Search Results (2,180)

The Research Integrity Risk Index (RI²), introduced as a tool to identify universities at risk of compromised research integrity, adopts an overly reductive methodology by combining retraction rates and delisted journal proportions into a single, equally weighted composite score. While its stated aim is to promote accountability, this commentary critiques the RI² index for its flawed assumptions, lack of empirical validation, and disproportionate penalization of institutions in low- and middle-income countries. We examine how RI² misinterprets retractions, misuses delisting data, and fails to account for diverse academic publishing environments, particularly in Indonesia, where many high-performing universities are unfairly categorized as “high risk” or “red flag.” The index’s uncritical reliance on opaque delisting decisions, combined with its fixed equal-weighting formula, produces volatile and context-insensitive scores that do not accurately reflect the presence or severity of research misconduct. Moreover, RI² has gained significant media attention and policy influence despite being based on an unreviewed preprint, with no transparent mechanism for institutional rebuttal or contextual adjustment. By comparing RI² classifications with established benchmarks such as the Scimago Institution Rankings and drawing from lessons in global development metrics, we argue that RI², although conceptually innovative, should remain an exploratory framework. It requires rigorous scientific validation before being adopted as a global standard. We also propose flexible weighting schemes, regional calibration, and transparent engagement processes to improve the fairness and reliability of institutional research integrity assessments. Full article

Phytate, an antinutritional molecule in poultry feed, can be degraded by applying phytase, but its use in low- and middle-income countries is often limited due to importation instead of local production. Here, inexpensive raw materials were used to optimize the production of a thermostable phytase from an indigenous strain of Bacillus subtilis SP11 that was isolated from a broiler farm in Dhaka. SP11 was identified using 16s rDNA and the fermentation of phytase was optimized using a Plackett–Burman design and response surface methodology, revealing that three substrates, including the raw material mustard meal (2.21% w/v), caused a maximum phytase production of 436 U/L at 37 °C and 120 rpm for 72 h, resulting in a 3.7-fold increase compared to unoptimized media. The crude enzyme showed thermostability up to 80 °C (may withstand the feed pelleting process) with an optimum pH of 6 (near pH of poultry small-intestine), while retaining 96% activity at 41 °C (the body temperature of the chicken). In vitro dephytinization demonstrated its applicability, releasing 978 µg of inorganic phosphate per g of wheat bran per hour. This phytase has the potential to reduce the burden of phytase importation in Bangladesh by making local production and application possible, contributing to sustainable poultry nutrition. Full article

Air pollution is linked to childhood mortality and morbidity in low- and middle-income countries globally. There is growing evidence linking air pollution to asthma and other respiratory diseases in children. Studies have shown that children are likely to experience asthma due to their narrow airways and their heightened sensitivity to environmental irritants. This study aims to investigate the relationship between ambient air pollution and respiratory diseases in children under the age of 5. The study will be conducted in the informal township of Alexandra, north of Johannesburg, South Africa. A quantitative approach will be used in this cross-sectional analytical study. Data will be collected using different tools that include a questionnaire to determine the prevalence of asthma and respiratory disease and potential risk factors. While environmental air pollution will be measured using Radiello passive samplers and Gillian pumps. Data will be analyzed using the latest version of the STATANow/MP 19.5 software. Furthermore, health risk assessment will be conducted for lifetime non-carcinogenic and carcinogenic risk estimation following the USEPA framework. The study will identify environmental triggers that exacerbate asthma and other respiratory conditions in other similar community settings and will contribute to the body of knowledge in public health. Ethical approval was obtained from the Research Ethics Committee, Faculty of Health Sciences at the University of Johannesburg. Full article

Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations. Full article

Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities. Full article

Background: Type 2 diabetes (T2D) is a growing public health concern, particularly in low- and middle-income countries. Although prediabetes is a major risk factor for T2D, it remains largely underdiagnosed and untreated. Structured lifestyle interventions have proven effective in preventing diabetes, but their feasibility within the Brazilian public health system remains unclear. Methods: This multicenter pilot randomized controlled trial assessed the feasibility of a culturally adapted lifestyle intervention (PROVEN-DIA) across the five regions of Brazil. A total of 220 adults at high risk for T2D were randomized to an intervention group or a control group (usual care) and followed for three months. Both groups received similar educational content on healthy eating and physical activity, but the intervention group participated in a structured and personalized lifestyle program with regular follow-up sessions. The primary outcome was adherence to dietary recommendations, assessed using the BALANCE Index—a validated dietary score (range: 0–40) based on the Brazilian Cardioprotective Diet that classifies foods into color-coded groups according to nutritional quality—along with engagement in moderate-to-vigorous physical activity (MVPA). Secondary outcomes included diet quality (DQIR), anthropometric and metabolic parameters. Results: Feasibility was demonstrated by a 93.2% retention rate (n = 205). There was no significant difference in the primary outcome (simultaneous improvement in diet and MVPA). However, the PROVEN-DIA group exhibited significantly greater improvements in diet quality, with a 2.8-point increase in the BALANCE Index (vs. 0.5 in the control, p = 0.03), and a significant improvement in the DQIR (p < 0.001). No significant differences between groups were observed in MVPA, HbA1C, glycaemia, or body weight. Conclusions: The PROVEN-DIA intervention proved feasible within the Brazilian public health context, resulting in significant improvements in dietary quality among individuals at high risk for T2D. A larger trial with longer follow-up is warranted to evaluate its effectiveness in preventing the progression to diabetes. However, to enhance physical activity outcomes, specific adaptations and targeted strategies may be required to better support participant engagement in exercise. Full article

Climate change mitigation Official Development Assistance (ODA) primarily aims to reduce greenhouse gas (GHG) emissions in developing countries while also seeking to enhance human welfare as a fundamental goal of development aid. This study investigates whether climate mitigation ODA contributes to achieving the principles of the doughnut framework—staying within the ecological ceiling (mitigating GHG emissions) while meeting the social foundation (enhancing human development index, HDI). We analyzed data from 77 developing countries between 2010 and 2020, including subgroup analyses by income level (high-, middle-, and low-income groups), using an instrumental variable–fixed effect approach. The results show that climate change mitigation ODA significantly improved the HDI but had no impact on reducing overall GHG emissions, including fossil fuel-based and land use change and forestry-based mitigations. When disaggregated by income level, ODA was found to improve the HDI and reduce fossil fuel-based GHG emission in low-income countries; however, these effects weakened as income levels increased. Across all income groups, there was no significant reduction in GHG emissions resulting from land use change or forestry. These findings suggest that climate change mitigation ODA can yield a greater impact when prioritized for low-income countries and that current ODA strategies for addressing GHG emissions related to land use change and forestry should be reconsidered. Full article

Background: Since the current increase in antimicrobial resistance globally, parasitic infectious diseases have become a greater public health crisis than ever before and an absolute priority. The Egyptian community pharmacist, as a health care provider and advisor, has a potential role to play in deworming. Objective: To evaluate the outcomes of community pharmacist-led deworming-related counseling services. Methods: A prospective randomized controlled study was conducted in Damanhur, Behera, Egypt. The intervention group received community pharmacy counseling, and the control group received the usual care. Both groups were monitored for 12 months for recurrence evaluation. Results: A total of 173 patients were included, of whom 96 (55.5%) received patient counseling. The types of infection included Oxyuris (44.5%), Entamoeba histolytica (28.9%), Ascaris (8.7%), Entamoeba Cyst (8.7%), Giardiasis (4.6%), Schistosomiasis (2.9%), and pinworm (1.7%). A total of 119 participants (68.8%) reported a need for dose repetition. Personal hygiene practices were reported by 71 participants (41%). Recurrence of infection was observed in 101 cases (58.4%). Patient counseling was significantly associated with lower recurrence rates and higher rates of personal hygiene application (p < 0.001). Multivariate logistic regression analysis revealed that patient counseling and personal hygiene measures were the only significant predictors of infection recurrence rate. Conclusions: Community pharmacists’ deworming-related counseling had positive behavioral and clinical outcomes. Full article

Background: The quality of decision-making processes is increasingly recognized as critical to public trust and policy sustainability. Objectives: This narrative review aims to identify and describe process-focused decision support models (DSMs) applied in pharmaceutical policy, and to examine their potential contributions to improving procedural quality in decisions related to pricing, reimbursement, and access to medicines. Methods: Relevant peer-reviewed and gray literature published between 2000 and 2025 was considered, drawing from key databases (e.g., PubMed and Scopus) and international policy reports (e.g., WHO, ISPOR, and HTA agencies). Studies were included if they provided insights into DSMs addressing at least one dimension of decision process quality. Results: Findings are synthesized narratively and organized by tool type, application context, and key quality dimensions. Frequently referenced tools included the Quality of Decision-Making Orientation Scheme (QoDoS), WHO-INTEGRATE, and AGREE II. QoDoS emerged as the only tool applied across regulatory, HTA, and industry settings, evaluating both individual- and organizational-level practices. WHO-INTEGRATE highlighted equity and legitimacy considerations but lacked a structured format. Overall, most tools demonstrated benefits in promoting internal consistency, transparency, and stakeholder engagement; however, their adoption remains limited, especially in low- and middle-income countries. Conclusions: Process-focused DSMs offer promising avenues for enhancing transparency, consistency, and legitimacy in pharmaceutical policy. Further exploration is needed to standardize evaluation approaches and expand the use of DSMs in diverse health systems. Full article

More than 50 years ago, children were viewed as naturally resilient and often labeled invulnerable or invincible. Resilience is now understood to be the result of dynamic interactions between individual, familial, social, and environmental systems, decentralizing the focus from the individual to the global society. Experiences with adversity may emanate from the youth’s family environment, their community, the school system, and larger structural challenges related to poverty, discrimination, health disparities, and educational inequities. Youth experiences with adversity, trauma, and tragedy have the potential to negatively impact youth well-being, with consequences manifesting across the lifespan. Children and adolescents generally hold limited power to change their circumstances and are often ill-equipped to resolve the adverse or traumatic experiences occurring within their ecosystem. The value of social supports in the young person’s ability to be resilient has been affirmed. This understanding is particularly important for children growing up in poverty or in Low- and Middle-Income Countries (LMICs) where significant challenges occur as a result of economic and social disadvantage. Resilience at the individual level is unlikely to eliminate macrolevel issues. Developing and deploying strategies to enhance the ability of youth to rebound from adversity represents a positive step at the micro level, but the larger issues of economic and social disadvantage are unlikely to change without macro-level interventions. Glancing toward the future, traumatized youth may grow into traumatized adults without appropriate interventions and changes in social policies, programs, and protections. Full article

Background/Objectives: Syphilis, a re-emerging global public health issue, has shown increasing incidence over the past decade, particularly among key populations such as men who have sex with men (MSM), people living with HIV, and pregnant women. This narrative review aimed to synthesize global epidemiological trends of syphilis from 2015 to 2025, with a focus on surveillance gaps, regional disparities, and structural determinants. Methods: A broad narrative approach was used to collect and analyze epidemiological data from 2015 to 2025. The literature was retrieved from databases (PubMed, Scopus) and official reports from the WHO, CDC, and ECDC. Included materials span observational studies, surveillance reports, and modeling data relevant to global trends and public health responses. Results: Globally, syphilis incidence has increased, with notable surges in North America, Europe, and Asia. MSM remain disproportionately affected, while congenital syphilis is resurging even in high-income countries. Low- and middle-income countries report persistent burdens, especially among women of reproductive age, often exacerbated by limited screening and surveillance infrastructure. The COVID-19 pandemic disrupted syphilis-related services and further exacerbated underreporting, hindering timely detection and response efforts. Surveillance systems vary widely in their completeness and quality, which significantly hinders global data comparability and coordinated public health responses. Conclusions: Despite its curability, syphilis continues to spread due to fragmented prevention strategies, inequities in access to care, and insufficient surveillance. Strengthening diagnostic access, integrating prevention efforts into broader health systems, and addressing social determinants are essential. Improved surveillance, equitable access, and innovation—including diagnostics and potential vaccine research—are critical to controlling the global syphilis epidemic. Full article

Background: Community-acquired pneumonia (CAP) is the leading cause of mortality in children from middle- to low-income countries; diagnosing CAP includes clinical evaluation, laboratory testing and pulmonary imaging. Lung ultrasound (LUS) is a sensitive, accessible, non-invasive, non-radiant method for accurately evaluating the lung involvement in acute diseases. Whether LUS findings can be correlated with CAP’s severity or sepsis risk remains debatable. This study aimed to increase the importance of LUS in diagnosing and monitoring CAP. We analyzed 102 children aged 1 month up to 18 years, hospital admitted with CAP. Mean age was 5.71 ± 4.85 years. Underweight was encountered in 44.11% of children, especially below 5 years, while overweight was encountered in 11.36% of older children and adolescents. Patients with CAP presented with fever (79.41%), cough (97.05%), tachypnea (18.62%), respiratory failure symptoms (20.58%), chest pain (12.74%) or poor feeding. Despite the fact that 21.56% had clinically occult CAP and six patients (5.88%) experienced radiologically occult pneumonia, CAP diagnosis was established based on anomalies detected using LUS. Conclusions: Detailed clinical examination with abnormal/modified breath sounds and/or tachypnea is suggestive of acute pneumonia. LUS is a sensitive diagnostic tool. A future perspective of including LUS in the diagnosis algorithm of CAP should be taken into consideration. Full article

Cadmium is widely recognized as an important environmental toxicant that may give rise to kidney dysfunction, bone disease, and cancer in humans and animals. Kidney dysfunction occurs at very low exposures and is often considered as the most sensitive or critical effect. Cadmium exposures of concern occur in many countries. In low- and middle-income countries with small-scale mining, excessive exposure to cadmium and other metals occurs in occupational and environmental settings. This is of particular importance in view of the growing demand for metals in global climate change mitigation. Since the 1970s, the present authors have contributed evidence concerning the role of metallothionein and other factors in influencing the toxicokinetics and toxicity of cadmium, particularly as it relates to the development of adverse effects on kidneys in humans and animals. The findings gave a background to the development of biomarkers employed in epidemiological studies, demonstrating the important role of metallothionein in protection against cadmium-induced kidney dysfunction in humans. Studies in cadmium-exposed population groups demonstrated how biomarkers of kidney dysfunction changed during 8 years after drastic lowering of environmental cadmium exposure. Other epidemiological studies showed the impact of a good zinc status in lowering the prevalence of cadmium-related kidney dysfunction. Increased susceptibility to Cd-induced kidney dysfunction was shown in a population with high exposure to inorganic arsenic when compared with a group with low such exposure. Several national and international organizations have used part of the reviewed information, but the metallothionein-related biomarkers and the interaction effects have not been fully considered. We hope that these data sets will also be included and improve risk assessments and preventive measures. Full article

Infant clothing represents a critical yet overlooked exposure pathway for heavy metals, with significant implications for child health and sustainable consumption. This study investigates cadmium (Cd) and chromium (Cr) contamination in 33 textile samples, integrating in vitro bioaccessibility assays, cytotoxicity analysis, and risk assessment models to evaluate dermal exposure risks. Results reveal that 80% of samples exceeded OEKO-TEX Class I limits for As (mean 1.01 mg/kg), Cd (max 0.25 mg/kg), and Cr (max 4.32 mg/kg), with infant clothing showing unacceptable hazard indices (HI = 1.13) due to Cd (HQ = 1.12). Artificial sweat extraction demonstrated high bioaccessibility for Cr (37.8%) and Ni (28.5%), while keratinocyte exposure triggered oxidative stress (131% ROS increase) and dose-dependent cytotoxicity (22–59% viability reduction). Dark-colored synthetic fabrics exhibited elevated metal loads, linking industrial dye practices to health hazards. These findings underscore systemic gaps in textile safety regulations, particularly for low- and middle-income countries reliant on cost-effective apparel. We propose three policy levers: (1) tightening infant textile standards for Cd/Cr, (2) incentivizing non-toxic dye technologies, and (3) harmonizing global labeling requirements. By bridging toxicological evidence with circular economy principles, this work advances strategies to mitigate heavy metal exposure while supporting Sustainable Development Goals (SDGs) 3 (health), 12 (responsible consumption), and 12.4 (chemical safety). Full article

Although intracranial hypertension (ICH) has traditionally been framed as simply a numerical escalation of intracranial pressure (ICP) and usually dealt with in its clinical form and not in terms of its complex underlying pathophysiology, an emerging body of evidence indicates that ICH is not simply an elevated ICP process but a complex process of molecular dysregulation, glymphatic dysfunction, and neurovascular insufficiency. Our aim in this paper is to provide a complete synthesis of all the new thinking that is occurring in this space, primarily on the intersection of glymphatic dysfunction and cerebral vein physiology. The aspiration is to review how glymphatic dysfunction, largely secondary to aquaporin-4 (AQP4) dysfunction, can lead to delayed cerebrospinal fluid (CSF) clearance and thus the accumulation of extravascular fluid resulting in elevated ICP. A range of other factors such as oxidative stress, endothelin-1, and neuroinflammation seem to significantly impair cerebral autoregulation, making ICH challenging to manage. Combining recent studies, we intend to provide a revised conceptualization of ICH that recognizes the nuance and complexity of ICH that is understated by previous models. We wish to also address novel diagnostics aimed at better capturing the dynamic nature of ICH. Recent advances in non-invasive imaging (i.e., 4D flow MRI and dynamic contrast-enhanced MRI; DCE-MRI) allow for better visualization of dynamic changes to the glymphatic and cerebral blood flow (CBF) system. Finally, wearable ICP monitors and AI-assisted diagnostics will create opportunities for these continuous and real-time assessments, especially in limited resource settings. Our goal is to provide examples of opportunities that exist that might augment early recognition and improve personalized care while ensuring we realize practical challenges and limitations. We also consider what may be therapeutically possible now and in the future. Therapeutic opportunities discussed include CRISPR-based gene editing aimed at restoring AQP4 function, nano-robotics aimed at drug targeting, and bioelectronic devices purposed for ICP modulation. Certainly, these proposals are innovative in nature but will require ethically responsible confirmation of long-term safety and availability, particularly to low- and middle-income countries (LMICs), where the burdens of secondary ICH remain preeminent. Throughout the review, we will be restrained to a balanced pursuit of innovative ideas and ethical considerations to attain global health equity. It is not our intent to provide unequivocal answers, but instead to encourage informed discussions at the intersections of research, clinical practice, and the public health field. We hope this review may stimulate further discussion about ICH and highlight research opportunities to conduct translational research in modern neuroscience with real, approachable, and patient-centered care. Full article