampling was used to select 22 participants for in-depth and key informant interviews. These included 14 elderly NHIS members, 6 staff members from health insurance facilities, and 2 NHIMA provincial office managers. The data was analysed using a thematic analysis approach. This was achieved by identifying patterns in service delivery and user experiences in accessing health services. The study findings revealed that the National Health Insurance Scheme (NHIS) has improved healthcare access for the elderly by offering affordable and increasing utilisation of services through accrediting facilities and reducing financial risks. Outreach efforts have helped register elderly members directly from their homes. However, challenges remain, including medication shortages, inadequate healthcare providers, long-distance travel, and system inefficiencies. The strategies to address the challenges include the government increasing medical subsidies, improving monitoring of the NHIS fund, policy reform to enhance equitable elderly care, and health infrastructure expansion. While NHIS might have enhanced health service access among the elderly, service-related gaps still hinder its optimal effect. The challenges include limited health facility accreditation, shortages of medicines, and weak governance. Overcoming the barriers requires ethical NHIS reforms that promote better accreditation of healthcare, increased funding for improved infrastructure, and universal availability of medical services.

Perimenopause is the time leading up to a woman's last menstrual cycle and includes the 12 months afterward. Studies that systematically compare perimenopause symptoms across diverse cultural and geographic settings are lacking. This study, utilizing data from Flo, an international mobile health application, aimed to assess global knowledge and symptom experiences related to perimenopause. This cross-sectional survey was conducted via the Flo application, offered to users aged 18 years and above. The primary endpoints were knowledge of perimenopause symptoms from all survey participants, and self-reported perimenopause symptoms for survey participants aged 35 years and above. Secondary analyses compared knowledge scores and symptoms across geographic regions. A total of 17,494 women from 158 countries were included. Commonly recognized perimenopause symptoms included hot flashes (71%), sleep problems (68%), and weight gain (65%). Of the participants, 12,681 were aged 35 years or above, with the most common self-reported symptoms being fatigue (83%), physical and mental exhaustion (83%), irritability (80%), depressive mood (77%), sleep problems (76%), digestive issues (76%), and anxiety (75%). This pattern of symptoms was similar among those who self-reported being in perimenopause, though higher than in those not in perimenopause. International variation in perimenopause symptom knowledge and symptoms experienced was noted (P<0.001). This survey highlights a discordance between perimenopause knowledge and actual symptoms experienced across diverse global populations. While hot flashes were the most widely recognized symptom, respondents aged 35 years or above most commonly reported experiencing fatigue, physical and mental exhaustion, and irritability.

The rapid increase in the number of Chinese international students in English–medium instruction programs in Southeast Asia has raised concerns about their psychological well-being. Despite growing scholarly attention to international student mental health, a comprehensive, region-specific synthesis for Southeast Asia remains lacking. This review examined empirical studies published between 2015 and 2025 on psychological outcomes, acculturative stress, and well-being among Chinese students in Southeast Asian higher education. Drawing on Berry’s acculturation theory and Lazarus and Folkman’s coping framework, this review identified recurring stressors, including English communication anxiety, localized challenges in English comprehension, heavy academic workloads, and cultural expectations related to religion, food, and gender norms. Protective factors such as social and family support, resilience, and self-efficacy reduce stress, whereas avoidance coping intensifies it. Methodological limitations included reliance on cross-sectional surveys, inconsistent adaptation of measurement instruments, and limited theoretical integration.

Surgical site infections (SSIs) remain one of the most significant challenges in modern medicine, representing a major cause of patient morbidity, prolonged hospitalization, and increased healthcare costs in medical institutions. This issue deserves particular attention due to the possibility of preventing adverse outcomes through the implementation of standardized, evidence-based preventive measures approved by international health authorities. This narrative review examines recommendations aimed at reducing the incidence of SSIs based on publications indexed in major scientific databases, along with guidelines issued by the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), and the National Institute for Health and Care Excellence (NICE). The article focuses on perioperative recommendations, categorized as preoperative, intraoperative, and postoperative, while considering both the strength of evidence and areas of consistency or divergence among these guidelines. Researchers worldwide generally agree on the most essential preventive strategies, including proper timing of antimicrobial prophylaxis, the use of chlorhexidine-based antiseptics, maintenance of normothermia and glycemic control, and avoidance of unnecessary hair removal. However, differences persist in certain preventive components, such as the use of advanced wound dressings, intraoperative oxygen supplementation, and mechanical barriers, highlighting the need for further discussion and harmonization of global standards. The review emphasizes the importance of implementing these guidelines in clinical practice and identifies unresolved issues requiring additional research. Strengthening education among healthcare professionals and ensuring adherence to correct perioperative practices under expert supervision will undoubtedly contribute to improved surgical outcomes and reduced infection-related complications worldwide.

Objectives: The study aims to assess the strategies used to estimate antimicrobial consumption (AMC) and the barriers encountered in data collection. It also addresses the perception about AMC based on the World Health Organization (WHO) definition. Methodology: The qualitative study adhered to the standard consolidated criteria for reporting qualitative studies (COREQ) guidelines. It involved stakeholders from diverse sectors, i.e., regulatory bodies, the pharmaceutical industry, international health organizations, policy experts, medical professionals, veterinary doctors, and academia (nursing, medicine, and pharmacy). A total of 37 in-depth interviews were conducted using a semi-structured interview schema. The interviews were recorded and transcribed verbatim. Codes were generated afterward and organized into themes. Results: Data analysis yielded five themes consisting of (i) Perception about Antimicrobial Consumption, AWaRe (Access, Watch, Reserve) classification and related terms, (ii) Antimicrobial Consumption: Policy Design, (iii) Data management and record keeping for the Estimation of Antimicrobial Consumption, (iv) Levels of Estimation for Antimicrobial consumption and Organizations, and (v) Challenges and suggested solutions in estimation of AMC: One health approach is the way forward. Conclusions: The study concluded that AMC and AMR are two sides of the same coin. The solution to AMR and excessive AMC is to re-evaluate the policy and implement legislation strictly. Efforts focused on irrational prescribing and unsupervised OTC sales of antimicrobials. This will help in reducing the consumption of broad-spectrum antimicrobials.

There have been notable improvements in patient safety in recent years; however, significant challenges remain in reducing the incidence of preventable patient harm. Supporting patient safety efforts is increasingly important given increasing complexity of care and changing health needs, especially with aging populations. Emerging technologies and capabilities open new possibilities to address longstanding patient safety problems. For example, predictive analytics to support provider decision-making, increased patient interest in engagement in their care, and artificial intelligence provide opportunities to further reduce harm. Many of these examples support a more proactive approach to patient safety by focusing on anticipating, predicting, and preventing patient harm; however, implementation is essential to avoid unintended consequences. Additionally, health care organizations oftentimes cannot accomplish this work on their own and strategic partnerships are crucial for continued improvement. This paper proposes a strategic focus for health care leaders as they build comprehensive plans to prevent harm from adverse events. Drawing on international case examples from the Future of Health Community, it outlines actionable approaches to partnerships that can be adapted and implemented across diverse health care organizations.

BackgroundGlobal Burden of Disease (GBD) estimates are widely used for international health comparisons, but their validity in high-data settings remains debated. Gastric cancer provides a critical case, given its high incidence in East Asia and the availability of robust national screening and mortality data.MethodsWe compared estimates from the Korean National Burden of Disease (KNBD) study and the GBD for gastric cancer between 2008 and 2018. We additionally examined Japan, another country with nationwide gastric cancer screening and high-quality mortality reporting, to assess whether similar patterns emerged.ResultsKNBD reported declines in years of life lost (YLLs), reflected in the decreasing YLL share of disability-adjusted life years (DALYs), alongside substantial increases in years lived with disability (YLDs), underscoring survivorship-related disability. By contrast, GBD Korea showed a decrease in YLL but virtually no change in YLD. In Japan, where mortality has also declined substantially through national screening programs, GBD nevertheless reported negligible changes in YLL and YLD shares of total DALYs. Although a Japanese national DALY study is not available for direct comparison, these similar patterns across GBD Korea and GBD Japan raise concerns about the capacity of GBD methods to adequately capture survivorship in high-data countries.ConclusionOur findings demonstrate that the same disease can generate fundamentally different burden-of-disease narratives depending on the metric framework applied. In Korea, national data highlight survivorship-related disability that is effectively absent in GBD estimates; in Japan, GBD may similarly downplays disability despite declining mortality. Policymakers may consider national burden-of-disease estimates as more appropriate for local planning, while global models could be strengthened by integrating high-quality country-level data to better reflect survivors’ burdens.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13690-025-01801-2.

The Democratic Republic of the Congo (DRC) conducted a national self-assessment of the 2005 International Health Regulations (IHR) core capacities using the revised 2021 electronic State Party Self-Assessment Annual Reporting tool. Held in March 2022, the hybrid workshop involved multisectoral stakeholders and evaluated 15 core capacities. The average national score was 36%, indicating limited capacity to implement IHR and the 2019 National Action Plan for Health Security. Four capacities, including points of entry and radiation emergencies, showed no capacity, while 10 were classified as limited. Only the IHR coordination reached the developed capacity level. Key weaknesses were identified in emergency operations, laboratory systems and legal preparedness. Strengths included One Health integration and risk communication efforts. These findings underscore the urgent need to improve multisectoral coordination, operational readiness and infrastructure investment to meet IHR requirements and better respond to public health threats. Strategic recommendations were proposed to guide national and international support.

Community-based approaches have proven effective in improving early access to diagnosis for Chagas disease (CD). This study aimed to assess whether such strategies could reduce the number of patients lost to follow-up and contribute to the detection of concomitant Strongyloides stercoralis infection. The intervention was implemented at the Consulate General of Bolivia in Barcelona and began with awareness-raising activities about CD. The Public Health and Community team (eSPiC) subsequently offered on-site serological screening for CD, as well as diagnostic confirmation, antiparasitic treatment, and follow-up at the Drassanes-Vall d'Hebron International Health Unit (USIDVH). Of the 325 participants, 96.3% were adults of Bolivian origin residing in Catalonia, Spain. The mean age was 43 years, and 64.3% were women. Forty-two participants (13.5%) tested positive for CD and received a follow-up appointment. Of these, 22 (52%) attended the consultation; 10 (45.5%) completed antiparasitic treatment; 4 (18.2%) had been previously treated; 2 (9.1%) were not treated due to medical decision; and 6 (27.3%) were lost to follow-up. This study suggests that community-based follow-up strategies are advisable, particularly among middle-aged women with primary or secondary education. They facilitate a comprehensive continuum of care-from on-site screening to treatment adherence-which is essential for achieving the Chagas disease targets of the World Health Organization's Road Map for Neglected Tropical Diseases by 2030.

The growing international mental health care burden highlights the urgent need for scalable, effective, and affordable therapeutic alternatives. While conventional psychotherapy is constrained by scope and personalization, digital therapeutics promise to be a better option. This paper introduces a new personalized digital therapy platform based on artificial intelligence (AI) and machine learning to provide customized, evidence-based treatment for mental health. The platform employs a multi-modal strategy, processing user-reported information, in-app behavior patterns, and embedded biofeedback, to dynamically change therapeutic material, exercises, and support features. A 150-participant randomized controlled trial was performed to evaluate the effectiveness of the platform compared with routine care. Outcomes revealed statistically significant depressive and anxiety symptom reduction, with a significantly greater level of patient engagement and compliance with the control group. These results validate the platform's ability to provide effective and highly tailored care. The success of the platform illustrates a viable mechanism for bridging barriers to conventional therapy, improving patient outcomes, and expanding access to mental health care. Future research will involve the integration of virtual reality elements to enhance the therapeutic experience even further.

In response to growing uncertainty in global health driven by geopolitical tensions, pandemics, and climate-related challenges, global health education must evolve to equip students with theoretical knowledge and core competencies, such as leadership, cross-cultural communication, and strategic thinking. This study reviews the updates to the International Health Project Management (IHPM) course and examines its three key changes: introducing a student-oriented teaching module, incorporating teamwork and role-play to promote autonomy and accountability; expanding geographic flexibility to encourage broader strategic thinking; and strengthening team dynamics through clearer role definitions and targeted support mechanisms. Students formed project teams, established internal regulations, and selected global health scenarios for project design. This revised approach fostered in-depth discussions that encouraged open-minded thinking, enabling students to move beyond disease-focused content to strategic systemic considerations. Greater group ownership also improved collaboration and accountability, addressing common teamwork challenges such as role confusion and uneven participation. However, the analytical depth varied depending on students' disciplinary backgrounds. Finally, we argue that a tiered curriculum that moves from theory to competency building can better support student growth. Overall, these findings highlight the potential of student-oriented approaches to strengthen leadership, cross-cultural communication, and strategic thinking, competencies essential for contributing to a shared future for global health.

Introduction: Between 2020 and 2025, Cuba experienced a profound healthcare collapse, exposing structural weaknesses in a system long praised for universal coverage. Economic decline, political constraints, and institutional limitations hindered service delivery, leading to shortages of essential supplies and personnel.Objective: To examine the main factors driving the deterioration of Cuba’s healthcare workforce and assess the resulting public health consequences, including maternal and child health, resurgence of preventable diseases, and urban–rural disparities.Methods: A review of secondary sources, including official Cuban statistics, international health reports, and independent media, was conducted to analyze trends in physician migration, workforce shortages, resource limitations, and health outcomes.Results: Low salaries, restrictive policies, and supply shortages triggered a large-scale exodus of physicians and healthcare professionals. Consequences include rising maternal and infant mortality, outbreaks of preventable diseases such as measles and dengue, and widening urban–rural health disparities. Cuba’s diminished capacity has also weakened its role in global health diplomacy, threatening regional health security.Conclusions: Without urgent economic, institutional, and policy reforms, Cuba’s healthcare system risks irreversible deterioration. Immediate measures are needed to retain healthcare professionals, ensure adequate resources, and maintain domestic and international public health standards.