Frontiers in Public Health

The COVID-19 pandemic caused a significant shift in peoples travel behaviors and distractions while driving. This paper aims to investigate the impacts of the COVID-19 pandemic on distracted driving by comparing their behavior before and during the pandemic (from 3/1/2019 to 3/1/2021) in the state of Maryland using a stated preference online survey. Some 158 people were recruited for the survey. Participants were asked about their risky driving behaviors and self-reported distraction both before and during the pandemic. To analyze the results, the Chi-square and posthoc tests with the Bonferroni adjustment were applied. The results showed that during the pandemic, distraction dropped from 25% to 21%. The highest reported distracted driving behavior during the pandemic was using hands-free cell phones (64%), using GPS (75%), and eating or drinking (57%). The respondents daily trips have significantly decreased - about 44% below prepandemic rates. Moreover, using a binary logistic regression, it was revealed that the odds of becoming distracted among participants who used a handheld cell phone before and during the pandemic were 4.5 and 6.6 times higher than others, respectively. The findings of this study shed light on the causes of distraction before and during the pandemic.

In the present study, tuberculosis specialists were surveyed to rate the most effective strategies to eliminate TB as a public health problem by 2050. Then were investigated the most promising emerging technologies for the prevention, diagnosis and treatment of tuberculosis (TB) expected to reach the market by 2035. This Technology Foresight study was specifically carried out by means of a web survey closed questionnaire, which was sent to 29,988 TB specialists worldwide. Of these, 2,657 answers were obtained and analysed. Respondents had demonstrated a high level of academic training (PhD), more than 10 years of professional experience, and a great diversity of both areas of knowledge and geographic reach. In the view of experts, the strategies with the greatest potential impact on epidemic TB were a) shorter time between diagnosis and start of treatment of DS and MDR-TB; b) strengthening tuberculosis control actions in the most vulnerable populations; c) shorter and less expensive regimens for drug resistant MDR/XDR-TB. Regarding the strategies with the highest potential for eliminating TB, our data suggests that the biomedical paradigm is the strongest among the specialists. The most promising technologies expected to reach the market by 2035 selected by the specialists were: (1) new drugs of known chemical classes or new chemical classes; (2) new point-of-care diagnostic tests for DS-TB, drug resistant or multidrug resistant (MDR/XDR)-TB and TB Infection (TBI). We contribute by discussing the most promising technologies and strategies for the elimination of TB in light of social determinants of health models and forecasting studies. We conclude by suggesting that the expected emerging technologies ongoing development will not suffice to end TB by 2050.

This study explores the influence of social determinants of health (SDOH) on follow-up behavior among patients referred to community-based organizations (CBOs) in the Emergency Department (ED) of Long Island Jewish (LIJ) Medical Center. A retrospective analysis was conducted on data collected from 342 patients who were screened for SDOH between February and July 2023. Descriptive statistics and Chi-squared tests were used to identify potential associations between demographic and social factors (race, language, age, gender, employment status, and insurance status) and follow-up rates. The results revealed several trends: non-White patients (73.2%) and non-English speakers (81.8%) followed up more frequently than their counterparts, as did older adults (80.0%) and insured patients (77.8%). However, none of the variables reached statistical significance (all p-values > 0.05). The findings suggest that while demographic and social factors may influence follow-up behavior, the lack of statistical significance could be attributed to the limited sample size. These trends align with previous literature on SDOH and follow-up behavior, highlighting the need for further research with larger, more representative samples. Addressing the complex interplay of SDOH, including factors such as language, insurance, and cultural differences, is crucial for improving follow-up rates and ensuring better health outcomes for underserved populations. Future research should focus on refining referral systems, exploring additional socioeconomic factors, and conducting longitudinal studies to develop more effective strategies for integrating SDOH interventions in healthcare systems.

Lung transplantation recipients (LTx) were susceptible to severe acute respiratory syndrome-corona virus-2 (SARS-Cov-2) and suffered a higher mortality risk than healthy subjects. Here we aim to analyze whether it was appropriate or and valuable to maintain lung transplant programs in medical institutions accepting coronavirus disease 2019 (COVID-19) patients. In this study, the clinical characteristics, laboratory testing and epidemiology survey results of 10 LTx recipients undergoing allograft lung transplantation surgeries in the First Affiliated Hospital of Zhengzhou University during the COVID-19 pandemic were collected. A web-based epidemiology questionnaire was used to collect the information of LTx recipients after discharge. Up to now, none of the LTx recipients or their family members get infected with SARS-CoV-2 during the novel coronavirus pandemic. In conclusion, under the premise of taking appropriate preventive measures during hospitalization and after discharge, the lung transplant program can be maintained in the medical institution that accepts patients with COVID-19.

BackgroundThe COVID-19 pandemic posed unprecedented challenges to healthcare systems worldwide. In densely populated urban areas such as Mexico City, the strain on hospitals was amplified due to the high volume of cases and resource limitations. Understanding the spatial and temporal dynamics of hospital demand is crucial for informing effective public health strategies and improving system resilience. MethodsA retrospective analysis of COVID-19 hospitalization data in Mexico City was conducted utilizing a line-list dataset from the SISVER surveillance system. The analysis included the spatial distribution of hospital demand using the weighted centroid of hospitalizations as well as a model system of the interactions between residential areas and hospitals as a bipartite network. The emergence of giant components in the network was used as indicators of system strain and the relationship between network strain and patient outcomes was evaluated. FindingsHospital demand in Mexico City exhibited significant spatial dynamics, with a northward shift in the weighted centroid of hospitalizations as the pandemic progressed. Despite the changing distribution of cases, a small subset of 17 hospitals managed the majority of hospitalizations. During high-demand periods, the network transitioned to a more disordered state, characterized by a giant component encompassing multiple neighborhoods. This disordered strain was associated with higher case fatality rates, particularly in patients over 40 years of age. InterpretationOur findings highlight the complex, adaptive nature of the healthcare system in response to the pandemic. The emergence of giant components in the hospital demand network can serve as an early warning indicator of the health system overload. Adaptive measures, such as the establishment of temporary COVID-19 units, were effective in mitigating strain. These insights can guide future public health strategies for rapid response and resource allocation in similar crises. FundingThis project was partially funded through CONACYT Project 320557 (to GA-J).

The pandemic of Coronavirus Disease 2019 (COVID-19) and its variants is rapidly spreading all over the world, generating a high number of infections, deaths and negative impact on socioeconomic system of countries. As vaccines and appropriate drugs for treatment of the COVID-19 can reduce the effectiveness in the presence of variants and/or new viral agents, one of the questions in social studies of medicine is effective public policy responses to reduce the impact of COVID-19 global pandemic and similar infectious diseases on health of people and on economies. This study analyzes public policy responses to the pandemic crisis across Italian regions that were the first areas to experience a rapid increase in confirmed cases and deaths of COVID-19. The analysis of regional strategies, from January to July 2020, reveals differences in public policy responses to delay and reduce the height of epidemic peak and to afford health-care systems more time to expand and respond to this new emergency. Veneto Region in North-East Italy has managed health policy responses with: a) a timely and widespread testing of individuals, b) units of epidemiological investigation for tracing all contacts of infected people in an effective contact tracing system. This public policy response has reduced total deaths and the final size of COVID-19 pandemic on health of people. Other regions have done public interventions without a clear strategy and goals to cope with diffusion of COVID-19 and as a consequence, they have had a higher negative impact on public health. Lesson learned can be important to design an effective public policy that can be generalized in different regional and national systems to prevent and/or reduce future epidemics or pandemics similar to the COVID-19.

The outbreak of coronavirus disease 2019 (COVID-19) caused by the recently emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a serious challenge for the healthcare system worldwide. We collected information, which were posted online as of February 25, 2020, on demographic characteristics of the directors of provincial and municipal health committees in China, and analyzed the education level and medical education background according to geographic region or GPD per capita. We found that the overall information disclosure rate is insufficient (63.39%). The mean age of the directors of provincial and municipal health committee was ~54 years. Among the 277 officials whose information is available, those in economically less-developed regions or remote areas had significantly poorer educational background. Regardless of economic status, the proportion of officials with a background of medical education in most regions was low. This might hinder the efficiency of healthcare and public health administration, which requires personnel with a background of medical training.

Frontline rescue workers during the COVID-19 pandemic faced heightened psychological risks, yet existing tools like PHQ-9 and GAD-7 lack crisis-specific relevance and brevity. This study aimed to develop and validate a simplified risk probability scale (SRPS) tailored for rapid self-assessment of depression and anxiety in frontline rescue teams. A cross-sectional survey of 273 frontline workers in Lanzhou, China, was conducted using snowball sampling. Participants completed questionnaires integrating socio-economic, occupational, and psychological metrics, analyzed via univariate, multivariate, and ROC curve analyses. Key findings revealed middle-income earners (3000-4000 CNY/month) faced elevated depression risk [OR=3.666, 95%CI (1.085-12.385), p=0.036], while work stress intolerance strongly predicted anxiety [OR=14.258, 95%CI (4.213-58.983), p<0.001]. The SRPS demonstrated moderate predictive accuracy (depression AUC=0.572, sensitivity=58.2%, specificity=53.7%; anxiety AUC=0.662, sensitivity=72.5%, specificity=64.8%)] but prioritized brevity (10 items) and contextual relevance over diagnostic precision. The tools integration into mobile health platforms offers real-time screening potential, enabling targeted interventions for high-risk groups. This study highlights the necessity of context-specific mental health tools in crisis settings and provides a foundation for scalable, dynamic risk assessment in future public health emergencies.

BackgroundAssessing burnout in physicians is relevant as it can adversely affect both their mental and physical health by also decreasing the quality of care, especially since the onset of the COVID-19 pandemic. This study aimed at standardizing the Copenhagen Burnout Inventory (CBI), a psychometrically sound, worldwide-spread tool, in Italian physicians. MethodsNine-hundred and fifteen Italian physicians were web-administered the CBI, Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7) and General Self-Efficacy Scale (GSE). The present CBI is a self-report questionnaire including 18 Likert items (range=19-90) assessing Personal, Work-related and Client-related Burnout. Client-related adaptation was performed. Construct validity, factorial structure (Confirmatory Factor Analysis) and internal consistency were tested. Diagnostic accuracy was assessed simultaneously against the PHQ-8, GAD-7 and GSE. ResultsAll CBI measures yielded optimal internal consistency (Cronbachs =.90-.96). The CBI met its original three-factor model (CFI=.94; TLI=.93; RMSEA=.09; SRMR=.04), was positively related with the PHQ-8 (r=.76) and GAD-7 (r.=73), whereas negatively with the GSE (r=-.39), and yielded optimal diagnostics (AUC=.93; sensitivity=.91 and specificity=.85 at the optimal cut-off of 69/90). DiscussionThe CBI is a valid, reliable and normed tool to assess burnout levels in physicians, whose use is encouraged in both clinical practice and research as being short-lived, easy to use and openly accessible.

BackgroundChina is now in the midst of period of large population aging, which coincides with a global nurse shortage. What added to this problem is the high turnover rate among nurses. MethodsThe longitudinal national statistics of registered nurses were analyzed in order to provide a broad background to understand and interpret the high turnover rate among nurses properly. ResultsA great number of beds, predominantly hospital-based beds, has been hurriedly prepared for potential inpatients in past two decades, and accordingly the increase of medical professionals especially registered nurses. The workload discrepancies of registered nurses among three tiers of hospitals may come from different sources. ConclusionThis discrepancy is helpful in understanding of high nurse burnout and turnover rate though it seems as inherent systematic problems. A trend of high quality medical service attracting more inpatients has shown, this may cause concerns rather than an satisfied answer, were this trend continued.

OBJECTIVEThis study aimed at determining the magnitude of stress among COVID-19 health workers in Kabwe district. METHODSThe study was a cross-sectional study which recruited 138 health care workers managing COVID-19 cases in Kabwe. Data were collected through structured questionnaires and in-depth interviews. Quantitative data was analyzed using SPSS version 16 while qualitative data was analyzed using Nvivo8. RESULTSThe study obtained 100% responses from the respondents and the prevalence of stress among the respondents was 73%. The nurses were more perceived to experience stress compared to the pharmacy personnel (28% vs. 3%). Similarly, women displayed a higher likelihood of experiencing stress compared to men. Lack of support, increased workload and fear were among the factors leading to stress. CONCLUSIONThe study went out to determine stress among healthcare workers in Kabwe district. It was established that nurses were more vulnerable than groups. And women were found to be more stressed than men. It is therefore recommended that effective and meaningful interventions be put in place to mitigate the impact of long-term psychological distress and physical well-being in healthcare workers during the COVID-19 pandemic and future outbreaks. ARTICLE SUMMARYO_ST_ABSStrengths and limitations of the studyC_ST_ABSO_LIA cross-sectional study method was employed; it does not assist in determining the cause and effect, in addition, the timing of the snapshot may not guarantee representation of the situation overtime. Therefore, there may be need to evaluate the effects of the COVID-19 pandemic on health workers mental requirements using a longitudinal study design. C_LIO_LIThere might have been bias from respondents as the outcomes were self-reported. However, irrespective of the aforementioned limitations, this is a novel study in Kabwe describing stress among health workers in the district during the COVID-19 pandemic. C_LIO_LIThe study grants access to initial evidence on stress among health workers managing the COVID-19 pandemic in Kabwe district, with the expectation of drawing the attention to legislators, health facility supervisors and those involved in the response to COVID-19 or impending epidemics. C_LI

BackgroundThe Information Technology (IT) sector is growing and encompasses all professions, from leisure and recreation to hospitals and emergency response groups. IT professionals are experiencing increased threats (e.g., ransomware attacks), but little is known about the relationship between these IT-profession-specific stressors and the professionals mental health. This study aimed to 1) estimate the associations between IT-profession-specific stressors and anxiety, depression, and stress, and 2) examine the role of mental health literacy (MHL) as a mediator of the relationship between depression, anxiety, stress, and help-seeking. MethodsBetween February and May 2023, 388 IT professionals working in the US were surveyed online. Participants reported demographic characteristics, and their MHL, mental health symptoms, and help-seeking intentions were assessed with the following scales: MHL-in the workplace (MHL-W), Center for Epidemiological Studies Depression-10 (CESD-10), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale-10 (PSS-10), and the mental help seeking intention scale (MHSIS). ResultsRespondents who had experienced ransomware attacks in the past year reported significantly higher symptoms of depression, anxiety, and stress. Adapting to rapid changes in technology and business requirements was associated with higher levels of stress. MHL was found to partially mediate the relationship between depression and help-seeking, but not between anxiety or stress and help-seeking. ConclusionThese findings provide insight into the workplace stressors that pose a greater psychological health risk for IT professionals. These results emphasize the important role of MHL in helping facilitate the connection between depressive symptoms and help-seeking.

ObjectivesTo present a model that enhances the accuracy of clinicians when presented with a possibly critical Covid-19 patient. MethodsA retrospective study was performed with information of 5,745 SARS-CoV2 infected patients admitted to the Emergency room of 4 public Hospitals in Madrid belonging to Quiron Salud Health Group (QS) from March 2020 to February 2021. Demographics, clinical variables on admission, laboratory markers and therapeutic interventions were extracted from Electronic Clinical Records. Traits related to mortality were found through difference in means testing and through feature selection by learning multiple classification trees with random initialization and selecting the ones that were used the most. We validated the model through cross-validation and tested generalization with an external dataset from 4 hospitals belonging to Sanitas Hospitals Health Group. The usefulness of two different models in real cases was tested by measuring the effect of exposure to the model decision on the accuracy of medical professionals. ResultsOf the 5,745 admitted patients, 1,173 died. Of the 110 variables in the dataset, 34 were found to be related with our definition of criticality (death in <72 hours) or all-cause mortality. The models had an accuracy of 85% and a sensitivity of 50% averaged through 5-fold cross validation. Similar results were found when validating with data from the 4 hospitals from Sanitas. The models were found to have 11% better accuracy than doctors at classifying critical cases and improved accuracy of doctors by 12% for non-critical patients, reducing the cost of mistakes made by 17%.

The geographical spread of COVID-19 across Chinas provinces provides the opportunity for retrospective analysis on contributors to the timing of the spread. Highly contagious diseases need to be seeded into populations and we hypothesized that greater distance from the epicenter in Wuhan, as well as higher province-level GDP per capita, would delay the time until a province detected COVID-19 cases. To test this hypothesis, we used province-level socioeconomic data such as GDP per capita and percentage of the population aged over 65, distance from the Wuhan epicenter, and health systems capacity in a Cox proportional hazards analysis of the determinants of each provinces time until epidemic start. The start was defined by the number of days it took for each province to reach thresholds of 3, 5, 10, or 100 cases. We controlled for the number of hospital beds and physicians as these could influence the speed of case detection. Surprisingly, none of the explanatory variables had a statistically significant effect on the time it took for each province to get its first cases; the timing of COVID-19 spread appears to have been random with respect to distance, GDP, demography, and the strength of the health system. Looking to other factors, such as travel, policy, and lockdown measures, could provide additional insights on realizing most critical factors in the timing of spread.

BackgroundAlthough exposure to solar radiation is beneficial for humans, too much of it can cause severe health conditions, including sunburn and skin cancer. The biological effects of solar radiation vary enormously with wavelength and exposure time. Ultraviolet and infrared radiations are the two main invisible components of solar radiation, causing skin damage. People are becoming more aware of the significance of sun protection, though little attention is directed to the exposure of the skin to UV and IR radiations through car windows. According to a survey of 1293 participants, mainly from Saudi Arabia, the fact that UV radiation can penetrate through car windows is known by the majority, i.e., 82%. However, the capability of IR radiation to penetrate vehicle windows is unknown to most people. Even though car windows reduce the transmission of ultraviolet and infrared rays, drivers are not isolated from them completely. To the best of our knowledge, this is the first study that measures solar exposure in cars in the middle east region, which is famous for its hot and arid (dry) climate with temperatures reaching over 52{degrees}C. Specifically, this study aimed to determine the driver exposure to UV and IR radiations in Dammam, Saudi Arabia, and emphasize the need to take the necessary measures to avoid exposure to these rays. MethodAn experiment using a PMA2100 datalogger radiometer was conducted inside and outside twenty vehicles. The radiometer measured the transmitted radiation through the front and the side windows. Then, the UV and IR measurements were analyzed and evaluated inside all vehicles. ResultsThe average transmission percentage of ultraviolet through the cars side window was 10.47%, while the front window only transmitted 4.06%. In comparison, the average transmission percentage of infrared through the side window was 30.02% and 39.30% through the front windows. ConclusionThese results highlight the importance of protection against UV and IR radiations since the drivers are exposed to significant UV and IR radiations. Furthermore, the protection methods must be increased in areas with a hot climate, such as the middle east region.

OBJECTIVETo investigate the impact of temperature and absolute humidity on the coronavirus disease 2019 (COVID-19) outbreak. DESIGNEcological study. SETTING31 provincial-level regions in mainland China. MAIN OUTCOME MEASURESData on COVID-19 incidence and climate between Jan 20 and Feb 29, 2020. RESULTSThe number of new confirm COVID-19 cases in mainland China peaked on Feb 1, 2020. COVID-19 daily incidence were lowest at -10 {degrees}C and highest at 10 {degrees}C, while the maximum incidence was observed at the absolute humidity of approximately 7 g/m3. COVID-19 incidence changed with temperature as daily incidence decreased when the temperature rose. No significant association between COVID-19 incidence and absolute humidity was observed in distributed lag nonlinear models. Additionally, A modified susceptible-exposed-infectious-recovered (M-SEIR) model confirmed that transmission rate decreased with the increase of temperature, leading to further decrease of infection rate and outbreak scale. CONCLUSIONTemperature is an environmental driver of the COVID-19 outbreak in China. Lower and higher temperatures might be positive to decrease the COVID-19 incidence. M-SEIR models help to better evaluate environmental and social impacts on COVID-19. What is already known on this topicO_LIMany infectious diseases present an environmental pattern in their incidence. C_LIO_LIEnvironmental factors, such as climate and weather condition, could drive the space and time correlations of infectious diseases, including influenza. C_LIO_LISevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be transmitted through aerosols, large droplets, or direct contact with secretions (or fomites) as influenza virus can. C_LIO_LILittle is known about environmental pattern in COVID-19 incidence. C_LI What this study addsO_LIThe significant association between COVID-19 daily incidence and temperature was confirmed, using 3 methods, based on the data on COVID-19 and weather from 31 provincial-level regions in mainland China. C_LIO_LIEnvironmental factors were considered on the basis of SEIR model, and a modified susceptible-exposed-infectious-recovered (M-SEIR) model was developed. C_LIO_LISimulations of the COVID-19 outbreak in Wuhan presented similar effects of temperature on incidence as the incidence decrease with the increase of temperature. C_LI

BackgroundType 2 diabetes mellitus (T2DM) is a chronic disease that imposes a significant burden on healthcare systems and society. In Vietnam, the prevalence of T2DM is rapidly increasing; however, evidence on treatment expenditure derived from large administrative databases remains limited. This study was carried out provides an overview of total treatment expenditures for T2DM across hospital tiers between 2018 and 2022. MethodsThis cross-sectional descriptive study utilized retrospective health insurance (HI) data from 2018-2022. Data was collected and analyzed based on cost components (medications, diagnostic tests, hospital beds, etc.) across healthcare facilities classified by hospital level. Costs were converted to 2024 USD using the CCEMG-EPPI-Centre cost converter. ResultsTotal expenditure increased from 227.17 million USD in 2018 to 425.53 million USD in 2022 with spending concentrated in Class I and Class II healthcare facilities, although their shares declined over time, while the proportions attributed to unclassified and special-class facilities increased. Drugs accounted for the largest share of expenditure (49.65%-78.95%), followed by laboratory tests (7.31%-19.89%) across all hospital classifications. Other components, including hospital beds, diagnostic imaging, procedures/surgeries, and medical supplies, contributed smaller proportions but increased over time in several facility groups. ConclusionThe study indicates that medication costs constitute the largest share of treatment expenditure for type 2 diabetes mellitus at healthcare facilities, reflecting the long-term treatment requirements of this chronic disease. In addition, health expenditure remained concentrated in Class I and Class II healthcare facilities, although their shares declined over the study period, while the proportions attributed to unclassified and special-class facilities increased. These findings suggest the need to strengthen diabetes screening, treatment, and follow-up at lower-level healthcare facilities in order to reduce the burden on higher-level hospitals and improve the efficiency of healthcare resource allocation.

BackgroundCutaneous Leishmaniasis (CL) is a neglected tropical disease with profound physical, psychological, and social consequences, particularly in low-resource settings. In rural Ethiopia, Tigrai, CL remains poorly understood and heavily stigmatized, shaped by deeply rooted sociocultural perceptions that interpret the disease through supernatural, moral, and spiritual frameworks. These beliefs affect how affected individuals are perceived and treated within their communities, often resulting in social exclusion and delays in care. Methodology/principal findingsThis ethnographic study was conducted in rural districts of northern Ethiopia, Tigrai, using ethnographic field observations, in-depth interviews, and focus group discussions with affected individuals, caregivers, Health Extension Workers (HEWs), and Community Advisory Group (CAG) members. Findings reveal that CL is widely perceived as a condition linked to divine punishment, impurity, or ancestral curses. These beliefs contribute to stigma, emotional distress, and restricted social participation, especially among women and children. Structural barriers including economic hardship, limited access to biomedical care, and poor health literacy further exacerbate the disease burden. While HEWs and CAGs attempt to address misconceptions and promote treatment uptake, their efforts are constrained by systemic resource limitations and community resistance. Conclusions/significanceCL in rural Ethiopia, Tigrai, is not only a biomedical issue but also a socially constructed and culturally embedded affliction. Addressing the disease requires a holistic public health response that integrates ethnographic insights, respects local belief systems, and prioritizes stigma reduction and community engagement. These findings contribute to a growing body of literature emphasizing the need for culturally sensitive, equity-driven approaches in global NTD programming. Author summaryCL is a skin disease caused by parasites and transmitted by sandflies. While it may not cause death, it often leads to visible skin scars that have serious emotional, social, and economic impacts especially in rural areas with limited access to healthcare. In this study, we explored how people living in rural Ethiopia, Tigrai region, experience and understand CL. Through interviews, focus group discussions, and field observations, we found that many community members believe CL is caused by supernatural forces, divine punishment, or moral wrongdoing. These beliefs cause people with CL to be stigmatized and socially excluded, particularly women and children. People often turn to traditional remedies instead of modern treatment, which delays recovery. We also learned that community health workers try to educate people and support treatment, but they face many challenges. Our study shows that treating CL should involve more than just medicine it must include efforts to reduce stigma, engage communities, and understand local beliefs. These findings can help improve public health programs for CL and similar neglected diseases.

Background: In crises, hospitals must rapidly shift from routine operations to structured crisis management, requiring the activation of an incident command system. However, empirical insight into their operational functioning during activation remains limited. Goal: to identify operational enablers and barriers influencing effective crisis response. Methods: Prospective cross-sectional, qualitative, single-center study conducted after a table-top exercise within a hospital incident command system at a tertiary care university hospital (NCT06913010). Data was collected through semi-structured interviews, participant observation, and document analysis, and analyzed using a narrative-phenomenological approach. Results: Nineteen participants were included. Analysis identified nine thematic clusters shaping operational performance: (1) structure and roles; (2) communication; (3) decision-making and prioritization; (4) information management; (5) infrastructure and technology; (6) personnel and organization; (7) training, exercises, and team dynamics; (8) documentation; and (9) external communication and media. Enablers included clear role definition, structured communication, phased decision-making, and regular training. Barriers included role ambiguity, fragmented communication, insufficient prioritization, infrastructure limitations, and staffing constraints. Conclusion: Preparedness frameworks are necessary but insufficient as stand-alone approaches, as operational execution determines real-world performance. Recurring deficits included unclear roles, inconsistent communication, weak prioritization, and gaps in infrastructure and personnel. A limited set of standardized practices - including a clear separation od roles, leadership intent, closed-loop communication, explicit decision cycles from information gathering to structuring to decision-making, checklists, visualization, central information management, and rapid "80% decisions"-substantially enhanced performance. Mission command (Auftragstaktik) further enabled adaptive, coordinated action. Strengthening hospital incident command is a key lever for achieving system-level resilience in crises.

BackgroundMalignant skin melanoma (MSM), a highly aggressive skin cancer from melanocytes, has a higher mortality rate than other skin cancers due to its metastatic nature. Despite advancements in diagnostics and treatment, melanoma remains a significant health concern in China. MethodsData from the Global Burden of Disease (GBD) 2021 database was utilized to analyze MSM trends in China from 1990 to 2021. Statistical analyses, including Joinpoint regression and decomposition analysis, were employed to examine changes in incidence and mortality. The ARIMA model was used to project age-standardized incidence and mortality rates through 2036. ResultsIn 2021, China reported approximately 13,437 new cases of MSM, with a total patient population of 81,219 and 5,373 MSM-related deaths. Between 1990 and 2021, the incidence and prevalence rates of MSM significantly increased, while mortality rates showed a slight decline. The highest incidence rate was observed in the 55-59 age group, with males facing notably higher risks than females. Joinpoint regression analysis indicated rapid Age-Standardized Incidence Rate (ASIR) growth from 2004 to 2012, and decomposition analysis identified population aging as the primary driving factor. ARIMA forecasts suggest that by 2036, ASIR will reach 0.88 for males and 0.71 for females, while Age-Standardized Death Rate (ASDR) will stabilize or decline. ConclusionThe MSM burden in China has intensified, with increasing incidence and prevalence rates over time. Although mortality rates have declined slightly, the impact of melanoma on public health remains significant.