Report of a one-day convening on regulatory science, practices, and innovative approaches to facilitate approval of novel combination vaccines.

Antibody responses to SARS-CoV-2 vaccine in nursing home residents support a Bi-annual update schedule.

Purpose This study examined the effect of health expenditure on income inequality in sub-Saharan Africa (SSA) using data for 30 SSA countries covering the period 2007 to 2022. Design/methodology/approach The study employed the fixed effect estimator with Driscoll and Kraay standard errors. A sensitivity analysis was conducted involving an estimation for the aggregate sample and a sub-sample of low-income and middle income countries. Three measures of health expenditure such as out of pocket health expenditure, private health expenditure and public health expenditure were considered. Findings The results showed that out of pocket expenditure and private health expenditure significantly increased income inequality while public health expenditure had a significant reduction effect. The results are consistent for both the aggregate sample and the sub-sample of middle-income countries. It was also similar to the results for the case of low-income countries except for the effect of out of pocket expenditure which was not significant. Originality/value This study considered three measures of health expenditure in order to determine their differential effect. This study accounted for possible heterogeneity by considering the sensitivity of the samples used. It therefore established the case for low- and middle-income countries separately.

ABSTRACT The COVID-19 pandemic has precipitated profound socioeconomic and public health ramifications globally. Wastewater-based epidemiology has been increasingly utilized for the surveillance and mitigation of COVID-19 outbreaks and transmission. The implementation of wastewater surveillance methodologies at a small scale has demonstrated considerable cost-effectiveness as an alternative to individual clinical testing, particularly in high-density environments such as academic institutions. Wastewater surveillance necessitates the acquisition and analysis of complex spatiotemporal data, requiring sophisticated interpretation and integration with complementary epidemiological parameters to effectively inform intervention strategies. The systematic management and analysis of these multivariate datasets present formidable logistical and computational challenges for timely decision making. This investigation advances geospatial science through a novel web-based spatial decision support system (SDSS) framework to resolve these challenges. This study encompasses the main campus of the University of North Carolina at Charlotte, where we implemented a spatiotemporal data model that revolutionizes management of multidimensional space-time data of wastewater surveillance. We employ advanced spatiotemporal analysis incorporating innovative cluster detection algorithms and uncertainty quantification to elucidate latent spatio-temporal patterns of SARS-CoV-2 virus abundance, which conventional approaches consistently fail to detect. This investigation conclusively demonstrates the superiority of integrated space-time cluster pattern analysis from both wastewater surveillance and clinical test results, quantifying their differential robustness when subjected to spatiotemporal uncertainties. The SDSS framework developed here represents a breakthrough in automated management, analytics, and dissemination of spatiotemporal wastewater epidemiological data. Our framework delivers transformative capabilities for informing evidence-based prevention strategies and establishing targeted intervention protocols for COVID-19 outbreaks within complex institutional environments.

Preconception health (PCH) is a globally accepted strategy to reduce preventable adverse pregnancy outcomes and ultimately improve the health of the unborn child. Optimal PCH can be achieved through preconception care (PCC), which encompasses the behavioural, biomedical, and social interventions women and couples undertake and/or receive before conception. However, there is a lack of clarity on various aspects of PCH and PCC, such as what constitutes preconception risk factors, what the optimal interventions are, when the preconception period is, and who the overall target population is. Additionally, marginalised groups such as sexual and racial or ethnic minority individuals are routinely excluded from PCH research and PCC interventions. PCH and PCC are topical issues given changing societal norms worldwide, such as delayed childbirth, exponential rises in fertility treatments, and the growing trend of unplanned pregnancies. We hypothesised that the ambiguity surrounding the definition of PCH and PCC may limit their understanding and application to improve pregnancy and childhood outcomes. This is a systematic review of existing definitions of PCH and PCC to understand the commonalities and disparities in definitions and critical components of PCH and PCC, to aid in the development of a comprehensive and globally standardised definition. MEDLINE, PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar, PsychINFO, and Google were searched to identify published studies, guidelines, and public health websites containing definitions of PCH and PCC published between January 1993 and October 2024. No restrictions were placed on language. We searched academic databases, organisational reports, and policy documents to capture the full range of definitions across clinical, health, and policy contexts. The narrative synthesis of 176 publications showed heterogeneity in the definitions of PCH and PCC. The themes developed from the thematic analysis showed that PCC is preventative care which identifies and utilises interventions to manage individuals' preconception risk factors and aims to improve pregnancy outcomes by optimising the short- and long-term health of potential parents and their children. The analysis also showed that PCH is relevant across the entire reproductive lifespan. PCC was described as a continuum of care that occurs before conception and encompasses the health of all potential parents, not just women. This systematic review found there is a lack of universality in the definitions of PCH and PCC. Current definitions often narrowly focus on women planning pregnancy, which may exclude important demographics such as unintended pregnancies and fathers, and aligned health needs such as contraception in the preconception period. We propose that there is a need for a definition that captures various demographics and emphasises a life-course approach to reproductive health, acknowledging that the preconception period is much wider than only the period in which couples are actively trying to conceive. Congruence between policymakers, researchers, and public health professionals on the definition of PCH and PCC may address research operationalisation and clinical implementation to better assess global uptake and impact. CRD42023480536.

High-Consequence Infectious Diseases at Mayo Clinic: A Collaborative Approach to Readiness.

SUMMARYChronic diseases, defined as conditions that persist for 1 or more years and require ongoing medical attention or impede daily life, represent an urgent public health challenge in the United States. In the last decade, fungal infections have garnered increased attention from public health officials and the media owing to the rapid and global rise of severe and antifungal-resistant infections. It is well-established that certain chronic diseases can increase the risk of invasive fungal infections. However, the inverse relationship-how fungal infections contribute to the development or exacerbation of chronic diseases-is less well studied. In this review, we summarize the current literature on the role of fungal infections in the development of chronic diseases, discussing pathophysiologic mechanisms and examining how chronic conditions can arise from the direct effects and sequelae of fungal infections. In addition, we discuss how the toxic effects of antifungal therapies can also contribute to the development of chronic disease states. Overall, our review highlights the significant yet underexplored role of fungal infections in the burden of chronic disease and emphasizes the need for further research, improved surveillance, increased public and healthcare awareness, and better access to diagnostics and treatments to address this issue.

The mental health treatment gap is an important issue for young people in the East Mediterranean Region as financial constraints and cultural factors continue to play a limiting role. This paper examined predictors and barriers for help-seeking for mental health problems in children and adolescents in Lebanon. The Psychopathology in Children and Adolescents in Lebanon Study, a nationally-representative household sample of n = 1,517 youth aged 5-17 years, was used. Parents and adolescents completed several self-reported mental health questionnaires, and a demographic information sheet. Potential barriers to care utilization assessed included: (i) discomfort in discussing mental health, (ii) stigmatization, (iii) distrust in effectiveness of mental healthcare, (iv) costs, (v) unavailability of nearby services. Regression models were conducted to examine the correlates of help-seeking for psychiatric disorders. Of the n = 498 youth with a positive screen for a psychiatric disorder, only n = 25 (5.0%) reported ever receiving professional mental healthcare services. Male gender, receiving school accommodation, higher parent-reported hyperactivity and depression were associated with help-seeking after adjustment for other variables. For children with a positive screen who had not sought help, the most often endorsed barriers were costs (22.3% major barrier) and unavailability of nearby services (16.1% major barrier). This study showed that costs and unavailability of nearby services were the biggest barriers to help-seeking among children and adolescents in Lebanon, underscoring the importance of incorporating mental health in public health policies and budget allocation in the East Mediterranean Region.

Despite the current recommendation of human papillomavirus (HPV) vaccination for girls and boys, vaccination rates in Germany remain low. Vaccination awareness is essential for vaccination behaviour and thus for an increase in vaccination rates. The aims of the present work were to investigate HPV vaccination awareness among the general population in Germany and to identify potential factors (sociodemographic, family and relationship characteristics, regional context) associated with HPV vaccination awareness. The results will help to conceptualize, manage, optimize and evaluate measures of public health. As part of the LIEBESLEBEN study, population-wide data were collected via an online survey (n = 4640). Data were weighted according to criteria representative for Germany. Bivariate analyses and multivariate logistic regression models were calculated. In total, 61.5% of respondents are aware of HPV vaccination for girls and 32.6% are aware of HPV vaccination for boys. The results of regression analyses show that the awareness of HPV vaccination for girls and boys is significantly associated with gender, formal education level, sexual orientation and living with children. The awareness of HPV vaccination for girls is additionally associated with relationship status and the degree of regional deprivation. In addition, HPV vaccination awareness for boys is associated with age. In Germany, HPV vaccination awareness is still modest. This is particularly true in terms of vaccination for boys. Measures to raise awareness should be intensified. These include communication and informational offerings, settings-based approaches to address target groups as well as involving (medical) professionals, and supporting ahealthcare structure that promotes vaccination.

Climate change is threatening respiratory health in Southeast Asia. This review aims to synthesize existing evidence on the effects of climate change on respiratory diseases specifically in the region. A systematic review where PubMed, Scopus, and Google Scholar were searched identified 22 relevant studies published within the past five years and analyzed per PRISMA guideline. There was a clear association between the climate factors such as air pollution, rising temperatures, humidity, and extreme weather, with respiratory health outcomes. There was increased vulnerability for groups such as children, elderly, low-income communities and outdoor workers, highlighting inequities in exposure to clean air. There was generally little evidence of gender disparity, though some contexts showed minor differences. Most studies conducted were from Vietnam, Singapore and Indonesia. Research in other Southeast Asian countries such as Brunei, Myanmar and the Philippines remains sparse. Climate change has a significant association with increasing respiratory disease incidence in Southeast Asia, and the most vulnerable communities are at risk. These impacts are further complicated by uneven research distribution and limited access to healthcare. Urgent climate-resilient health policies, as well as regional collaboration in addressing these challenges, are crucial to help build long-term public health resilience.

Childhood obesity is a global public health issue with strong familial and intergenerational transmission. However, existing syntheses often overlook the active role of parents and fail to assess outcomes beyond the child. This systematic review and meta-analysis specifically investigate the effects of family-based interventions, which position parents as active co-agents of change, on health outcomes for both children with obesity and their parents. A systematic review and meta-analysis were conducted. Six databases were searched for randomized controlled trials (RCTs) targeting children with obesity and at least one family member. Primary outcomes were children's BMI z-score and parental BMI; secondary outcomes included other adiposity measures and dietary behaviors. Outcomes for both children and parents were synthesized. Subgroup analyses were conducted based on intervention characteristics. Risk of bias was assessed using RoB 2, and evidence certainty was evaluated using GRADE. Twenty RCTs with 1740 participants were included in the meta-analysis. The interventions demonstrated a significant reduction in children's BMI z-score. Additional benefits were observed for long-term BMI z-score and percentage of total body fat. The most effective interventions commonly integrate health education, behavioral strategies, and motivational support. Subgroup analyses indicated that interventions positioning parents as active co-participants, rather than mere supporters, yielded larger effects. However, no significant effects were found on parental BMI. This study demonstrates that family-based interventions can confer significant benefits for children with obesity. Their success hinges on strategically framing parents as active co-agents and integrating motivational strategies.

Traumatic brain injury (TBI), a growing public health concern worldwide, has recently been recognized as one of the most common etiologies of hypopituitarism. Leading causes of TBI-induced pituitary dysfunction include road traffic accidents, falls, domestic violence, sport-related injuries and war injuries. The prevalence of hypopituitarism after TBI is about 15% and growth hormone is the most common pituitary hormone deficiency after TBI. Because the clinical spectrum of TBI-induced pituitary dysfunction is broad and most of the manifestations are nonspecific, the diagnosis is often delayed and many patients remain undiagnosed and untreated. Current evidence show that pituitary hormone deficiencies seen in patients with mild and moderate TBI may improve over time in a considerable number of patients, but some may also worsen over time. Since not all TBI patients develop pituitary dysfunction, testing all patients with a history of TBI is not realistic and cost-effective. Predictive factors of post-TBI hypopituitarism including number of hormone deficiencies during acute phase, radiological abnormalities, genetic polymorphism, older age, female gender should be taken into account for development of screening strategies. Prospective screening of pituitary functions is required in complicated mild TBI (defined as clinically mild by all severity measures but considered complicated due to a traumatic intracranial abnormality visible on neuroimaging), moderate and severe TBI patients. Increased awareness of TBI-induced hypopituitarism in the medical community may lead to earlier diagnosis and prompt treatment of hypopituitarism with appropriate replacement of deficient hormones.

We comment here on the recently published paper by Ostentag et al., 2026, which examined self-reported environmental exposures in a group of patients with Parkinson's Disease (PD). Patients with GBA1-associated Parkinson's Disease (PD) were two times more likely to have been exposed to occupational pesticides compared to those with idiopathic PD, while there was no difference for any other exposure between the two groups. Combined with previous work, these findings suggest that GBA1 pathogenic variant status in combination with exposure to pesticides leads to a high risk of developing PD, and have several implications: at the genetic epidemiological level, they provide a partial explanation for the missing penetrance of GBA1 pathogenic variants; at the biological level, they suggest that the biological mechanisms of pathogenicity conferred by the genetic predisposition and the environmental exposure may converge on the same pathways, potentially involving the interplay between lysosomal and mitochondrial function; at the public health level, they suggest that exposure to even low levels of environmental toxins may be especially deleterious for genetically susceptible individuals with GBA1 pathogenic variants. Further studies are needed to verify these results using rigorous methods for exposure ascertainment, to identify the exact class of substances underlying this association and their biological mechanisms in this context, and to determine the exposure levels that could be considered safe in this vulnerable population.

The rapid expansion of electronic waste (e-waste) has emerged as a critical global sustainability challenge, with low- and middle-income countries (LMICs) bearing a disproportionate share of its environmental and health burdens. Large volumes of discarded electronics are processed through informal and weakly regulated systems that rely on manual dismantling, open burning, and crude material recovery, leading to widespread contamination of air, soil, water, and food systems. These environmental releases generate chronic exposure pathways that contribute to neurological, respiratory, reproductive, and developmental health risks, particularly among informal workers, women, and children. Using a narrative and conceptual review approach, this article synthesizes evidence across environmental science, public health, and circular economy literature to examine contamination pathways, human health impacts, and institutional constraints associated with e-waste management in LMICs. Building on this synthesis, we advance a health-embedded circular economy framework that integrates exposure reduction, equity, and governance into circular e-waste interventions. Our analysis demonstrates that circular strategies focused solely on material recovery are insufficient and may reproduce existing inequities if health protection is not treated as a core performance metric. Embedding public health considerations, social inclusion, and global responsibility into circular e-waste systems is essential for achieving sustainable and just transitions. Aligning e-waste governance with planetary health principles and the Sustainable Development Goals offers a pragmatic pathway to reduce environmental contamination, safeguard vulnerable populations, and transform e-waste from a public health liability into an opportunity for inclusive development in LMICs.

High-risk human papillomavirus (hrHPV) is an important cause of cervical cancer. hrHPV testing has emerged as an effective screening modality to address the limitations of cytology-based screening. However, in Korea, the absence of standardized clinical guidance has resulted in variability in practice. This consensus-based clinical practice guideline was developed by a multidisciplinary expert committee under the Korean Society of Gynecologic Oncology and includes specialists in gynecologic oncology, pathology, laboratory medicine, and public health. Relevant domestic and international evidence was systematically reviewed and perspectives from diverse clinical settings were incorporated through four public hearings. The final recommendations were established through expert consensus. These guidelines present four key recommendations. First, hrHPV testing may be considered for women aged ??5 years, with a screening interval of 3 to <5 years. Second, screening assays should differentiate between HPV genotypes 16 and 18 while detecting other high-risk types, and tests with established clinical validity are recommended. Third, hrHPV testing should be performed in appropriately equipped settings, following standardized procedures for specimen handling and reporting, with clear documentation of HPV 16/18 status in positive cases. Fourth, the testing should operate under rigorous internal and external quality control systems to ensure reliability and consistency. These guidelines aim to promote consistent and evidence-based implementation of hrHPV testing for cervical cancer screening in Korea, supporting early detection and prevention.

The United States (U.S.) healthcare system consistently underperforms in equity and value compared to peer countries. Socially disadvantaged groups, such as racial and ethnic minorities, refugees, and low-income populations, experience worse access to healthcare and poorer health outcomes. This issue highlights the need for targeted interventions to reduce disparities and improve healthcare quality in both public health and clinical practice. This scoping review aims to map existing literature on interventions that promote healthcare equity and value in the US, focusing on access to healthcare and health outcomes for disadvantaged populations. A scoping review of systematic reviews was conducted to map literature on high-value, equitable healthcare in the U.S. Using the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on systematic reviews of interventions, strategies, and policies promoting healthcare equity and value published between 2018 and 2023 that addressed U.S.-based healthcare. A two-step article selection process and qualitative synthesis of findings were employed. The review synthesized 54 studies, comprising mostly systematic reviews, scoping reviews, and meta-analyses. These studies focused on disadvantaged populations, including racial and ethnic minorities, refugees, and low-income groups. Interventions were categorized into four themes: community engagement and outreach (e.g., use of community health workers), culturally-tailored interventions (e.g., language-concordant care), technology adoption (e.g., digital health tools), and policy reforms (e.g., Medicaid expansion). Findings highlighted the critical role of community health workers and culturally responsive programs in improving access to care and health outcomes for disadvantaged populations. However, most interventions, including these approaches, aim to improve health outcomes measured across whole populations, rather than healthcare gaps between groups within populations. This review underscores the importance of culturally tailored interventions, community engagement and outreach, and policy reforms in addressing equity and value in healthcare. There is a significant gap in research directly tackling healthcare inequities. Future research should focus on system accountability, addressing structural inequities, and developing new care models to enhance equity and value.

As the population ages worldwide, ovarian cancer (OC) poses a serious public health issue for elder women. The objective of this study is to outline the global impact of OC in individuals aged 60 and above from 1990 to 2021, thus guiding specific policies and approaches for prevention, screening, and treatment. A global secondary data analysis using the Global Burden of Disease (GBD) 2021 data was performed to estimate the burden and project future trends of OC in older women (aged 60 and above). We gathered data regarding incidence, mortality rates, and disability-adjusted life years (DALYs) from the GBD 2021. For trend analysis, we employed joinpoint regression to assess temporal variations, calculating the average annual percentage change (AAPC) to quantify these trends. Furthermore, we used the age-period-cohort (APC) model to examine the influences of age, time, and birth cohort on incidence, mortality, and DALY figures. Additionally, the Bayesian age-period-cohort (BAPC) model was applied to forecast changes extending to the year 2050. A worldwide assessment of the impact of OC on public health from 1990 to 2021 highlights notable patterns: the age-standardized incidence rate (ASIR) showed a net decrease; however, its estimated annual percentage change (EAPC) was positive, indicating an overall upward trend in annual rates over the period. In contrast, the age-standardized prevalence rate (ASPR), the age-standardized DALYs, age-standardized death rate (ASDR), and the age-standardized mortality rate (ASMR) have all shown a decline. The distribution of the disease burden shows considerable regional disparities, with uncertainty analyses indicating a sustained decline in regions with a high socio‑demographic index (SDI) and a corresponding increase in regions with low‑to‑medium SDI. Among older women (aged 60 and above), the disease burden demonstrates a disproportionate concentration in younger elderly subgroups: the 60-64 age group experiences the highest incidence and prevalence burden, while mortality peaks in the 65-69 age group. This pattern is particularly pronounced in regions such as South Asia and Central Europe. Risk factor analysis identifies high body mass index (BMI) at 21% and occupational asbestos exposure at 7% as the two major risk factors contributing to OC mortality. Projections based on the BAPC model indicate that by 2050, the global prevalence of OC will continue to rise, while incidence rates are expected to persistently decline. The global fight against OC confronts dual challenges: increasing incidence rates and a shifting disease burden toward low- and middle-income regions. Future efforts must embrace targeted global strategies that integrate improved prevention, diagnosis, treatment, and chronic disease management.

The continuous emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants continues to influence the global coronavirus 2019 (COVID-19) pandemic. Even vaccinated individuals or those with prior infections may experience reinfection, depending on the immune evasion capacity of the circulating variants. Therefore, analyses of variant characteristics and immune escape are critical for informing public health policy. However, as COVID-19 has been downgraded in terms of infectious disease classification, the availability of patient sera has become increasingly limited, restricting the timely immunological analyses of emerging variants. To address this challenge, we established an antiserum production and neutralization assay system using a hamster model and demonstrated the utility of this animal serum-based approach. In this study, antisera against 10 circulating SARS-CoV-2 variants were generated in golden Syrian hamsters, and they showed high titer of humoral and neutralizing antibody using enzyme-linked immunosorbent assay and plaque reduction neutralization test (PRNT) assay. In addition, we compared serum from an unvaccinated patient (n = 1) infected with the BA.5 variant with serum from a BA.5-infected hamster (n = 1). Although the number of comparable samples was limited, the PRNT50 titer patterns in serum from an unvaccinated individual infected with BA.5 and in hamster antisera were similar. These findings indicate that antisera generated in the hamster model can provide timely immunogenicity assessments of newly emerging SARS-CoV-2 variants, thereby contributing to the rapid characterization of variant immune escape and the generation of essential data for future public health preparedness.

SUMMARYAntimicrobial resistance (AMR) is a public health threat that requires a coordinated and multi-sectoral approach. AMR is largely underexplored in Central Asia, a region shaped by the Soviet legacy. This narrative review aimed to synthesize evidence on the AMR landscape from articles published in five countries: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. A structured search of peer-reviewed and gray literature was conducted, covering AMR prevalence, consumption patterns, knowledge, awareness, practices, stewardship interventions, and AMR governance. Key findings revealed that all five countries in the region have retained the rigidly centralized public health system, which was formerly known as the Sanitary Epidemiological Service during the Soviet era. This has led to fragmented surveillance and poor AMR monitoring. Up to 70% of Enterobacterales spp. were resistant to third-generation cephalosporins, and up to 58% of Staphylococcus species exhibited macrolide resistance. Consumption of Watch group antibiotics ranged from 53% to 68%, with a broad preference for injectables. Self-medication was found to be common, with rates ranging between 26% and 40% among the general public. High levels of patient demand coincided with medical errors, affecting up to 80% of antibiotic prescriptions. Only a limited number of antimicrobial stewardship studies were found, highlighting the insufficient integration of stewardship practices into routine healthcare delivery. Central Asian countries continue to face significant challenges because of the persistence of poor surveillance, high antibiotic consumption, and inadequate implementation of AMS because of long-standing legacies and systemic weaknesses. Addressing these gaps demands structural reforms, integrated surveillance systems, targeted education, and robust stewardship programs as urgent priorities.

Urban landscape architecture design plays an essential role in public health because it is influenced by several factors such as social connection, safety, walkability and amenities access. Traditional planning techniques are time-consuming and often result in suboptimal or aesthetically incoherent layout decisions, which diminish the accessibility and safety of landscape design. The research issue is addressed by integrating artificial intelligence (AI) techniques in architectural design to improve the overall aesthetic design while handling health decisions. This study uses Generative Adversarial Networks (GAN) and Reinforcement Learning (RL) to satisfy the health objectives via landscape layouts. The GAN uses the generator and discriminator to design the landscape layout that covers inputs such as functional requirements, site dimension, zone restrictions and health design principles. The combination of generator and discriminator helps to maximize the outcomes in injury prevention, mental restoration and physical activities. The generated layouts are further explored using RL rewards regarding usage, safety, and access, ensuring the layout appearance and aesthetics are directly tailored to health. The incorporation of new technology into landscape architecture can offer evidence-based approaches for constructing salutogenic landscapes. The scalable computational technique enables faster scenario evaluation, providing information for informed planning policies. Then, the excellence of the landscape layout is evaluated using experimental results.