Building your future ICU in Asia Pacific: A structured regional priority-mapping summit report from the Asia Pacific Critical Care Societies Summit 2025.

Population Health, Right: A Framework for Core Services, Bounded Risk, and Strategic Partnerships for Health Systems.

Body size, cardiometabolic risk, and educational disparities in mortality among U.S. adults, 1988-2019.

Prospective Study of Multiparametric Renal MRI for CKD Progression (AFiRM).

Reflections since the formation of the American College of Epidemiology (ACE) ethics and policy committee, 2023-2025.

Developing a state-level structural cisheteropatriarchy legal index in the United States.

Political distrust and confidence in medical institutions in the United States: An institutional spillover perspective.

Educational inequalities are associated with distinct metabolomic and gut microbiome patterns in adults.

Eco-affective one health: A public health framework for climate, emotion, and systemic resilience.

Health technology assessment (HTA) processes are becoming increasingly established and embedded in healthcare decision making around the world. Yet, there is limited evidence on whether HTA processes at the system level offer value for money to those presiding over their creation, such as governments and ministries of health. That is, whether the value of improvements in the health system exceed the costs. To address this issue, we outline the approaches adopted in a sample of recent evaluations of HTA systems and propose a set of considerations for measuring and valuing HTAprocesses. The scale and remit of the process can help identify the relevant system-level impacts of HTA such as those on productive efficiency and population health, health equity, guiding innovation and care pathways, and broader impacts. We further describe the methodological challenges and potential approaches to evaluating HTA including the appropriateness of approaches. The considerations discussed can reveal the potential for ill-designed HTA processes to generate less social value than intended.

BackgroundPhysical functioning (PF) tests are scalable screening tools for neurodegenerative risk that differ by race and ethnicity, reflecting upstream social inequities. Prior work shows that PF relates to Alzheimer's disease blood biomarkers differentially by race and ethnicity, yet it is unclear if similar associations exist with structural brain outcomes (hyperintensities and brain volumes).ObjectiveThis study evaluated associations between PF and white matter hyperintensity volume (WMH), total brain volume (TBV), and hippocampal volume (HV) and assessed heterogeneity by race and ethnicity.MethodsCognitively normal non-Hispanic Black (n = 420), non-Hispanic white (n = 917), and Hispanic (n = 828) older adults (mean [SD] age = 64.7 [8.4]) from the Healthy Aging Brain Study-Health Disparities cohort completed the Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB). Brain imaging was collected via 3 T magnetic resonance imaging (MRI). Multivariable linear models related PF to brain imaging outcomes (normalized by intracranial volume) and assessed heterogeneity by race and ethnicity.ResultsBonferroni adjusted significant (p < 0.05) associations were observed between WMH and PF (TUG: β = 0.28, 95% CI = 0.17, 0.40; SPPB:β = -0.19, 95% CI = -0.32, -0.07), TBV and PF (TUG: β = -0.50, 95% CI = -0.61, -0.40; SPPB: β = 0.30, 95% CI = 0.18, 0.42), and HV and PF (TUG: β = -0.28, 95% CI = -0.38, -0.18). Associations were generally similar across race and ethnicity groups for TBV and HV.ConclusionsPoorer PF was associated with reduced TBV and HV and greater WMH. Results support PF tests as scalable, non-invasive indicators of brain health in community-based populations.

Many Americans are in a coverage gap and unable to obtain affordable health insurance-particularly in non-Medicaid expanded states-which is associated with less preventative care, worse health outcomes, and a reliance on emergency care. To evaluate whether navigating uninsured patients to community-based primary care clinics that provide integrated care reduces preventable emergency visits and associated costs. This retrospective study evaluated the volume and costs of emergency department (ED) and inpatient hospitalization for patients accessing community-based integrated primary care (BCC) located near hospital centers as compared with those receiving usual care (non-BCC). The BCC group included 16,069 patients, and a propensity score-matched control group included 16,069 non-BCC patients. Patients less than 18 years old, with documented mental health issues, or whose electronic health record data were incomplete were excluded from the study. ED and inpatient hospitalization (IP) visits and direct costs. Overall, the average per-person-year direct IP costs of BCC patients was 48% lower ( P <.001) and direct ED costs 43% lower ( P <.0001) than non-BCC patients. BCC patients had ∼44% fewer IP visits, and 29% fewer ED visits compared with non-BCC at 1-2 years of follow-up. BCC patients with diabetes related complications had 28% less IP costs and 27% less ED costs compared with non-BCC patients over 4 years ( P =.03, P =.01, respectively). This study supports the strategic navigation of uninsured patients from emergency departments and community settings to community-based primary care clinics offering integrated services, highlighting a promising population health approach.

Culturally and linguistically diverse (CALD) communities have unique strengths, needs, and health seeking behaviours reflecting their cultural background. Therefore, top-down population-level health promotion initiatives with externally imposed performance indicators are frequently ineffective in CALD contexts. Accordingly, the Healthy New Communities (HNC) program implements an equity-based bottom-up commissioning model aimed at addressing socio-cultural factors impacting health seeking behaviours with people from refugee and migrant backgrounds. In the first phase of a comprehensive evaluation of the HNC program commissioning model, stakeholders involved in the implementation of commissioned activities and programs shared their experiences with this innovative funding model pioneered by the Queensland Health Metro South Hospital and Health Services, Health Equity and Access Team. Their perspectives were gathered in focus groups and interviews and analysed using an inductive approach to thematic analysis. The findings demonstrate the effectiveness of the HNC program commissioning model in engaging CALD communities in health promotion initiatives. Flexibility, responsiveness, trust, relationships, shared commitments, and cultural representation facilitated community members' participation in the commissioned activities. The impacts of the HNC program commissioning approach extend beyond the adoption of healthy lifestyles and include positive social, emotional, cultural, and physical impacts across a range of life domains and the creation of employment, training, and career pathways. The HNC program demonstrates how socio-cultural determinants of health can be influenced by commissioning models that prioritise community engagement, relationships, co-design, and the culturally shaped health-seeking behaviours of CALD individuals, families, and communities in the funding, design, and implementation of health promotion initiatives. SO WHAT?: Phase one results are promising and lay the foundation for an in-depth investigation of the potential of equity-based commissioning models for improving health and wellbeing outcomes for CALD communities across Queensland and beyond.

Do somatic symptoms bias depression screening? Reliability and equivalence of PHQ-8 in those with and without chronic pain: A nationally representative study of U.S. adults.

Ethylene oxide (EtO) is a widely used industrial compound with known carcinogenic potential in humans. Due to its high reactivity and short biological half-life, occupational exposure assessments (> 1ppm) rely on the detection of stable biomarkers, such as N-(2-hydroxyethyl)-L-valine (HE-V), formed as hemoglobin adducts in blood. Existing analytical methods for HE-V detection often require large volumes of blood and purified hemoglobin due to limited sensitivity, restricting their application in characterizing the dose-response relationship between EtO exposure and HE-V accumulation-particularly at low environmental exposure levels relevant to assessing potential general population health risks. In this study, we aimed to characterize the molecular dosimetry of HE-V formation in B6C3F1 mice exposed by whole body inhalation to a broad range of concentrations of EtO: 0, 0.05, 0.1, 0.5, 1, 50, 100, and 200ppm, 7days/week for 4weeks. To achieve this, we developed a sensitive LC-MS-based workflow for HE-V quantification, incorporating hemoglobin purification, HE-V release plus enrichment, and targeted mass spectrometric detection from as little as 10μL of blood and 50μg of extracted hemoglobin. A clear, dose-dependent increase in HE-V levels was observed following EtO exposure, with statistically significant elevations detected even at 0.05ppm compared to endogenous background levels. At lower concentrations (0.5 to 1ppm), HE-V levels increased linearly with dose, while higher concentrations (50 to 200ppm) exhibited an upward-bending (increasing slope) dose response. No sex-specific differences were observed. Taken together, these findings indicate EtO exhibits linear systemic toxicokinetics at lower exposures that transition to nonlinear toxicokinetics in the range of higher exposures (likely due to saturation of glutathione-mediated detoxification), thus providing new quantitative insights to support improved risk assessments and toxicological evaluations of EtO exposure.

Population health equity provisions in impact assessment: Legal mapping of federal, provincial, and territorial frameworks in Canada

This narrative and conceptual review examines the interface between implementation science and health policy research. Drawing on literature from both disciplines, we analyze key areas of convergence and divergence, explore how these distinctions contribute to the persistent ‘know-do gap,’ and discuss opportunities for integrated approaches connecting micro-level implementation processes with macro-level policy dynamics, with particular attention to LMICs. Implementation science and health policy research have evolved largely in parallel, despite sharing a common objective: improving population health by translating knowledge into action. Implementation science focuses on integrating evidence-based interventions into real-world settings, while policy research examines how policies are formulated, adopted, and sustained within complex political systems. This disciplinary separation has contributed to a persistent “know–do gap,” particularly in low-and middle-income countries (LMICs), where fragmented health systems, political economy constraints, and donor influence shape both policy trajectories and implementation realities. The disconnect between researchers and policymakers often stems from differing timing, priorities, and even language. Researchers may not address the immediate concerns of policymakers, and scientific evidence alone seldom drives policy changes. In LMICs, this divide is exacerbated by political cycles, vested interests, and the significant influence of international donors. In this review, we argue that bridging implementation science and policy research is not merely desirable but necessary. We examine how differences in scope, actors, settings, and theoretical frameworks have reinforced this divide, and we propose the development of integrated, hybrid approaches that connect micro-level implementation processes with macro-level policy dynamics. Bridging the gap between implementation research and policy change necessitates a context-sensitive approach that acknowledges the complexities of political, economic, and social systems, particularly in LMICs. By leveraging multi-level frameworks, engaging stakeholders, and fostering continuous learning, it is possible to enhance the translation of research into effective, sustainable health policies.

SWAP IT is a school-based nutrition programme that promotes healthier lunchbox choices for children in Australia. As part of the programme scale-up, ensuring that implementation responds to the social and cultural determinants that shape food and nutrition practices for Aboriginal and Torres Strait Islander communities is important for equitable impact. To inform the cultural adaptation of SWAP IT, this study aimed to explore the experiences and perspectives of Aboriginal school staff regarding the implementation of SWAP IT in schools with high Aboriginal and/or Torres Strait Islander enrolments. An exploratory qualitative study was conducted within the Hunter New England (HNE) region of NSW Australia-a large and geographically diverse area (132 000 km2) and one of 15 Local Health Districts in NSW. The study was led by an Aboriginal Program Manager from the Population Health Unit of HNE Local Health District, with further cultural oversight provided by programme governance groups. Grounded in Indigenous methodology, data were collected using yarning (an Aboriginal communication method and data collection tool) through individual and group yarns with 11 staff from seven SWAP IT schools. Data were analysed using Thematic Analysis and group yarns to inductively identify and refine key themes. Eight themes were identified. Four themes captured participants' direct experiences and perspectives of SWAP IT, including positive perceptions of its value (1A), and opportunities to strengthen cultural responsiveness in programme processes (1B), resources and content (1C) and distribution methods (1D). A second set of four themes reflected broader contextual considerations that emerged through the yarns and were seen to influence implementation, including preferences for culturally responsive materials and methods (2A), food access and insecurity as a significant challenge (2B), potential barriers to family engagement (2C) and sustainability concerns (2D). Incorporating surface level adaptations (e.g., Aboriginal artwork) and deep-level adaptations (e.g., cultural food practices) will enhance the programme's cultural responsivity for equitable delivery. Additional implementation strategies that account for the broader considerations may maximise impact for Aboriginal children and communities. Co-designing and piloting an adapted programme with Aboriginal communities is a critical next step. SO WHAT?: These findings highlight opportunities to strengthen cultural responsivity in programme design and delivery to better support Aboriginal and Torres Strait Islander communities.

Sociodemographic Status and Interest in Public Health Work After Medical Training in First-Year Medical Students: A Cross-Sectional Study.

The global prevalence of obesity has more than doubled between 1990 and 2022, making it a significant public health concern. Obesity is associated with an increased risk of various complications, including cardiovascular diseases, type 2 diabetes, as well as increased risk for all-cause mortality. Existing research also indicates that higher BMI is linked to increased healthcare costs, but most evidence comes from cross-sectional studies and older populations. The present study aims to estimate the direct healthcare cost of obesity from late adolescence through mid-adulthood. The study included a national cohort of 496 404 conscripts for mandatory military service that underwent medical evaluation at age 17. Study participants were retrospectively followed for hospitalization days and total healthcare costs at ages 35, 45 and 55 using data from a large national healthcare provider. Direct medical costs were standardized using gross domestic product (GDP) inflation rates and purchasing power parity. Analyses were adjusted for sex and socioeconomic status. Higher BMI categories in adolescence were associated with increased hospitalization rates and total healthcare costs across all follow-up ages. At age 45, individuals with obesity class I and class II/III had 1.65-fold and 1.62-fold higher costs, respectively, compared to those with normal BMI. This association was stronger among males. The correlation between obesity in adolescence and higher medical costs is evident already in early-and-mid-adulthood. The study underscores the need for comprehensive approaches targeting adolescents to reduce long-term healthcare costs and improve population health outcomes.