Search Results (1,942)

Ebola alerts reveal the truth about preparedness. They show whether a health system can recognize danger early, protect health workers, isolate and care for patients, trace contacts, communicate clearly, and sustain public trust before fear replaces cooperation. In the Pandemic Agreement Era, this truth has become harder to ignore. The 2026 Bundibugyo virus disease outbreak in the Democratic Republic of the Congo and Uganda is a sharp reminder that the principles of pandemic prevention, preparedness, response, equity, and cooperation become meaningful only when they work where the first cases occur. In the absence of licensed vaccines and specific treatments for Bundibugyo virus disease, preparedness depends on the basic functions of public health: surveillance, diagnosis, infection prevention and control, referral, risk communication, community engagement, and operational coordination. These functions are often described as routine. They are not. During high-consequence infectious disease alerts, they serve as the primary protective infrastructure. Ebola also exposes a deeper ethical failure. Frontline countries and communities are expected to contain threats of global relevance, but international support often intensifies only after the risk becomes visible beyond the affected area. This reactive model is neither fair nor efficient. The WHO Pandemic Agreement defines a political direction for a more equitable and coordinated global response. Here, Ebola is not presented as a typical pandemic event but as an operational test of preparedness, solidarity, early support to affected settings, and international cooperation. Ebola alerts test whether that direction can become an operational reality before escalation. Digital tools, telemedicine, and artificial intelligence may strengthen this agenda but only when they make local systems faster, safer, more trusted, and more usable. Ebola preparedness is therefore not only a technical task. It is a test of responsibility. Full article

Healthcare workers (HCWs) and medical providers are regularly exposed to a wide range of infectious diseases in the course of their duties. This occupational risk is significant in the context of highly contagious infections such as measles, which can spread rapidly in healthcare institutions. This study aimed to assess the seroprevalence of protective anti-measles and anti-rubella IgG antibodies and factors influencing immunity among HCWs across all 28 districts in Bulgaria. Methods: A total of 1854 individuals, including 540 (29%) doctors and 1314 (71%) medical specialists from all 28 districts in Bulgaria, were screened for protective immunity against measles and rubella. Serum samples were analyzed for the presence of protective IgG antibodies by ELISA (Enzyme-Linked Immunosorbent Assay) using commercial EUROIMMUN Anti-Measles/Anti-Rubella Virus IgG ELISA kits. According to the manufacturer’s instructions, the results were interpreted semi-quantitatively as positive, negative, and equivocal. Results: Anti-measles protective IgG antibodies were detected in 86.1% of participants for measles and in 95.2% for rubella. Our study found a statistically significant difference when analyzing demographic factors (age) for measles: the samples from older participants (over 50-year-old persons) were characterized by higher immunity levels; staff working in non-infectious-disease wards (n+ = 95.7%) were more frequently positive for rubella IgG antibodies compared to staff employed in infectious wards; and region locations varied for both groups. Gender and professional roles were not significant predictors. Conclusions: HCWs are at a greater risk of contracting infections than the general public because they have contact with sick patients or infectious material. Their vaccination or IgG immunity status must be strictly monitored, especially to limit the spread of nosocomial infections in hospital settings. Full article

The ongoing Bundibugyo virus disease outbreak in the Democratic Republic of the Congo and Uganda has become the largest documented outbreak caused by this orthoebolavirus and already ranks as the second-largest Ebola disease outbreak recorded in history. This review highlights its major public health relevance, given its cross-border spread, substantial mortality burden, high clinical severity, infections among healthcare workers, and the lack of any approved vaccine or specific treatment for Bundibugyo virus disease. We discuss the epidemiological and virological significance of this exceptional event, the limitations of current diagnostic and therapeutic preparedness beyond Ebola virus, and the urgent need for broader filovirus-focused strategies, including improved diagnostics, genomic surveillance, candidate vaccines, antiviral platforms, and resilient local health systems. The outbreak illustrates how preparedness efforts centered mainly on the Ebola virus have left substantial gaps for other human-pathogenic orthoebolaviruses. Full article

Background: Leptospirosis is a neglected tropical disease with substantial public health impact in Brazil, closely associated with socio-environmental vulnerabilities and climatic extremes. This study analyzed the epidemiological profile and spatiotemporal distribution of leptospirosis incidence and lethality rates in Brazil from 2015 to 2024. Methods: An ecological time-series study was conducted using secondary data from the Notifiable Diseases Information System (SINAN). Variables included geographic region, probable infection environment, and occupational and educational level (ISCED-2011). Results: A total of 31,397 cases were notified, with an annual average of 3140 cases. The South and North regions exhibited the highest incidence rates, while the Northeast and Southeast presented lethality rates above the national average (9.20%). A marked reduction in notifications occurred during the COVID-19 pandemic. Infections occurred predominantly in the domiciliary environment (64%). Rural workers (27.45%) and civil construction workers (18.63%) were the most affected occupational groups, with a higher incidence rate among illiterate and low-education populations. Conclusions: The dynamics of leptospirosis in Brazil are complex and multifactorial, influenced by climatic variations and driven by deficits in basic sanitation and education level. Mitigating the disease burden requires sustained, region-specific public health strategies, targeted infrastructure improvements, and enhanced epidemiological surveillance to address underreporting. Full article

Background/Objectives: Occupational contact dermatitis (OCD) is the most common work-related skin disease, accounting for roughly 90–95% of occupational dermatoses and falling predominantly on the hands. It is rarely dangerous yet imposes a substantial burden through impaired quality of life, lost productivity, and premature exit from affected trades. The COVID-19 pandemic intensified this burden among healthcare workers, in whom the pooled one-year prevalence of self-reported hand eczema reaches around 27%; meta-analytic data link the increased risk principally to frequent handwashing and wet work rather than to alcohol-based hand rub. Methods: This narrative review, which follows a non-systematic, thematically organised search strategy rather than PRISMA methodology, integrates current evidence on the epidemiology, pathophysiology, diagnosis, prevention, and management of OCD, with particular emphasis on the self-reinforcing cycle linking skin barrier disruption, microbiome dysbiosis, and antimicrobial-peptide dysregulation to inflammation. Results: We critically appraise the prevention evidence, foregrounding the low certainty of the existing trial base and the tension between the randomised trials of primary and secondary prevention, which have been null, and the encouraging but uncontrolled results of structured tertiary-prevention programmes. We summarise recent therapeutic advances, including topical delgocitinib, and situate the field within the World Health Organisation’s 2025 recognition of skin diseases as a global public health priority. Established evidence and hypotheses are kept separate throughout: we additionally advance, explicitly as a conjecture rather than as a demonstrated mechanism, a conceptual trans-kingdom dialogue model in which protease-generated LL-37 fragments may modulate staphylococcal quorum sensing, and each step of that model is labelled according to whether the supporting evidence is direct, extrapolated, or as yet untested. Conclusions: We argue that the prevention failure is less one of biology than of trial design and measurement, and outline the research needed to close the gap. Full article

Infectious diseases remain a major global public health concern, disproportionately causing morbidity and mortality in low- and middle-income countries. Sexually Transmitted Infections (STIs) heavily affect sexually active populations. Sex workers, encompassing female sex workers (FSWs), male sex workers (MSWs), and transgender/gender-diverse individuals, face heightened vulnerabilities due to occupational exposures, structural barriers, stigma, and criminalization. While substantial focus has historically centered on HIV, non-HIV STIs such as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and viral hepatitis present significant co-morbidity. Crucially, drug resistance across these pathogens presents distinct biological and epidemiological challenges: bacterial antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis, antiretroviral (ARV) resistance in HIV, and direct-acting antiviral (DAA) resistance in hepatitis B and C. This perspective article synthesizes the current epidemiological landscape, critiques the reliance on syndromic management over molecular diagnostics (e.g., NAATs, point-of-care, and genomic surveillance), highlights diagnostic stewardship, and outlines priority public health strategies aligned with the WHO 2022–2030 Global Health Sector Strategies. Full article

People living with HIV (PLHIV) are at an increased risk of progressing from Mycobacterium tuberculosis (TB) infection to TB disease. Tuberculosis preventive treatment (TPT) is recommended for PLHIV; however, its uptake remains suboptimal. In Zimbabwe, three months of weekly rifapentine and isoniazid (3HP) and six months of daily isoniazid (6H) are the most commonly prescribed TPT regimens. We explored barriers to TPT uptake among PLHIV from the perspective of healthcare workers (HCWs) in Zimbabwe. Facility nurses who had been implementing TPT for at least six months were invited to participate in in-depth interviews and/or focus group discussions conducted in March 2023. Audio recordings were transcribed into English, coded using NVivo 12 (QSR International), and analyzed thematically. Eleven HCWs participated in in-depth interviews and 15 in focus group discussions. Barriers were categorized as person- and health system-related. Person-related barriers included misconceptions about TPT, fear of adverse events, and pill burden. Health system barriers included stock-outs of TPT medications, limited HCW knowledge and skills to promote TPT, limited expertise in initiating TPT among children under five years of age, and limited access to chest radiography. Barriers to TPT uptake and completion remain in Zimbabwe and contribute to missed opportunities for TB prevention among PLHIV. TPT implementation could be strengthened through an uninterrupted supply of TPT medications, continuous training and mentorship of HCWs, and community engagement to improve awareness of the benefits and risks of TPT. Full article

Background/Objective: This study aimed to develop and validate an automated framework for detecting pleural plaques (PPs) at the patient level using a single chest CT scan. Methods: A database of chest CT scans with corresponding individual binary annotations for PP presence was first established through expert visual assessment, based on consensus among a board of specialized radiologists. This dataset served to train and validate a patient-level classification framework for automated PP presence detection. This framework leverages a pre-trained PP segmentation network, thus obviating the need for retraining large-scale deep learning models. This segmentation backbone is supplemented by a lightweight classification module that integrates the network’s outputs to infer the presence or absence of PPs at patient level. Furthermore, a patch-wise processing strategy was employed to optimize computational efficiency and training time while retaining critical local contextual information. Results: The framework was evaluated on a cohort of 1241 retired workers with documented occupational asbestos exposure, using 10-fold cross-validation (30% training, 10% validation, 60% testing). It achieved a balanced accuracy of 97.0%, sensitivity of 96.6%, and specificity of 97.4%, demonstrating performance slightly superior to that of two expert radiologists (balanced accuracy: 90.9%/91.4%, sensitivity: 88.0%/88.8%, specificity: 93.9%/94.1% for Expert1/Expert2) and substantially superior to that of a radiologist without specialized expertise in asbestos-related manifestations (balanced accuracy: 80.0%, sensitivity: 75.1%, specificity: 84.8%). Conclusion: The proposed framework demonstrates strong potential for automated patient-level identification of pleural plaques from a single CT scan. Our approach could be particularly useful in screening settings that involve compensation claims related to occupational diseases. Full article

Healthcare workers experienced substantial psychosocial challenges during the coronavirus disease 2019 (COVID-19) pandemic, yet longitudinal evidence on changes in work-related pleasure, suffering, and harm remains limited. This study investigated longitudinal changes in psychosocial risk indicators among Brazilian healthcare professionals during two phases of the pandemic. A prospective observational study was conducted with 113 healthcare professionals who completed two online assessments in April–June 2020 (T1) and November 2020–January 2021 (T2). Work-related pleasure and suffering were assessed using the Scale of Indicators of Pleasure and Suffering at Work (EIPST), and work-related harm was evaluated using the Work-Related Harm Assessment Scale (EADRT). Paired comparisons were performed using paired t-tests with bootstrap confidence intervals; effect sizes were estimated using Cohen’s d and probability of superiority. After adjustment for multiple comparisons, statistically significant reductions remained for professional burnout (p = 0.001; d = 0.31) and psychological harm (p = 0.006; d = 0.26). Although overall work-related suffering showed a nominally significant reduction (p = 0.034; d = 0.21), this finding did not remain statistically significant after adjustment for multiple comparisons. The corresponding effect sizes were small, and most psychosocial risk indicators remained within critical risk classifications at both assessments. Professional fulfillment changed from a critical to a satisfactory classification, although its longitudinal difference was not statistically significant. These findings suggest modest reductions in psychosocial distress over time while highlighting the persistence of critical psychosocial risks. Organizational strategies aimed at preventing psychosocial hazards and promoting healthy working conditions remain essential to protect healthcare workers during routine practice and future public health emergencies. Full article

Alcohol consumption is associated with significant social and economic challenges for nations worldwide, including alcohol-related healthcare costs and alcohol-related crime. According to the U.S. Center for Disease Control (CDC), even moderate drinking correlates with greater health risks compared with not drinking at all. These health risks include physical harm to a person’s heart, brain, liver, and other organs; impaired social functioning; reduced work performance; and increased incidence of alcohol-related violence and injury (e.g., physical and sexual assault and drunk driving-related injuries and death). Although personal health and social problems are correlated with alcohol consumption across genders, women experience disproportionately worse problems associated with alcohol-related crime and family disruption. At the societal level, alcohol use coincides with substantial negative economic problems, including increased healthcare costs, often covered by the government; reduced worker productivity; and higher criminal justice system costs. This paper applies an econometric analysis to evaluate the association between alcohol consumption and key social and economic factors and suggests actions that business firms, government entities, universities, and other organizations can take to reduce alcohol-related harm, such as encouraging sobriety in the workplace, offering alcohol-related counseling services, and not establishing associations with nor accepting payments of any kind from alcohol beverage companies. The findings have implications for business managers, government leaders, policy-makers, and others. Full article

Background: Palliative care is a clinically, relationally and emotionally demanding field. Continuous exposure to suffering and death exposes professionals to compassion fatigue, vicarious trauma and grief, and burnout, while also offering opportunities for compassion satisfaction and meaning-making. How professionals cope is central to sustaining the supporting role in diseases with a poor prognosis. Objectives: To explore the emotional and experiential dimensions of palliative care work and the coping strategies, individual and team-based, that professionals deploy when accompanying patients and families at the end of life. Methods: Reflexive thematic analysis of 16 semi-structured interviews with palliative care professionals (5 physicians, 7 nurses, 3 psychologists, and 1 social-health worker; 14 women and 2 men) recruited from hospices, hospital wards and home-based services in Northern Italy. Sample size was guided by an information power model. Reporting follows the COREQ checklist. Results: Four themes were constructed: (1) the unsustainability of the workload; (2) the pleasure of care between empathic relationship, listening and welcoming; (3) the holistic role of the professional; and (4) the awareness of death. Across themes, participants mobilised a layered repertoire of problem-, emotion- and meaning-focused coping. Narratives fitting a structured moral-distress pattern were comparatively limited in participants’ accounts. Conclusions: Sustaining supporting roles in poor-prognosis care may require more than individual resilience; it depends on organisational support—structured supervision, reflective spaces, and communication and emotional training—that makes professionals’ largely informal coping work a shared and sustainable resource. Full article

Community pharmacies are increasingly providing health care services like tobacco treatment and disease-related management but need sustainable models for implementation. As several state Medicaid programs reimburse for community health worker (CHW) services, one promising model is to have pharmacy technicians engage with patients as designated CHWs. This qualitative study interviewed staff in seven California pharmacies about their experience with and perspectives on implementing community pharmacy technicians as CHWs. Guided by implementation science frameworks, data were hand-coded and analyzed iteratively using thematic analysis. Relative advantage and compatibility of CHWs was high across all pharmacies. Pharmacy culture aligned with CHW values, and CHW integration helped formalize the work that pharmacy staff were already doing. Challenges included the complexity of billing and obtaining payment for services provided. Despite these barriers, pharmacies successfully integrated and expanded their CHW services, ranging from social service connections to tobacco treatment or disease-related management education. Pharmacy peer networks, health plan champions and patient outcome improvements accelerated diffusion. Community pharmacies provide a trusted setting for delivering both CHW education and extending health care services, but broad implementation will need health plans to improve policy and procedure with guidance specifically for the pharmacy context that helps overcome administrative barriers. Full article

Climate change is increasing the frequency, intensity, and duration of heatwaves, making extreme heat a recurrent public health challenge with important nutritional implications. High ambient temperatures affect human health through thermoregulatory strain, sweating, dehydration, electrolyte imbalance, cardiovascular and renal stress, impaired cognitive and physical performance, and exacerbation of chronic diseases. Diet and hydration may therefore represent modifiable, although still underinvestigated, components of heat-health prevention. This narrative review synthesizes evidence on hydration, electrolyte balance, meal composition, dietary quality, vulnerable populations, Mediterranean dietary patterns, seasonality, environmental sustainability, and public health strategies for reducing heat-related health risks. Evidence from climate-health research, physiology, nutrition science, occupational and sports medicine, geriatrics, pediatrics, and public health guidance was integrated. Particular attention was given to distinguishing direct heat-health evidence from recommendations based on indirect evidence, physiological plausibility, or expert consensus. Regular water intake, water-rich foods, avoidance of alcohol, moderation of sugar-sweetened beverages, and individualized electrolyte replacement during prolonged or intense sweating are supported by physiological rationale and public health guidance, although direct heatwave-specific intervention studies remain limited. Dietary recommendations should prioritize smaller, digestible, nutrient-dense meals that preserve nutritional adequacy while reducing unnecessary digestive and metabolic burden. However, evidence on meal size, macronutrient composition, and heat-related outcomes remains largely indirect. Vulnerable groups, including older adults, children, pregnant women, individuals with chronic diseases, outdoor workers, athletes, and socioeconomically disadvantaged populations, require tailored strategies. The Mediterranean diet may provide a useful regional model because it emphasizes seasonal plant foods, fruits and vegetables with high water content, legumes, whole grains, olive oil, culinary simplicity, and environmental sustainability; however, its specific role in heat adaptation requires further study. Integrating nutrition and hydration into heat-health action plans may improve preparedness and support climate-resilient food systems. Future studies should evaluate hydration protocols, meal patterns, Mediterranean diet adherence, biomarkers of nutritional heat resilience, and nutrition-sensitive interventions in real-world heat exposure settings. Full article

Background/Objectives: Empowerment strategies promoting healthy behaviors are important for preventing chronic diseases and cancer, while individual health responsibility (IHR) plays a significant role. Although widely discussed in the literature, the concept of IHR does not have clearly defined domains or a validated instrument for assessment. Its overlap with locus of control theory, self-motivation, and personality type creates further difficulties. Meanwhile, perception of one’s own responsibility for health is an intuitive, simple item to answer, reflecting a person’s belief related to this topic. Moreover, for ethical reasons, this concept cannot be separated from personal beliefs and should not be adjusted according to strict scales and externally imposed definitions. Therefore, this study aimed to: (1) explore whether there is an association between self-perception of IHR and preventive/risk-taking behaviors; and (2) examine socio-demographic factors associated with the IHR score and three self-perceived characteristics, namely self-perceived locus of control, health literacy, and health status. Methods: A cross-sectional study with 968 healthcare workers was conducted in a large, multidisciplinary hospital covering several behaviors (smoking, alcohol consumption, diet, and participation in a screening program for hepatitis C). IHR was evaluated on a scale from 1 to 10, where 1 meant “to very little extent” and 10 meant “to a great extent”. Results: The average IHR score was 8.80 (SD = 1.88). In the univariate analysis, the IHR score was significantly related to gender, age, education, marital status, and all three personal characteristics. In the multivariate analysis, the socio-demographic associations lost statistical significance. IHR maintained its association with the healthy diet score in the multivariable model (B = 0.113, p = 0.036). In the unadjusted analyses, the distribution of IHR differed between participants who declared alcohol consumption and those who declared abstinence (χ² = 17.157, p = 0.002). However, this association was not retained in the multivariable model. Self-perceived internal locus of control was negatively associated with screening acceptance, but not with IHR. The OR of 0.927 refers to a one-point increase on the 1–10 scale. Across the full observed scale range, this corresponds to an OR of 0.51 (95% CI: 0.29–0.89), indicating lower odds of screening acceptance among participants with higher perceived internal control. Because this estimate assumes linearity across the entire scale, it should be interpreted cautiously. Conclusions: The gap between perceived responsibility and actual behavior suggests that IHR messaging alone is unlikely to be sufficient. Future research should consider social desirability and external locus of control when analyzing IHR and health behaviors. Full article

Non-communicable diseases (NCDs) represent a growing challenge for developing countries, as they are among the leading causes of morbidity and mortality within the working-age population. Beyond their effects on health outcomes, NCDs are associated with reductions in labor productivity, which may influence long-term development dynamics through human capital. This study estimates the conditional labor productivity penalty associated with Non-Communicable Diseases (NCDs) among employed workers in Mexico using an observational high-dimensional framework. By addressing high-dimensional confounding under the Conditional Independence Assumption (CIA), the analysis isolates the relationship between NCD status and hourly labor earnings. Using microdata from the Mexican National Survey of Household Income and Expenditure, labor productivity is defined as the ratio of labor income to hours worked. To obtain robust causal estimates, a Double Machine Learning (DML) framework is implemented, integrating regularized regression and machine learning algorithms to control for high-dimensional confounding factors. These covariates include socioeconomic, demographic, and health-related variables, allowing for flexible adjustment of observable heterogeneity across individuals. The empirical findings demonstrate a statistically significant conditional negative penalty of −11.44% (p = 1.03 × 10⁻¹¹, 95% CI: [−14.59, −8.40]) on hourly labor earnings under the cross-fitted DML specification using XGBoost and Random Forest. To resolve an observational measurement artifact where chronic individuals report artificially inflated hourly wages due to severe hours contraction, a presenteeism adjustment factor ($\theta *=0.8125$) was calibrated. Incorporating this presenteeism correction, the aggregate national economic burden among the employed population is estimated at approximately 496.82 billion pesos annually. The findings suggest that NCDs constitute a relevant constraint on labor productivity at the microeconomic level. The study highlights the importance of prevention-oriented health strategies, workplace health promotion, and early disease management. From a methodological perspective, the results illustrate the usefulness of Double Machine Learning for purging high-dimensional confounding in cross-sectional survey data, providing robust conditional empirical benchmarks for public health policy. Full article