Search Results (458)

Single-country livestock-mortality insurance programs in smallholder economies face a structural problem: under regime-switching mortality, the capital needed to stay solvent in a bad year can approach annual premium revenue, so public budgets become the insurer of last resort. This paper designs and prices a regional alternative for the smallholder cattle and buffalo systems of the ASEAN-5 (Thailand, Vietnam, Cambodia, Laos, and Myanmar): a sovereign risk pool with a catastrophe (CAT) bond that transfers the extreme tail to capital markets. A 100,000-iteration Monte Carlo simulates correlated regime-switching mortality, with cross-country dependence structured by epidemiological proximity and calibrated to Food and Agriculture Organization, national-statistics, and World Organisation for Animal Health data. Pooling cuts the 99 percent Value-at-Risk capital requirement by 41 percent relative to the sum of country buffers, a saving of USD 464 million per year, and the saving stays between 25 and 47 percent across plausible correlations. A parametric CAT bond attaching at the 95 percent and detaching at the 99.5 percent pool VaR transfers USD 353 million at an expected loss of 2.2 percent and a spread of 3.6 to 4.1 percent. The Southeast Asia Disaster Risk Insurance Facility provides a ready operational vehicle. For ASEAN agriculture and finance ministries, the practical implication is to build the national mortality-data systems and pooled financing arrangements, through SEADRIF, that would move this cover from design to issuance. Full article

This study investigates carbon monoxide (CO) emission potential and kinetics in two biowaste composting facilities, one of which implements process hermetization in a closed hall, in accordance with the Best Available Techniques (BAT) for Waste Treatment, representing a more sustainable waste management approach due to the reduction in uncontrolled gaseous emissions to the environment. The flux chamber method was used to measure cumulative CO concentrations before and after compost turning across 10 compost piles located either indoors or outdoors. Maximum cumulative CO concentrations (C_COmax) and CO production rate constants (k) were calculated. Results indicate that indoor composting leads to significantly higher net CO emissions, both before and after pile turning. In all indoor piles, cumulative CO concentrations exceeded the United States Environmental Protection Agency (EPA) 1 h and 8 h exposure limits. Post-turning cumulative CO levels reached over 3000 mg CO·m⁻³, with averages ranging from above 15 to over 70 mg CO·m⁻³. These levels pose a serious health risk, potentially causing headaches, collapse, or even loss of consciousness in workers after approximately two hours of exposure. Additionally, compost turning in closed systems resulted in slower CO production, prolonging exposure. The study demonstrated that, although BAT-compliant enclosed systems are beneficial for the environment and support sustainable waste management practices, they may create hazardous conditions for workers. Therefore, continuous monitoring of gas concentrations is essential in closed composting facilities to ensure that environmentally sustainable waste treatment technologies are implemented together with adequate occupational safety measures, supporting a more comprehensive and balanced approach to sustainability. Full article

Background and Objectives: The World Health Organisation (WHO) promotes respectful, woman-centred care during childbirth, aimed at preserving women’s autonomy, their sense of control and the fulfilment of their expectations. Loss of control during childbirth has been linked to a poorer birth experience and adverse emotional consequences in the postpartum period. To analyse the maternal and perinatal factors associated with perceived control and support during childbirth, and their relationship with childbirth satisfaction in women in Spain. Materials and Methods: A cross-sectional study was conducted with postpartum women who had given birth within the previous six months in Spain. Validated instruments were used, including the “Support and Control in Birth” (SCIB) scale and the “Birth Satisfaction Scale-Revised” (BSS-R). Sociodemographic, obstetric and neonatal variables were also collected. Associations were assessed using multiple linear regression models. Results: A total of 302 postpartum women participated, with a mean age of 35.2 years (SD = 4.18), of whom 70.2% (n = 212) were primiparous. Satisfaction with childbirth (BSS-R) was the strongest positive association with all dimensions of the SCIB: internal control (adjusted mean difference [aMD] = 0.56; 95% CI: 0.48, 0.64), external control (aMD = 0.75; 95% CI: 0.61, 0.89), support (aMD = 0.89; 95% CI: 0.77, 1.01) and overall score (aMD = 2.34; 95% CI: 2.13, 2.56). Greater pain intensity was associated with a lower perception of internal control (aMD = −1.00; 95% CI: −1.31, −0.70). In comparison with adherence to the birth plan, non-adherence showed a negative association with the support dimension (aMD = −7.71; 95% CI: −10.72, −4.71) and with the overall SCIB score (aMD = −10.21; 95% CI: −16.01, −4.42). Women’s active participation in decision-making was positively associated with perceived control and support (aMD = 7.15; 95% CI: 2.21, 12.09). Conclusion: A greater perception of support and control during labour is associated with a more positive birth experience. Deviation from the birth plan and greater pain intensity are associated with a poorer perception of control, whilst women’s active participation was associated with higher perceived control. These findings underscore the importance of personalised and respectful care to improve women’s childbirth experience, particularly perceived support, control and satisfaction. Full article

Freshwater amphipods of the genus Gammarus are important trophic components of aquatic ecosystems and are increasingly considered a potential bioresource for aquaculture. However, their role in the maintenance and transmission of infectious agents remains poorly understood. This study evaluated the presence of major crustacean and fish pathogens in Gammarus lacustris populations from Kazakhstan and characterized associated viral communities using metagenomic sequencing. Six pooled samples collected from freshwater ecosystems across Kazakhstan were screened using PCR and RT-PCR assays targeting World Organisation for Animal Health (WOAH)-listed pathogens, including White Spot Syndrome Virus, Taura Syndrome Virus, Infectious Myonecrosis Virus, Aphanomyces astaci, and Aphanomyces invadans. In parallel, high-throughput sequencing (Illumina NovaSeq) was performed to assess virome composition and structure. No WOAH-listed pathogens were detected, suggesting a low detectable occurrence of major notifiable agents under the conditions of the present study. Metagenomic analysis revealed a virome dominated by RNA viruses, particularly picorna-like viruses (Picornaviridae), Dicistroviridae, and Marnaviridae. Phylogenetic and genome organization analyses identified potentially novel or highly divergent viral lineages within Picornavirales. Collectively, these findings suggest a favorable epizootiological profile of G. lacustris populations while highlighting freshwater amphipods as hosts of diverse and partially uncharacterized viral communities relevant to aquatic disease surveillance and aquaculture biosecurity. Full article

Reuse of human excreta and derivatives is becoming a common practice in areas with agricultural predominance. While in situ treated faeces through ecological sanitation (Ecosan), known as “faecal by-products” are being used to sustain soil nutrients and improve on-site sanitation, the concern remains about the health risks related to the survival of pathogens in these by-products in the community of farmers. This study assessed the survival of faecal pathogens and estimated microbial risks associated with the use of Ecosan faecal by-products in agriculture. The quantitative microbial risks assessment (QMRA) framework was used to estimate the risks posed by each faecal pathogen in solid and semi-solid faecal by-products under the probabilistic model of Monte Carlo simulation. Ascaris lumbricoides (6.5 eggs/gr), Taenia species (0.3 egg/gr), Schistosoma species (9.3 cercariae/gr), Entamoeba species (4.4 cysts/gr), and Escherichia coli (451 Cfu/gr) were detected in semi-solid faecal products. Exposure scenarios were observed throughout four critical points: vault faecal by-products removal/unloading, transport, collection, and application of faecal by-products in the gardens. Due to the presence of eggs and cysts, an estimated annual risk of infections was found in semi-solid faecal by-products with Schistosoma species (88%) and Ascaris lumbricoides (90%). Both concentrations were above World Health organisation (WHO) standards of associated infective risks of 0–10% of helminths in faecal sludge applied in the gardens. The users of faecal by-products, particularly farmers are exposed not only to high concentrations of helminth eggs but also to protozoa and bacteria with infective risks of Entamoeba species (99%) and E. coli species (62%). A stepwise implementation of faecal pathogens die-off during treatment of faecal by-products in compliance with the WHO’s 2018 guidelines can prevent the use of unsanitary faecal by-products. According to these findings, the proper control of intestinal protozoa and soil-transmitted helminths (STHs) should be enforced through personal protective measures in Burera district, Rwanda. Full article

Integrated care is increasingly shaped by digital infrastructures, data governance, and AI-enabled analytics, yet the relevant literature remains fragmented across health-services research, digital health, and machine learning. This article reports a scoping review, conducted in line with PRISMA-ScR guidance, that maps how integrated care models have evolved conceptually, what digital and AI-enabled infrastructures support them, how their clinical, economic, and equity impacts can be evaluated, and what current implementations imply for sustainable scaling. We searched PubMed, Scopus, Semantic Scholar, and Crossref (retrieval date 31 October 2025; forward screening to 31 March 2026) and added grey literature from named policy bodies. The searches identified 15,189 records, reducing to 11,789 after intra- and cross-source deduplication and grey-literature integration; 620 full texts were assessed and 192 were included in the synthesis. Four domains were synthesised: conceptual foundations of integrated care, AI and multimodal analytics, implementation barriers, and digital-governance foundations. We chart the field using a Type I–V maturity scheme (disease, cohort, whole-system, digital-integrated, learning), benchmarked against the Rainbow, MacColl, EMRAM/AMAM, and NHS ICS models. Most deployments cluster at digitally integrated but only weakly adaptive Type IV; recurrent failure modes—temporal blind spots, maintenance debt, semantic drift, and governance gaps—block progression to Type V, and high-profile clinical-AI failures illustrate the cost of attempting Type V analytics on Type IV-or-worse infrastructure. A walk through nine world regions maps each to its current Type I–V position and shows that organisational and payment integration—not digital sophistication alone—is currently the dominant driver of progress. The COMFORTage Integrated Care Model Library is positioned as a workflow of AI agents orchestrating predictive, preventive, and personalised care across the integrated-care lifecycle rather than as a single federated-learning programme. The review positions AI-enabled integrated care less as a finished model than as an emerging design space requiring longitudinal data assets, stewarded model lifecycles, accountable governance, and outcome-based contracting for clinically useful, equitable, and trustworthy learning systems. Full article

Background/Objectives: Despite ongoing innovation, few interventions—including Clinical Decision Support Systems (CDSS)—are successfully integrated into routine care. Understanding the process through which innovations are implemented is therefore essential for advancing practice and research. In perinatal settings, evidence on how CDSS implementation unfolds and which strategies support adoption, scale-up, and sustainment remains limited. This study aimed to understand the implementation process, key determinants and implementation strategies of a shared antenatal psychosocial CDSS (i.e., the Born in Belgium Professionals [BIB-Pro]) implemented in a real-world, cross-sectoral perinatal care setting. Methods: A qualitative exploratory case study was conducted between January and March 2025. Data included semi-structured interviews with all seven implementation agents, document analysis of the implementation plan. Directed content analysis was applied using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to categorise contextual determinants and the ERIC taxonomy to classify implementation strategies. Data were synthesised across the four EPIS phases. Results: The implementation process unfolded across all EPIS phases, showing a shift in responsibility from the policy level to the implementation team and healthcare organisations. Implementation was shaped by key determinants across multiple levels: (1) the bridging functions by the BIB-Pro implementation agents connecting policy, innovation, and organisational practice; (2) the system-level leadership and funding by the National Institute for Health and Disability Insurance that enabled initiation and sustainability; and (3) the multilevel stakeholder involvement and inter-organisational collaboration across care settings. In addition, the personal attributes of implementation agents—accessibility, active listening, adaptability, and persistent follow-up—were also identified as relevant factors in the implementation process. Across the implementation process, a broad range of implementation strategies was identified. The most prominent ERIC strategies were developing stakeholder interrelationships, evaluative and iterative strategies, engaging stakeholders, training and educating stakeholders, and providing interactive assistance. Barriers encountered during the implementation process included fragmented care networks, inconsistent regional referral structures, legal uncertainties, and variable digital readiness. In response to these challenges, implementation strategies were applied to support collaboration, clarify procedures and provide targeted support. Conclusions: This study provides insight into how a CDSS was introduced, scaled, and sustained across complex multiple Belgian perinatal care settings. Strong bridging functions, stakeholder interrelationships, iterative evaluation, and system-level support were key factors throughout the implementation process. Across all phases, stakeholder interrelationship strategies and evaluative and iterative strategies were the most prominent and consistently applied, supporting stakeholder engagement and sustained use of the platform. These findings offer actionable guidance for implementing digital tools in multi-organisational and multi-level contexts within perinatal care and other healthcare settings. Full article

Background: In March 2026, a meningococcal cluster centred on the University of Kent, England, caused two deaths and resulted in over 20 reported cases within the first week, including confirmed and suspected invasive cases. Subsequent UKHSA updates in early April 2026 reported 21 laboratory-confirmed MenB cases (18 linked to the outbreak strain) and two deaths, with the outbreak subsequently spreading to a second Canterbury university, Canterbury Christ Church University, and confirmed as Neisseria meningitidis serogroup B (MenB). Sub-Saharan Africa (SSA) bears a disproportionate global burden of meningococcal disease, yet university settings remain a critically understudied outbreak amplifier. This narrative review extracts epidemiological and policy lessons from the Kent event and applies them to the SSA context. Methods: We conducted a narrative review following the SANRA criteria, searching PubMed, Embase, Scopus, Google Scholar, and African Journals Online (2000–2026), with supplementary grey literature retrieved from World Health Organisation (WHO), Africa Centre for Disease Control, and United Kingdom Health Security Agency (UKHSA). Outbreak data were drawn from official UKHSA public-health statements (grey literature, archived), the University of Kent communications, and peer-reviewed expert commentary. Results: The Canterbury outbreak exposed six reproducible vulnerabilities: unprotected serogroup circulation (confirmed MenB, not covered for the current university-age cohort), nightlife-linked transmission amplification, delayed serogroup identification, poor student symptom-recognition, inadequate institutional response capacity, and, critically, multi-institutional spread via shared nightlife venues (confirmed extension to Canterbury Christ Church University within five days). Each vulnerability is demonstrably more severe in SSA universities, which face a broader multi-serogroup threat environment (NmA, B, C, W, X), virtually no university-entry vaccination requirement, and critical evidence gap of campus-specific meningococcal evidence in the published literature. Conclusions: This review proposes a five-pillar preparedness framework for SSA tertiary institutions, derived from a synthesis of the Kent outbreak and broader epidemiological evidence, intended to inform policy discussion and future research. Moreover, these should be embedded within a broader age-linked prevention strategy that begins before university entry, particularly during the transition into secondary school in high-risk settings. Priority measures include meningococcal vaccination at key educational transition points, prophylactic antibiotic pre-positioning, serogroup-capable surveillance, symptom-recognition training, and pan-continental alert A predominantly reactive response may carry substantial risk in SSA settings. Full article

Background/Objectives: High sodium intake is a leading dietary risk factor for stomach cancer, particularly in East Asia. In Japan, traditional dietary patterns contribute to elevated sodium consumption and a high burden of stomach cancer. This study aims to forecast disability-adjusted life years (DALYs) for stomach cancer attributable to high sodium intake in Japan from 2022 to 2050, and to assess the impact of multiple sodium reduction policy scenarios. Methods: We conducted a longitudinal forecasting study using autoregressive integrated moving average with exogenous variables (ARIMAX) models based on Global Burden of Disease 2021 data (1990–2021). The Japanese population was stratified by sex and age groups (15–49, 50–69, and ≥70). Five future exposure scenarios were modelled: (1) reference (current trends), (2) best-case (50% reduction in sodium exposure by 2050), (3) optimal (30% reduction by 2032), (4) moderate (30% reduction by 2050), and (5) worst-case (highest exposure levels from recent years maintained). These scenarios were aligned with national and international sodium reduction targets, including the revised “Health Japan 21” (third term; 7 g/day by 2032) and the World Health Organisation (WHO) 5 g/day/30% reduction goals. Results: Under the reference scenario, age-standardised DALY rates are projected to decline by 31.4% (to 15.4 per 100,000) by 2050. The best-case scenario projects a 54.7% decline (to 10.1 per 100,000). Substantial demographic disparities persist: males and those aged ≥70 consistently show higher burdens. Notably, the 50–69 age group shows the greatest variation in 2050 projections across scenarios (17.1 to 73.5 per 100,000), indicating high policy sensitivity. Meanwhile, in the ≥70 group, DALY rates remain high regardless of scenario, especially among males (199.4 vs. 57.8 per 100,000 for females), reflecting cumulative lifetime exposure. Conclusions: Under modelled assumptions, sustained achievement of national sodium reduction targets could meaningfully reduce future stomach cancer DALYs in Japan, with the largest absolute gains in older adults but the largest relative gains in younger and middle-aged groups. Because stomach cancer aetiology is multifactorial and the projections rest on modelled associations and a continuity-of-trend assumption, these findings support strengthened, demographically targeted sodium reduction interventions as one complementary component of a broader, multi-risk factor approach to stomach cancer prevention. Full article

This review offers a critical and comprehensive overview of the most promising covalent inhibitors against traditional and emerging enzymatic targets of Mycobacterium tuberculosis (Mtb). Nearly three decades after the World Health Organisation’s (WHO) declaration of tuberculosis (TB) as a global health emergency, Mtb continues to claim millions of lives, remaining among the leading causes of death worldwide. In recent years, several efforts have been devoted to shortening and improving treatment outcomes and to overcoming increasing drug resistance. The aim of our work is to provide a perspective on recent progress in the field of covalent inhibitors of mycobacterial enzymes, highlighting the current landscape and outlining future directions for safer and more effective strategies. Full article

Complex psychosis is a clinically relevant rehabilitation construct rather than a formal diagnostic category and refers to psychotic illness associated with treatment-resistant symptoms, functional impairment, and additional cognitive, psychiatric, neurodevelopmental, or physical health complexity. In this clinician-oriented narrative review, we synthesised current evidence on rehabilitation interventions for adults with complex psychosis, integrating direct evidence from specialist rehabilitation settings with indirect evidence from schizophrenia-spectrum studies when clinically informative. We searched major clinical databases, prioritised guidelines, systematic reviews, meta-analyses, and controlled studies, and organised the synthesis by functional domain and pathway relevance. Evidence was strongest for cognitive remediation, particularly when combined with broader psychiatric rehabilitation or vocational support, for family interventions in relapse prevention, and for individual placement and support in competitive employment. Social–cognitive and metacognitive interventions appear clinically valuable, although transfer to real-world functioning is more variable. Community-based rehabilitation, supported accommodation, illness self-management, and ecological adaptation strategies remain central to functional recovery when embedded within multidisciplinary pathways. Digital and virtual interventions are promising adjuncts, but their efficacy remains heterogeneous and implementation challenges include engagement, privacy, and service integration. Overall, rehabilitation in complex psychosis is most convincing when it is personalised, measurement-based, and delivered through integrated service models linking assessment, intervention selection, supported living, and recovery-oriented care. Full article

“The knock” refers to the moment when the police first arrive at a house to investigate suspected sexual offending by a member of that family. This paper examines the levels of trauma, wellbeing and crisis support for partners, both at the time of the knock and at the current time. Forty-eight participants who had experienced the knock completed an online survey. All respondents were female; they had experienced the knock 0–20 years previously (M = 3.88 years). Participants provided demographics and completed the World Health Organisation (WHO) Wellbeing Index, the International Trauma Questionnaire (ITQ) and the Crisis Support Scale (CSS) for (i) retrospective (at the time of the knock) and (ii) current levels of social support. Participants reported lower levels of wellbeing and higher levels of trauma in comparison with general population norms. Approximately 40% of participants’ scores on the ITQ exceeded the criterion for post-traumatic stress disorder (PTSD), with a further 25% of participants meeting the criterion for Complex PTSD. Levels of trauma were negatively correlated with wellbeing and with both retrospective and current self-reported crisis support. Qualitative analysis of open-ended questions explored participants’ experiences of the knock, their perceptions of police conduct, and the personal, relational, and practical consequences that followed. The findings highlight substantial and enduring harm among partners and are discussed in relation to implications for current policy and practice. Full article

Adolescent vaping has become a persistent health and behavioural challenge in schools, yet many institutions lack reliable tools to detect and respond to concealed e-cigarette use. This study addresses this problem by evaluating the real-world performance of a low-cost “Internet of Things” (IoT) vape detection system deployed across 37 high-risk restroom and change-room locations at a large Australian Independent school. The aim was to determine whether an IoT-based environmental monitoring platform could accurately identify vaping events, support timely staff intervention, and provide actionable insights into student behaviour patterns. A longitudinal case study design was used, collecting continuous particulate matter (PM_2.5 and PM₁₀) data at one-minute intervals over an 18-month period, where PM_2.5 and PM₁₀ refer to particulate matter with aerodynamic diameters ≤ 2.5 µm and ≤10 µm, respectively, reported in micrograms per cubic metre (µg/m³. Threshold-based alerting, cloud-based data processing, and school-led Closed-circuit television (CCTV) verification were combined to assess detection accuracy, temporal trends, and operational responses. The system recorded more than 300 vaping-related incidents, with clusters aligned to predictable times of day and higher prevalence among senior students. Operational detection performance was high, with alert events characterised by rapid, concurrent PM_2.5 and PM₁₀ excursions consistent with vaping-related aerosol profiles, although staff responsiveness declined over time due to alert fatigue and competing priorities. A major environmental smoke event demonstrated the need for context-aware logic to reduce false positives. The findings demonstrate that real-time aerosol monitoring is not only technically reliable but also highly effective in detecting vaping within school environments. These perspectives help explain why user engagement, alert fatigue, and institutional follow-through are as critical as sensor accuracy itself. Ultimately, the effectiveness of vape detection relies on strong organisational commitment, well-defined response workflows, and alignment with broader wellbeing and policy strategies. When these elements are in place, such systems can evolve from simple detection tools into intelligent, integrated components of school health governance. Full article

Poliovirus wastewater surveillance (WWS) is an important complementary system to acute flaccid paralysis surveillance and a substitute surveillance for enteroviruses in stool samples of children, within global poliovirus eradication efforts. However, current guidelines provide limited data on sampling schemes for polio-free countries. This study aims to provide a summary of sampling schemes used for poliovirus WWS in studies done in countries of European Union (EU), together with an analysis of their objectives and a comparison with studies done in other countries. The study selection for this literature review was based on three sources: a World Health Organisation literature review, the PubMed database, and a systematic literature review of WWS of communicable disease agents. From 1446 studies, 72 studies published between 1 January 1995 and 5 September 2024 were included in the qualitative analysis. These studies were analysed by country of origin, objective, sampling site, catchment population size, sampling frequency, sampling method and sample volume. The results indicate that most studies from EU countries had conducted poliovirus WWS directly in line with World Health Organisation recommendations, despite these being primarily designed for developing countries. Our review may encourage countries to optimise their poliovirus WWS systems based on their own risks for poliovirus introduction and circulation. Full article

Contemporary societies are facing converging crises, including environmental degradation, worsening social inequalities, aging populations, and increasingly costly healthcare systems, prompting sustainable health to be proposed as an integrative conceptual perspective for rethinking health, its determinants, and collective action. This narrative review aims to trace the historical evolution of the concept, clarify the vision it offers for public health, and identify its implications for research, policy, and intervention. A literature search (May 2025) was conducted in PubMed, Google Scholar, and Google, with no restrictions on language, time period, or document type. Of 40 relevant documents, 21 were selected for in-depth analysis by two independent reviewers, with duplicate data extraction. The results show that sustainable health broadens the World Health Organisation (WHO) definition of health by incorporating sustainability, intergenerational justice, ecological limits, and social equity. Close to, but distinct from Planetary Health, One Health, and EcoHealth, sustainable health is based on ecological, social and ethical, economic, behavioral, intergenerational, and systemic/intersectoral dimensions. Sustainable health thus emerges as a systemic and transdisciplinary conceptual approach for transforming health systems, living environments, and public policy, requiring further conceptual clarification, robust interdisciplinary research programs, and intersectoral initiatives involving communities. Full article