Public Health in Practice

BackgroundSexual violence (SV) is a major public health problem with far-reaching consequences; however, adolescent survivors rarely seek help. This underestimates the prevalence of SV and undermines prevention and response efforts. This study was conducted to determine the prevalence and reporting of sexual violence among adolescents in Ibadan, Nigeria. MethodsBetween September and October 2021, a cross-sectional study was conducted among 360 in-school adolescents in Ibadan South-West local government area, Nigeria. Adolescents were selected using multi-stage sampling. Information on experience and reporting of sexual violence was obtained with the aid of an interviewer-administered questionnaire. Data were analysed using descriptive and inferential statistics at p[≤]0.05 level. ResultsRespondents mean age was 14.6{+/-}1.7 years, and 50% were female. Thirty-five per cent reported at least one incident within the past 12 months. Forms of sexual violence experienced included unwanted sexual touch (25.6%), forced sex (19.2%), attempted rape (15.2%), and suggestive comments (9.6%). Seventy per cent of adolescents who experienced sexual violence did not report to anyone; reasons included fear of getting in trouble (46.6%), thinking it was not a problem (31.8%), feeling it was their fault (30.7%), and embarrassment for self/family (27.3%). Adolescents who were closer to their mothers and younger adolescents were more likely to report their experience of sexual violence (p=0.006 and p=0.038, respectively). ConclusionSexual violence is common among in-school adolescents in Ibadan, yet reporting remains low. This study highlights the need to strengthen prevention and address barriers to reporting among adolescent survivors. Key MessageO_ST_ABSWhat is already known on this topicC_ST_ABSSexual violence has physical, psychological, and social consequences on the health and well-being of adolescent survivors, and low levels of reporting and help-seeking contribute to these consequences. What this study addsThis study provides evidence on the prevalence and reporting patterns of sexual violence among adolescents in Ibadan, Nigeria. It highlights key barriers and facilitators of reporting. How this study might affect research, practice, or policyThis study provides information about factors at individual, relationship, societal and policy levels that are associated with reporting and help-seeking among adolescent survivors of sexual violence in Ibadan, Nigeria. This highlights the importance of training stakeholders, such as parents, teachers, health workers, other caregivers and the adolescents themselves, on responding to sexual violence experience and reporting. It underscores the need for improved adolescent-friendly services, policy implementation and collaboration across families, schools, communities and states to address sexual violence.

Introduction: Solitary plasmacytomas (SP) are rare neoplasm of localised proliferation of clonal plasma cells. It can be classified based on site of involvement and bone marrow involvement. It is an indolent disease in the majority of patients. Primary modality of treatment is radiotherapy and surgical excision. Materials and methods: This was a retrospective audit of SP who were treated and followed up at a tertiary care center in eastern India from January 2012 to December 2025. Patients who has solitary plasma cytoma with more than 10% plasma cells, POEMS syndrome, have been excluded from analysis. Results: We identified 46 patients of SP. The median age of the studied population was 53 years (23-75 years). Males were more commonly affected than females (M:F=2.2:1). Most common chief complaints were bony pain (67.4%). SBP was seen in 39 (84.8%) cases whereas SEP was seen in 7 (15.2%) cases. Vertebra was the most common site of involvement (61.4%). Median M band concentration 0.24 g/dL (0.1 to 1.95 gm/dL). IgG was the most common isotype accounting for 60.6% cases. Six cases (13%) had minimal bone marrow involvement. The majority of the patients received local radiotherapy (89.1%). With a median follow up of 5.4 years (95% CI: 1.8 - 9.0), median OS was not reached, median PFS was 9.22 years (95% CI: 5.8-12.6), median time to next treatment (TTNT) was 9.86 years (95% CI: 6.8 - 12.9). Conclusion: Solitary plasmacytoma commonly affects young males. Bones are more commonly affected than extramedullary sites. SP has a lower rate of progression and excellent prognosis when treated with local radiotherapy.

Background: Firearms are frequently transferred through inheritance and other non-purchase pathways, leaving many individuals in possession of unwanted guns and limited options for safe disposal. This study examined the characteristics and motivations of individuals relinquishing firearms at community gun buyback and destruction events in Michigan to inform understanding of firearm divestment and disposal pathways. Methods: We conducted an explanatory sequential mixed-methods study of six faith-based gun buyback and destruction events held in southeastern Michigan between June and October 2024. Quantitative surveys (n = 109) captured participant demographics and firearm characteristics. Follow-up qualitative interviews (n = 7) explored participants' experiences and motivations using inductive-deductive thematic analysis. Results: Across six events, 151 individuals relinquished 318 firearms, most of which were handguns. Nearly one-third of participants disposed of firearms on behalf of others, and two-thirds of personally owned guns had been obtained through non-purchase transfers, most commonly inheritance. Participants frequently expressed anxiety about storing unwanted firearms and relief after safe disposal. The most common motivations were concern about misuse (59%) and fear of theft (54%). Interviews identified five intersecting themes: inheritance and unwanted firearms, safety and family protection, evolving views on ownership, barriers to legal disposal, and emotional relief and closure after relinquishment. Conclusions: Many individuals become firearm owners through inheritance or other non-purchase transfers rather than intentional acquisition. Their experiences reveal that unwanted firearms can generate sustained unease and moral responsibility, motivating voluntary divestment when safe, non-punitive options are available. Results: Across six events, 151 individuals relinquished 318 firearms, most of which were handguns. Nearly one-third of participants disposed of firearms on behalf of others, and two-thirds of personally owned guns had been obtained through non-purchase transfers, most commonly inheritance. Participants frequently expressed anxiety about storing unwanted firearms and relief after safe disposal. The most common motivations were concern about misuse (59%) and fear of theft (54%). Interviews identified five intersecting themes: inheritance and unwanted firearms, safety and family protection, evolving views on ownership, barriers to legal disposal, and emotional relief and closure after relinquishment. Conclusions: Many individuals become firearm owners through inheritance or other non-purchase transfers rather than intentional acquisition. Their experiences reveal that unwanted firearms can generate sustained unease and moral responsibility, motivating voluntary divestment when safe, non-punitive options are available.

Hemoglobinopathies are inherited disorders of hemoglobin, most notably sickle cell anemia and thalassemia. These conditions result from mutations in the globin genes, leading either to structural abnormalities in the globin chains or to reduced synthesis of normal globin chains. Hemoglobinopathies is a worldwide health problem according to the World Health Organization; it affects mostly the indigenous Tharu groups in Nepal. Both the global and local rates of illness and death associated with these diseases are on the rise. The objective of this study was to assess the presence of hemoglobinopathies and common mutations of the beta-globin gene within the Tharu population in western Nepal. A cross-sectional study of 1,400 Tharu individuals was conducted among individuals obtained through hospitals within the Banke district, Bardiya district, and Kailali district in western Nepal. A thorough hematological analysis was done with the use of a Sysmex XN-350 analyzer. Hemoglobin variants were detected via high-performance liquid chromatography (HPLC). The molecular characterization of the seven most common mutations of {beta}-thalassemia was performed on a subset of 20 confirmed cases by using a real-time PCR kit.The total number of cases diagnosed with hemoglobinopathies was 14.43% (n=202 out of 1,400). Sickle cell trait (HbAS) was reported as the most prevalent type of Hemoglobinopathies (8.50% of population), followed by {beta}-thalassemia trait (4.00%). In addition to these disorders were sickle cell disease (HbSS), HbE trait, and compound heterozygous states. Hematological parameters differed significantly across types of hemoglobinopathies, and the patterns of microcytic, hypochromic, and hemolytic anemia were also distinct. Commonly documented symptoms included fatigue and joint pain (42.5% and 23.1%, respectively). Molecular characterization of {beta}-thalassemia cases demonstrated that most individuals were compound heterozygotes with IVS1-6 (T>C) as the most prevalent variant. The research identified that the Tharu population in western Nepal has a significant burden of hemoglobinopathies (especially sickle cell trait and {beta}-thalassemia), highlighting the requirement for appropriate screening programs, genetic counseling and public health strategies to help manage and prevent these conditions within this particular region.

Purpose: Alpha-gal syndrome (AGS) is an emerging health issue. This syndrome, caused by the bites of ticks, induces allergic reactions to the sugar molecule galactose-alpha-1,3-galactose after exposure to non-primate mammalian meat and other byproducts. Agricultural workers spend significant time outdoors placing them at an increased risk for tick bites and tick-borne diseases, like AGS. This study aimed to characterize farmers and ranchers' prior knowledge, symptomology, and diagnostic experiences with AGS. Methods: We conducted a cross-sectional survey of more than 200 farmers and ranchers with a self-reported AGS diagnosis. The survey captured farmers and ranchers' experiences related to prior knowledge and experience with tick bites and AGS, reported symptoms, and obtaining a diagnosis. Findings: A total of 201 respondents across 26 states participated in the survey, with the majority from Missouri and Oklahoma. We identified four distinct symptom clusters, with the most reported symptoms being abdominal cramping, diarrhea, itchy skin, and nausea. Women more often reported gastrointestinal discomfort, and men were more likely to be in the mild symptom category. On average, participants reported 2.98 medical provider visits before receiving a diagnosis, most being diagnosed by general practitioners and allergists. Conclusions: No previous studies have focused on the symptom and diagnostic experiences of farmers and ranchers with AGS. Capturing such data is essential as these workers may experience unique occupational challenges following AGS diagnosis. The diagnostic experience data support a continuing need to educate and empower AGS patients and providers, especially agricultural workers and providers serving rural communities.

This study evaluates the feasibility of implementing artificial intelligence (AI)-driven disease surveillance systems at Julius Nyerere International Airport (JNIA) in Tanzania, a key hub for regional and international travel. Through a mixed-methods approach combining qualitative interviews and quantitative surveys, the research assesses the infrastructure, human resource capacity, and regulatory frameworks necessary for AI integration. Findings indicate that while Port Health Officers are strongly optimistic about AIs potential to enhance disease detection, the airport faces significant barriers, including outdated infrastructure, insufficient technical resources, and a lack of trained personnel. Ethical and privacy concerns, particularly surrounding data security, also emerged as key challenges, compounded by limited public awareness and the socio-cultural acceptability of AI systems. Furthermore, the study identifies gaps in national policies and inter-agency coordination that hinder the effective implementation of AI technologies. The research concludes that while current conditions render AI adoption infeasible, strategic investments in infrastructure, workforce training, and policy development could pave the way for future integration, enhancing public health surveillance at JNIA and potentially other airports in low- and middle-income countries. This study contributes critical insights into the barriers and opportunities for AI-driven disease surveillance in low-resource settings, specifically focusing on a high-priority transit point, international airports. It emphasizes the importance of region-specific solutions to enhance health security in East Africa and supports the broader global health agenda by advocating for international collaboration and the development of scalable disease surveillance systems. Future research should explore pilot AI implementations at other airports to evaluate real-world challenges and refine AI systems for broader applicability, including cost-effectiveness analyses and integration of public perspectives on AI.

Abstract Background People with disabilities use technology, like search engines, to seek health information online. This health information includes information on coronavirus disease, or COVID-19. COVID-19 remains a public health concern. Research shows that people with disabilities encounter frustrations, or "pain points," when seeking online information, but little is known about these specific pain points and who encounters them. Objective The goals of this study are to determine pain points for people with disabilities who seek health information online, and to assess how pain points impact the experience of technology use and information seeking. Methods Ten participants recruited from a prior quantitative survey completed the concurrent think-aloud study over a month-long period. Participants completed four online search tasks and narrated their experiences in real-time while doing so. Transcripts were stored in Taguette; thematic analysis was performed on these transcripts. Findings Participants were predominantly white, with three identifying as Asian. All ten participants reported having disabilities. Participants with attention deficit hyperactivity disorder (ADHD) reported distracting webpage layout, whereas participants with physical disabilities reported physical fatigue while navigating online information. All participants encountered AI-generated information; only one participant indicated trust in the AI-generated information. Other common sources of information included hospital and governmental webpages, peer-reviewed articles, and news and advertising results. News and advertising results were especially common with respect to search results for "COVID-19 vaccine." Themes identified included the following: accessibility/usability, AI-generated information, government/hospital and related sources of information, peer-reviewed articles, news and advertising, and sentiment and trust. Conclusions Information can be fatiguing, distracting, or otherwise difficult to navigate for people with diverse disabilities searching for COVID-19 related information online. Further work should incorporate user feedback from people with disabilities when designing online content.

Aim: To explore RSV knowledge and awareness, RSV vaccination perceptions and acceptability, and preferences for maternal vaccine delivery and communication amongst pregnant women and mothers of infants and toddlers in England. Methods: Between July and November 2024, semi-structured qualitative interviews were performed with 30 mothers (youngest child under 2 years), two of whom were pregnant with a subsequent child. The study was conducted as a follow-on to a UK Health Security Agency survey of attitudes towards RSV vaccination amongst pregnant and post-partum women in England. Findings: Although most mothers had heard of RSV, mothers with experience in health roles were more likely to understand the potential severity of RSV in infants. Likelihood of maternal RSV acceptance was reported as high, with most mothers considering RSV vaccination as beneficial in protecting infants. Most mothers preferred a hybrid approach to vaccine communication, with information available online (e.g. through the NHS website), via written sources (e.g. NHS produced leaflet), and through talking with midwives. For convenience, most mothers preferred the option of fitting vaccinations within the antenatal midwifery appointment schedule rather than going to general practice for a separate appointment. Conclusion: To support maternal RSV vaccination decision-making and access, women need vaccine information early in pregnancy; information provision through a range of different sources (i.e. online, paper, in-person); and vaccination delivery in a convenient location (i.e. as part of antenatal appointments).

Objectives Concerns about COVID-19 were a key driver of infection-prevention behaviour during the pandemic. The aim of this study was to gain an in-depth longitudinal understanding of the type and frequency of concerns experienced throughout the first two years of the COVID-19 pandemic. Design Content analysis of qualitative descriptions provided in a prospective longitudinal online survey as part of the COVID-19 UK Public Experiences (COPE) Study. Method At baseline (March/April 2020), when the UK entered its first national lockdown, 11,113 adults completed the COPE survey. Follow-up surveys were conducted at 3, 12, 18 and 24 months. Participants were recruited via the HealthWise Wales research registry and social media. Baseline surveys collected demographic and health data, and all waves included an open-ended question about COVID-19 concerns. Content analysis was used to identify the type and frequency of concerns at each time point. Results A total of 41,564 open-text responses were coded into six categories: personal harm (n=16,353), harm to others (n=11,464), social/economic impact (n=6,433), preventing transmission (n=4,843), government/media (n=1,048), and general concerns (n=1,423). The proportion of respondents reporting any concern declined from 75.3% at baseline to 65.8% at 24 months. Over time, concerns about personal harm increased (baseline 41.8% vs. 24-months 52.7%) whereas concerns about harm to others decreased (baseline 48.5% vs. 24-months 28.6%). Concerns about harm were also expressed in relation to clinical vulnerability, lack of trust in government/media, and perceived lack of adherence by others. These were balanced against concerns about wider social and economic impacts of restrictions. Conclusions Public concerns about COVID-19 evolved substantially over the first two years of the pandemic, reflecting changing perceptions of risk and responsibility. Monitoring concerns longitudinally is vital to help guide effective communication and behavioural interventions during future pandemics.

Abstract Background Musculoskeletal conditions, such as back pain and osteoarthritis, are common and disabling disorders. Musculoskeletal conditions are closely related to chronic disease risk factors like smoking/vaping, poor nutrition, alcohol misuse and physical inactivity and impact a person's risk of falling (SNAPF). Preventive care for SNAPF risks is often overlooked. Online delivery of preventive care may increase the provision of this care. We aimed to assess if an online tool for SNAPF risks would be used by and acceptable to patients waiting for an orthopaedic consultation. Methods We completed a multi-method study to test an online health risk self-assessment tool. A random sample of 300 people on the orthopaedic outpatient waiting list aged 18-64 years were sent the tool in batches of 20-50. The tool assessed SNAPF risks and provided feedback against national guidelines. After each batch, we completed feedback interviews with participants to assess acceptability and updated the tool. We summarised quantitative data using descriptive statistics and qualitative data using thematic analysis. Results Of the 300 participants sent the tool, 51.3% were female, 8.6% identified as Aboriginal and/or Torres Strait Islander, with a mean (SD) age of 52.0 years (11.2). There were 170 participants (59.2%) who completed the tool, 117 who did not complete it, and 13 participants who were excluded from analysis because they did not receive the SMS. We conducted 184 feedback interviews, including 125 'completers' and 59 'non-completers'. The percentage of participants who felt that SMS was an appropriate way to receive the tool was 84.7% of 'completers' and 50% of 'non-completers'. The two most common reasons for not completing the tool were due to perceived risk (13/59, 22.0%), and the SMS was received at an inconvenient time (11/59, 18.6%). Qualitative data from the feedback interviews captured three enablers: i) design, ii) high importance, and iii) engagement with health service, along with four barriers: i) design, ii) risk, iii) relevance, and iv) engagement with health service. Conclusion Our study found that an online health risk self-assessment tool appears to be an acceptable way to assess chronic disease and falls risk factors for people on an orthopaedic waitlist.

BackgroundThe World Health Organization has developed several global template protocols for epidemiological investigations, including for household transmission investigations (HHTIs). These investigations facilitate rapid characterisation of novel or re-emerging respiratory pathogens and support evidence-based public health actions. Beyond technical readiness, community buy-in is central to the feasibility and acceptability of HHTIs. Research is needed to determine the perceived legitimacy among the community to inform local protocol adaptation and development of implementation plans that consider community attitudes and needs. MethodsIn 2025, we conducted a convenience survey of community members living in Victoria, Australia to explore: their understanding of emerging respiratory diseases; their willingness to take part in public health surveillance activities such as HHTIs; the acceptability of clinical and epidemiological data collection and respiratory/blood sample collection as main components of HHTIs, and; participant comfort towards including their companion animals in HHTIs. ResultsWe received 282 survey responses, of which 235 were included in the analysis dataset. Compared to the general Victorian population, our participants included a higher proportion of participants who reported being female, tertiary-educated, of Aboriginal and/or Torres Strait Islander heritage, born in Australia and speaking only English at home. Participants indicated overall high levels of comfort and acceptability towards participation in HHTIs, particularly in relation to clinical and epidemiological data collection, with lesser but still high levels of comfort with providing multiple respiratory specimens in a 14-day period. Participants were least comfortable with other specimens such as urine and blood. Involving companion animals in HHTIs was similarly acceptable as human-focused components. ConclusionsDespite our survey population being non-representative of the general Victorian population, our findings provide valuable descriptive insights into the acceptability of HHTIs in Victoria, Australia from which to benchmark future local and international surveys and community engagement activities.

Background Individuals experiencing or at risk of homelessness face substantial barriers to preventive eye care that are poorly addressed by standard service models. Interdisciplinary optometry-social work collaboration offers a rights-based approach to improving engagement and continuity of care. Methods A convergent mixed-methods study was conducted between February and August 2024 at a multidisciplinary community centre. Clients experiencing or at risk of homelessness received integrated optometry and social work assessment and were prioritised as high, medium, or low based on combined clinical and social risk. Social work follow-up was guided by the Triple Mandate and W-Questions framework. Quantitative data were summarised using mean (SD), median [IQR], or n (%). Qualitative case notes were analysed using content analysis with inductive coding and secondary review for consistency. Results A total of 165 clients had priority categories coded (high: 68; medium: 47; low: 154). Demographic data were available for 132 clients (60% male; mean age 49.5 years [SD 16]); 27% had not completed high school, 89% reported weekly income below AUD 1000, and 28% had vision impairment. Two hundred forty-five case-note entries were consolidated into 146 unique records. SMS (46%) and phone calls (38%) were the most documented contact methods, although only 21% of calls were answered; missed calls (13%) and disconnected numbers (7%) were common. Multi-modal contact was more frequently documented for higher-priority clients. Appointment assistance was the most recorded facilitator (71%), while rights-based supports, including interpreter and transport assistance, were infrequently documented (<=5%). Qualitative analysis identified unstable communication, reliance on informal supports, and service fragmentation as key influences on recall outcomes. Conclusion This study supports an interdisciplinary, rights-based optometry-social work model to address barriers to preventive eye care among people experiencing or at risk of homelessness. Embedding structured handovers and tiered recall processes within community-based services may strengthen continuity and accountability for high-priority clients. Future implementation should evaluate outcomes related to equity of reach, service integration, and sustained engagement in care.

Context: In the UK, and in other countries, people living with a terminal illness are eligible for financial support to help with the costs of serious illness and to support their dignity and independence. This study investigates the take-up of benefits in the last year of life and identifies sociodemographic, clinical, and geographical factors associated with underclaiming. Methods: Retrospective cohort study using linked mortality, Census and benefits data for all people who died aged 16+ from chronic illnesses in England and Wales between 1 May 2018 and 30 April 2021. Outcome was receipt of non-means tested disability benefits in the last 12 months of life. We describe geographical variation in take up, and association with sociodemographic, clinical and geographical exposures using Poisson models. Findings: Our population included 1,049,493 eligible decedents, with an overall take-up rate of 65.9%. After adjusting for sociodemographic factors, variation in take-up by cause of death was wide: liver disease 44% (95% CI 43, 45%), heart failure 52% (51, 52%), cancer 62% (61, 62%), dementia 75% (74, 75%), and neurodegenerative diseases 90% (88, 91%). Across Local Authorities, the age-and-sex-standardised take-up varied from 53% to 78%; rates were generally higher in more deprived areas, but not uniformly. Conclusions: In England and Wales, 1 in 3 people who die from expected causes (120,000 each year) do not receive the benefits for which they are eligible. Our analysis uses novel data linkages and highlights clinical and sociodemographic groups and geographical areas that could be targeted with proactive take-up initiatives.

BackgroundAccess to safe, equitable, and affordable surgical and anesthesia care is critical to reducing the burden of surgical diseases in Africa. To understand the state of access in South Sudan, we conducted a baseline assessment of surgical services in Central Equatoria State (CES) in May 2024. ObjectivesThis study aimed to survey public healthcare facilities in CES capable of providing essential surgical services. We used the capacity to perform cesarean section, laparotomy, and open fracture management--Bellwether procedures--as a proxy for assessing workforce, infrastructure, financing, information management, and service delivery. MethodsWe used a validated and contextualized Surgical Assessment Tool developed by the Harvard Program on Global Surgery and Social Change and the World Health Organization. Data were collected at the facility level and summarized descriptively using percentages, means (standard deviations), medians (minimum, maximum), and visualized in graphs, charts, and tables. ResultsAll three public health facilities assessed could perform Bellwether procedures for their catchment populations. However, workforce availability, financing, and surgical infrastructure were major constraints. The surgical workforce density was 2.27 surgical, anesthesia, and obstetric specialists per 100,000 population. Specialized procedures--such as repair of cleft lip and palate, clubfoot, and hydrocephalus shunt--were unavailable at all sites. None had magnetic resonance imaging (MRI) machines. The total average annual facility budget was $918,850, ranging from $3,960 to $800,000 at the teaching hospital--insufficient for proper operations. ConclusionWhile Bellwether procedures are routinely performed, access to quality and affordable care is compromised by deficits in workforce, financing, and infrastructure. We recommend that the Ministry of Health scale this survey nationally and develop a surgical policy and strategic plan focused on improving infrastructure, workforce, and financing for surgical and anesthesia care in South Sudan.

Abstract Importance Stigma and discrimination against transgender and gender-diverse people are prevalent across many settings and may contribute to substantial health disparities. Objective To synthesize global evidence on the prevalence of stigma, discrimination, and resilience among transgender (trans) and gender-diverse adults. Data Sources A systematic search was conducted in PubMed, Embase, CINAHL, Cochrane Central, LILACS, and PsycInfo for articles published between January 1, 2010 and January 2, 2023. This database search was supplemented by grey literature and secondary reference searches. Article Selection Studies were eligible if they presented primary quantitative data on prevalence of stigma, discrimination, and/or resilience among trans and gender-diverse adults (aged 18 and over), with no restrictions on study design, language, or geographic region. Data Extraction and Synthesis Two independent reviewers extracted data using standardized forms, with discrepancies resolved by consensus. The JBI Critical Appraisal Checklist for Prevalence Articles was used to assess risk of bias. Random effects meta-analysis was conducted for dichotomous prevalence measures using inverse variance weighting and logit transformation; non-dichotomous prevalence data were summarized descriptively. Main Outcomes and Measures Outcomes included prevalence estimates for various forms of stigma (anticipated, perceived, internalized, and experienced), discrimination in legal/institutional settings (housing, healthcare, employment, police/prison), and resilience. Results A total of 97 articles, with data from 72,158 unique trans and gender-diverse participants across 26 countries, met inclusion criteria. Studies showed moderate levels of anticipated stigma, perceived stigma, and internalized stigma. Meta-analyses of 36 studies provided pooled estimates of discrimination prevalence across multiple domains: 21.4% in housing (e.g., eviction, rental denial), 24.6% in healthcare (e.g., denial of care, mistreatment), 32.8% in employment (e.g., hiring bias, workplace harassment), and 39.1% in police/prison settings (e.g., profiling, mistreatment). High heterogeneity was observed across studies, reflecting regional and methodological differences. Resilience scores ranged from moderate to high, indicating variation within trans and gender-diverse communities. Conclusions and Relevance This systematic review and meta-analysis found that stigma and discrimination against trans and gender-diverse adults are pervasive globally. Variation in stigma and discrimination across settings and regions underscores the need for targeted interventions and policy reforms. Funding World Health Organization through a grant from the Elton John AIDS Foundation and the Bill and Melinda Gates Foundation.

BackgroundCommercial motorcycle riders are among the most vulnerable road users in low- and middle-income countries and contribute substantially to the burden of road traffic injuries. The use of personal protective equipment (PPE), including helmets and protective clothing, reduces injury severity; however, uptake remains suboptimal. This study evaluated the effectiveness of a theory-driven health education intervention in improving knowledge, attitudes, and use of PPE among commercial motorcycle riders in Cameroon. MethodsA quasi-experimental, non-randomized controlled before-and-after study was conducted in Limbe (intervention) and Tiko (control) Health Districts between August 4, 2024, and April 6, 2025. Participants were recruited from a cohort of commercial motorcycle riders and followed over an eight-month intervention period. The intervention, guided by the Health Belief Model and developed using the Intervention Mapping framework, combined face-to-face sensitization sessions with mobile phone-based educational messaging adapted to participants literacy levels and communication preferences. Data were collected at baseline and endline using structured questionnaires and direct observation checklists. Intervention effects were estimated using difference-in-differences analysis with generalized estimating equations, adjusting for socio-demographic factors. ResultsA total of 313 riders were enrolled at baseline (183 intervention, 130 control), with 249 retained at endline (149 intervention, 100 control). The intervention was associated with significant improvements in PPE knowledge ({beta} = 2.91; 95% CI: 2.14-3.68; p < 0.001) and attitudes ({beta} = 5.76; 95% CI: 4.32-7.21; p < 0.001) compared with the control group. No statistically significant effect was observed for PPE practice scores ({beta} = 0.21; 95% CI: -0.09-0.52; p = 0.171). Among individual PPE items, helmet use increased significantly in the intervention group relative to the control group (AOR = 2.38; 95% CI: 1.19-9.45; p = 0.036), while no significant effects were observed for gloves, trousers, eyeglasses, or closed-toe shoes. ConclusionThe theory-driven health education intervention significantly improved knowledge and attitudes toward PPE and increased helmet use among commercial motorcycle riders but did not lead to broader improvements in the uptake of other protective equipment. These findings highlight the need for complementary structural and policy interventions to address persistent barriers to PPE use in similar low-resource settings. Trial registrationClinicalTrials.gov Identifier: NCT07087444 (registered July 28, 2025, retrospectively)

This study investigated retirement adjustment in retired police officers in the UK (N = 289), examining how time since leaving the service moderates the relationship between perceived organisational support and retirement adjustment while accounting for resilience. Results indicated a developmental trend: organisational support remains stable initially but becomes increasingly influential in later life. Using Johnson-Neyman analysis, a threshold of 32.07 years was identified, after which the association reaches statistical significance. These findings suggest an organisational legacy effect; for the older generation, the retrospective perception of being valued by the service acts as a durable psychological resource. This study offers a novel conceptualisation of long-term organisational influence by identifying a temporally delayed legacy effect that extends beyond existing models of retirement adjustment. The study advocate for lifelong wellbeing strategies that extend, recognising that the organisational relationship continues to shape adjustment outcomes decades after the conclusion of active duty.

Background. Vietnam's disease burden has shifted from communicable, maternal, neonatal, and nutritional (CMNN) causes to non-communicable diseases (NCDs), but the tempo, drivers, and regional positioning of this transition have not been jointly quantified. We characterised Vietnam's epidemiological transition 1990-2023 against ten Southeast-Asian (SEA) peers. Methods. Using Global Burden of Disease 2023 data, we computed joinpoint-regression AAPC with 95% CI (BIC-penalised, up to three break-points) for age-standardised DALY rates and cause-composition shares. We applied Das Gupta three-factor decomposition to 1990-2023 absolute DALY change (population-size, age-structure, age-specific-rate effects) and benchmarked Vietnam's NCD share against an SDI-conditional peer trajectory via leave-one-out quadratic regression. Premature mortality was quantified as WHO 30q70 under both broad NCD and strict SDG 3.4.1 definitions, using Chiang II life-table adjustment identically across all eleven countries. Findings. The CMNN age-standardised DALY rate fell from 13,295.9 to 4,022.1 per 100,000 (AAPC -4.63%/year; 95% CI -4.80 to -4.46); the NCD rate fell only from 21,688.2 to 19,282.8 (AAPC -0.37; -0.45 to -0.30). NCD share of total DALYs rose from 52.99% to 70.67% (+17.67 pp; AAPC +1.09). Vietnam ranked fourth of eleven SEA countries in 2023 (up from sixth in 1990) and sat 5.3% above the SDI-expected trajectory. Das Gupta decomposition attributed the +10.63 million NCD DALY increase to population growth (+6.26 M) and ageing (+6.08 M); rate change removed only 1.71 M. Premature NCD mortality fell from 25.02% to 21.80% (broad, 12.9% reduction) and from 22.17% to 19.50% (SDG 3.4.1, 12.0%; Vietnam sixth of eleven) - far short of the SDG 3.4 one-third-reduction target. Interpretation. Vietnam has entered a disability- and ageing-dominated NCD phase. Meeting SDG 3.4 by 2030 requires population-scale primary prevention sized to demographic momentum.

Introduction: The need to collaborate with community partners has long been considered essential for achieving sustainable HIV prevention and treatment. While the level of youth engagement in research varies by project, it is important that youth collaboration and partnership is meaningful and measurable. We previously conducted a survey that aimed to assess the acceptability of providing SRH/HIV services for young women at hair salons in Lesotho. The survey relied on participatory research with several community partners who were fundamental to its implementation. This study reports on the lessons learned from these participatory processes. Methods: The Hair SALON survey was conducted in Lesotho between December 2023 and August 2024. For the present study, we used the Report of Engagement in Community Research (REACH) tool to systematically define the various depths of engagement of stakeholders at different stages of the research. In addition, we conducted semi-structured individual interviews with the four young community partners who were involved as the Hair Salon Expert Group (HSEG) throughout the project, and a subset of six stylists who helped enroll clients to fill in the questionnaires. The audio-recorded interviews were transcribed, translated, and coded using thematic analysis. Results: Challenges to engagement with the research project included the lack of full understanding of the project team's expectations (for the HSEG), and difficulty engaging potential participants due to mistrust and the sensitive content of the project (for the stylists). As possible mitigation strategies, interviewees suggested developing better community dissemination efforts prior to the project start, and providing more training to the community partners. Facilitators for engagement included multiple altruistic, professional development, and material incentives. Conclusions: Our findings highlight that a participatory approach across all research phases is feasible and that various facilitators - beyond material incentives - motivate youth community partners to be part of such a project. However, some barriers remain. It is important to increase efforts to clarify community partners' roles and responsibilities beyond written agreements, which in turn improves their perceived ownership of the research.

Background: The urgent care departments in Europe face a structural paradox: accelerating digitalisation is accompanied by a patient population that is disproportionately unable to engage with standard digital tools. An internal analysis at the Emergency Department (Akutafdelingen) of Nordsjaellands Hospital in Hilleroed, Denmark found that 43% of emergency patients struggle with digital solutions - a figure that reflects the predictable composition of acute care populations rather than any individual failing. Objective: This paper presents the design, iterative development, and secondary validation of the ED Adaptive Interface (v5): a prototype adaptive patient terminal developed in response to this challenge. The system operationalises what the author terms impairment-first design - a methodology that treats the most constrained patient experience as the primary design problem and derives the standard experience as a subset. The interface configures itself in under ten seconds via nurse-led setup, adapting across four axes of impairment: visual, motor, speech, and cognitive. System: Version 4 supports five accessibility modes, a heatmap pain assessment grid, a Privacy and Dignity panel, a live workflow tracker with care notifications, structured dual-category help requests, and plain-language medical term definitions across four languages. Version 5, reported here for the first time, introduces a Condition Worsening Escalation button, a Referral Pathway Display, a "Why Am I Waiting?" triage explainer, a Symptom Progression Log, MinSP/Yellow Card Scan simulation, expanded language support (seven languages: English, Danish, Arabic with full RTL layout, Turkish, Romanian, Polish, and Somali), and an expanded ten-item Communication Board. The entire system runs as a single 79-kilobyte HTML file with zero infrastructure requirements. Methods: To base the design on patient-generated evidence, two independent social media threads were subjected to an inductive thematic analysis (Braun and Clarke, 2006): a primary corpus of 83 entries in the Facebook group Foreigners in Denmark (collected March 2026) and a corroborating corpus in an international community group in the Aarhus region (collected April 2026). All identifiers in both datasets were fully anonymised under GDPR Article 89 research provisions prior to analysis. No participants were contacted. Generative AI tools were used to assist with drafting, writing, and prototype code development; all scientific content, data collection, analysis, and conclusions are the sole responsibility of the authors. Results: The first discourse corpus produced five major themes corresponding to the five problem areas the prototype was designed to address: system navigation and triage literacy gaps (31 entries); language and cultural barriers (6 entries); communication failures during care (5 entries); staff overload and capacity constraints (8 entries); and pain and severity assessment failures (14 entries). The corroborating dataset supported all five themes and introduced two additional themes: differential treatment of international patients and medical gaslighting as a long-term pattern of patient advocacy failure. One structural finding - the five most-liked comments incorrectly criticised the original poster for self-referring when she had received explicit 1813 telephone triage approval - directly inspired the Referral Pathway Display and "Why Am I Waiting?" features in v5. Conclusions: The convergence of design rationale and independent social evidence across all five problem categories suggests that impairment-first design is not a niche accessibility concern but a structural approach to healthcare interface quality. The prototype is ready for a structured clinical pilot using the System Usability Scale (SUS) and semi-structured staff interviews. The long-term roadmap includes full MinSP integration, hospital PMS connectivity, and clinical validation.