The Lancet Regional Health - Western Pacific

Background Concurrent wasting and stunting (WaSt) is a severe form of child undernutrition, linked to higher mortality and long-term negative health outcomes. Malnutrition is a significant challenge in Yemen, where the country is experiencing a long-standing conflict, food insecurity, and socioeconomic deprivation. But there is still limited evidence on the burden and determinants of WaSt in Yemen on a national level. This study aimed to estimate the prevalence and identify factors associated with WaSt among children under 5 years in Yemen. Methods We conducted a cross-sectional analysis using nationally representative data from the 2022-2023 Yemen Multiple Indicator Cluster Survey (MICS). A significantly large dataset of 17,734 children aged 0-59 months from all the 22 governorates of Yemen was analyzed. Concurrent wasting and stunting (WaSt) was defined as the coexistence of a weight-for-height z-score (WHZ) below -2 standard deviations and a height-for-age z-score (HAZ) below -2 standard deviations from the WHO Child Growth Standards in the same child. Survey-weighted logistic regression was performed to analyze the factors associated with WaSt among the under 5 children in Yemen. Results The national prevalence of WaSt was 8.4% (95% CI: 7.6-9.2). The highest prevalence of WaSt was found in children aged 12-23 months (12.0%) and in the Western Coastal region (11.6%). After adjustment, male sex (AOR 1.52, 95% CI: 1.30-1.80), residence in the Western Coastal (AOR 2.00, 95% CI: 1.60-2.40), Eastern (AOR 2.00, 95% CI: 1.50-2.70), and Southern regions (AOR 1.60, 95% CI: 1.20-2.10), poorest household wealth (AOR 1.96, 95% CI: 1.30-2.90), moderate (AOR 1.51, 95% CI: 1.13-1.94) and severe food insecurity (AOR 1.94, 95% CI: 1.40-2.60), and recent diarrhoea (AOR 1.22, 95% CI: 1.02-1.44) were associated with higher odds of WaSt. Having a handwashing facility and improved sanitation were protective. Conclusion At least 1 in every 12 under-five children in Yemen was affected by WaSt, and there were significant socioeconomic, geographic, food-security and WASH-related factors influencing this devastating outcome. Instead of simple, one-dimensional approaches, multi-sectoral interventions are needed to address this adversity. And those efforts must be integrated into the system, interconnected with each other and specifically targeted to vulnerable children and households.

Introduction Cancer incidence is rising rapidly in low- and middle-income countries (LMICs), where diagnostic pathology capacity is constrained. AI applied to routine histopathology could strengthen diagnostic capacity and offer leapfrogging potential by embedding AI into diagnostic systems as they are built up. However, without empirically identifying implementation determinants in LMIC cancer-diagnostic settings, AI solutions risk being poorly aligned with local constraints, limiting impact or exacerbating existing disparities. Methods We conducted an exploratory mixed-methods pilot study across three phases: 1) a structured survey characterising the diagnostic and technical landscape and AI priorities; 2) focus group discussions (FGDs) to inductively identify implementation determinants and 3) a second survey quantifying FGD-derived themes. Twelve physicians were purposively recruited (10 from LMIC, 2 from high-income countries for reference) and findings integrated through narrative triangulation. Results There was substantial heterogeneity in diagnostic and AI infrastructure that did not track consistently with country income classification. H&E staining was universally available, immunohistochemistry capacity was rudimentary at 7 of 10 sites and molecular testing absent or minimal at 6 of 10 sites. Whole-slide-imaging scanners were available at 8 of 10 sites, while graphical processing units, required for efficient AI inference, were available at only 4 of 10 sites. The participants would prioritise use of AI for cancer screening, cancer diagnosis, and biomarker prediction from H&E slides. Six implementation determinants were identified: AI literacy, governance frameworks, funding, evidence generation, clinical deployment, and collaboration. Financial constraints emerged as the dominant barrier across all determinants, and collaboration as an important enabling mechanism. Conclusion AI implementation readiness in LMIC cancer-diagnostic settings is highly heterogeneous and cannot be inferred from income classification, underscoring the need for institution-level assessment. Realising the leapfrogging potential of AI in this context requires coordinated progress across all determinants, with sustainable financing, and collaboration enabling the remaining determinants.

Aim: This study aimed to estimate the prevalence and distribution of minimum dietary diversity for women (MDD-W) and underweight/thinness and examine sociodemographic and dietary factors associated with underweight/thinness among Cambodian women aged 15-49 years. Methods: We conducted a cross-sectional analysis of 9,181 women aged 15-49 years (9,262.5 weighted) from the 2021-22 Cambodia Demographic and Health Survey. Survey-weighted descriptive statistics and provincial mapping were used to describe MDD-W, food-group consumption and underweight/thinness. Rao-Scott chi-square tests assessed group differences, and survey-weighted logistic regression estimated factors associated with underweight/thinness. MDD-W and household wealth were retained a priori in the adjusted model, while other covariates with an overall crude Wald P value <0.20 were included. Results: The analysis included 9,181 women (9,262.5 weighted). Overall, 57.2% achieved MDD-W, and 6.7% had underweight/thinness; 22.8% were overweight, and 5.7% had obesity. Underweight/thinness was highest among women aged 20-24 years (17.7%). Achieving MDD-W was not associated with underweight/thinness in crude analysis (OR 0.93, 95% CI 0.74 to 1.17; P=0.545). In the adjusted analysis, the association remained imprecise (aOR 0.86, 95% CI 0.67 to 1.09; P=0.219). Provincial estimates showed geographic variation in both MDD-W and underweight/thinness. Conclusion: More than half of Cambodian women achieved MDD-W, while underweight/thinness coexisted with overweight and obesity. MDD-W was not clearly associated with underweight/thinness. These findings support monitoring dietary diversity, anthropometric status, and socioeconomic inequalities together in women's nutrition.

Wildfire smoke exposure is increasing across the U.S., but the long-term neurological effects of smoke-specific fine particulate matter (PM2.5) and its carbonaceous components remain uncertain. Using Medicare data from 2002 through 2019, we examined incident Alzheimer's disease (AD) and Alzheimer's disease and related dementias (ADRD) among 39,678,630 fee-for-service Medicare beneficiaries followed from 2005 through 2019. We identified 3,501,414 incident AD cases over 258.5 million person-years and 8,377,416 incident ADRD cases over 248.6 million person-years. We linked the cohort with annual, high-resolution estimates of smoke and non-smoke PM2.5 mass and carbonaceous components (elemental and organic carbon) and fitted stratified Cox proportional hazards models. Per 1 g/m3 increase, smoke PM2.5 was associated with incident AD (hazard ratio [HR], 1.015, 95% confidence interval [CI], 1.005-1.026) and ADRD (1.029 [1.024-1.035]). Smoke carbonaceous fraction was also associated with AD (1.063 [1.042-1.085]) and ADRD (1.090 [1.077-1.103]). Within the ADRD endpoint, smoke-related associations exceeded their corresponding non-smoke associations on a per-unit-mass basis. Per interquartile range, associations were smaller for smoke PM2.5 (AD, 1.005 [1.002-1.008]; ADRD, 1.009 [1.008-1.011]) than for non-smoke PM2.5 (AD, 1.086 [1.079-1.094]; ADRD, 1.048 [1.043-1.053]). Associations varied across geographic, racial, socioeconomic, and clinical subgroups. Long-term wildfire smoke exposure, particularly its carbonaceous fraction, was associated with higher incidence of AD and ADRD among older U.S. adults. The associations correspond to 2,284 and 11,142 incident cases per year of AD and ADRD attributable to smoke PM2.5 among older Medicare beneficiaries, with the carbonaceous fraction accounting for most of this burden. These findings support the use of source-resolved and composition-specific smoke metrics in dementia research and wildfire-smoke health-impact assessments.

BACKGROUND: Adverse consequences of neonatal hyperbilirubinemia disproportionately affect babies in low- and middle-income countries. Laboratory measurement of total serum bilirubin is limited in low-resource settings, necessitating simpler alternatives. Our study aimed to evaluate the diagnostic accuracy of visual inspection of jaundice via the World Health Organization Integrated Management of Childhood Illnesses algorithm compared to transcutaneous bilirubinometry for the identification of hyperbilirubinemia in community settings. METHODS: Hyperbilirubinemia was assessed by visual inspection for jaundice and transcutaneous bilirubinometry at 0-72 hours, 3-5 days, and 5-14 days postnatal in the PRISMA prospective cohort study in six sites in Asia and Africa. We assessed sensitivity, specificity, and positive and negative percent agreement. RESULTS: We analyzed data from 14,331 infants, including 1,852 preterm infants. 15% had hyperbilirubinemia, as defined by transcutaneous bilirubin values and the NICE nomograms, at 3-5 days postnatal. Visual inspection had a sensitivity of 16%, specificity of 96%, positive percent agreement of 56%, and negative percent agreement of 86% at 3-5 days postnatal age, pooled across all sites and gestational ages, versus transcutaneous bilirubin defined by NICE nomograms. CONCLUSION: The poor sensitivity of visual inspection underscores an urgent need for accurate, affordable screening tools to improve screening for hyperbilirubinemia.

Background Cancer stigma contributes to low cervical cancer screening rates among Nepali women. However, no stigma reduction interventions have been implemented thus far in Nepal. This study assessed the effectiveness of a muticomponent cervical cancer stigma reduction intervention on cancer stigma scores and cervical cancer screening uptake rates among urban Nepali women. Methods A two-arm, parallel cluster-randomized trial was conducted in Budhanilkantha Municipality, Kathmandu District, Nepal. Twelve administrative wards were randomized in a 1:1 ratio to the intervention or control group, with wards serving as the unit of randomization and individual women as the unit of analysis. A total of 310 women aged 30-60 years who had not undergone cervical cancer screening during the previous five years were enrolled. The three-hour intervention included cervical cancer education, a video featuring cervical cancer survivors, participatory group discussions, and myth-versus-fact activities addressing cancer stigma. Cancer stigma was assessed two months after the intervention using the Nepali version of the Cancer Stigma Scale. Cervical cancer screening uptake was assessed six months after the intervention. Data were analyzed using intent-to-treat and as treated approaches with a generalized estimation equation with logistic regression. Results From June 2022 to February 2023, 310 women were enrolled. At 2 months, stigma data were available for 248 participants (120 intervention, 128 control). In the intention-to-treat analysis, the odds of cancer stigma were lower in the intervention group than in the control group (OR 0.25, 95% CI 0.08 to 0.8; p=0.022). Odds were also lower for the severity domain (OR 0.31, 95% CI 0.10 to 0.90; p=0.048) and awkwardness domain (OR 0.21, 95% CI 0.08 to 0.56; p=0.001) with no differences in other subdomains. At 6 months, the odds of cervical cancer screening was 3.9 times greater in the intervention group than in the control group (95% CI: 1.1-13.20, p=0.028). As treated analysis reinforced these findings, with lower odds of stigma (AOR:0.09, 95% CI: 0.01-0.53, p=0.007), severity (AOR:0.16, 95% CI: 0.06-0.42, p<0.001), and awkwardness (AOR:0.1, 95% CI: 0.02-0.44, p=0.02). Cervical cancer screening odds was 4.02 times higher in the intervention group (95% CI:1.1-13.7, p=0.026). Conclusions Compared with the control condition, participants allocated to a community-based multicomponent intervention designed to reduce cancer stigma had lower odds of elevated cancer stigma two months after the intervention and higher odds of cervical cancer screening by six months. Larger cluster-randomized trials with more clusters and longer follow-up are needed to assess the reproducibility, durability, and generalizability of these findings.

Long-term PM2.5 exposure is associated with increased mortality and is usually represented by annual mean concentration, which does not capture how concentrations are distributed across days. We tested whether the prespecified PM2.5 magnitude-rank index (PMRI), a summary of within-year daily concentration structure, improves mortality prediction beyond the annual mean. Daily modeled PM2.5 estimates were linked to age-adjusted mortality rates for 27,289 county-years from 3,064 U.S. counties during 2003-2011. PMRI is the largest k for which at least k days reached k micrograms per cubic meter. County-grouped 10-fold cross-validation compared models with annual mean alone versus annual mean plus PMRI, with additional geographic, temporal, cause-specific, and specification analyses. Annual mean PM2.5 had the highest standalone predictive performance. Adding PMRI increased county-held-out R-squared from 0.0802 to 0.1391 (increase in R-squared = 0.0589; 95% CI, 0.0499-0.0677) and reduced RMSE and MAE. Improvement persisted across geographic and temporal validations and all six cause-specific mortality outcomes. Within-year PM2.5 exposure structure therefore contains reproducible mortality-predictive information not captured by annual mean concentration.

Background: In England, a national school-based human papillomavirus (HPV) vaccination programme was introduced in September 2008. Routine vaccination against HPV16/18 is offered to girls aged 12-13 and a 'catch-up' offer ran for girls aged 14-18 during the programme's first two years. Methods: Data from 19,407 women aged 25-29yrs attending cervical screening across England 2016-2025 were collected and residual samples from 4,837 high-risk (HR) HPV-screening-positive women were genotyped to monitor type-specific HR-HPV prevalence and evaluate vaccination impact. Results: Type-specific HR-HPV results were available for 3,683 HR-HPV-screen-positive samples. Estimated age-adjusted prevalence of HPV16 and HPV18 was 91% (95% confidence interval [CI]: 87-94%) and 84% (95%CI: 65-93%) lower respectively among routine-eligible women than vaccination-ineligible women. Large declines were also observed for HPV31 (85% [95%CI: 72-92%]) and HPV45 (84% [95%CI: 73-90%]) but not for other HR-HPV types. Among 618 women with cytological abnormalities, HPV16/18 was present in samples from 53.9% (95%CI: 34.8-73.1%) of vaccination-ineligible, 18.1% (95%CI: 13.5-22.7%) of catch-up-eligible, and 6.5% (95%CI: 3.6-9.3%) of routine-eligible women. Conclusions: The early years of the HPV vaccination programme in England conferred strong protection against HPV16, 18, 31 and 45, and dramatically changed the target remaining for screening strategies to detect and reduce cervical disease.

Gut microbiome plays an important role in human health. Urbanization has been suggested to alter the gut microbiome. We comprehensively evaluated differences in gut microbiome profiles of 76 urban and 81 rural female residents of Vietnam using shotgun metagenomic data. We evaluated rural-urban differences in gut microbial diversity, individual microbial taxa, and metabolic pathways. Rural residents had higher alpha and beta diversities in age-adjusted models (p<0.05). Additionally, significant rural-urban differences were observed for 35 microbial taxa in age-adjusted models (FDR<0.1). Rural residents had higher relative abundance of classes, orders, and families of FGB2982 and FGB38642 and strain SGB15332 of the species Faecalibacterium prausnitzii, whereas urban residents had higher relative abundances of species Bacteroides thetaiotaomicron, Coprobacter fastidiosus, Bilophila wadsworthia, Enterobacter cloacae, Enterobacter hormaechei, Klebsiella aerogenes, Dielma fastidiosa, and Holdemania massiliensis. Notably, these associations were attenuated after further adjustment for socioeconomic characteristics, lifestyle, dietary factors, and comorbidity (FDR>0.1). In the fully adjusted model, significant rural-urban differences were observed in the abundance of 17 microbial taxa, including Ruminococcus sp AF13 28 and Prevotella pectinovora, as well as in three metabolic pathways (FDR<0.1). This study suggests that urbanization-related factors may contribute to differences in the gut microbiome between urban and rural Vietnamese women.

Wildfire smoke poses a growing health risk worldwide, yet the magnitude and temporal evolution of mortality after episodic exposure remain poorly resolved, limiting burden assessment. Using monthly county-level wildfire PM2.5 and mortality data from the United State, we exploit episodic exposure contrasts to deconvolve overlapping mortality responses and recover the impulse-response function. The excess mortality response peaks approximately three years after an exposure pulse and subsides by five years. We estimate 1.7 (95% uncertainty interval: 1.1-2.3) million smoke-associated deaths during 2011-2023, approximately ten times estimates using long-term ambient PM2.5 mortality relative risks. Circulatory and respiratory diseases contribute comparably and dominate this burden. Responses are markedly greater among adults [&ge;]65 years; during the COVID-19 pandemic, population-wide cumulative responses are significantly higher over at least the first seven months after exposure. Reducing wildfire smoke exposure can thus yield substantial health benefits over multiple years, particularly when population vulnerability is heightened.

Background. Skilled healthcare workers are essential for neonatal survival; however, the Kenyan public health system has historically faced strikes compounded by a human resource crisis. Evidence on how strikes affect neonatal care and mortality remains limited. This study evaluated changes in neonatal admissions, clinical care processes, and inpatient mortality associated with 56 days of disruption during the 2024 Kenyan physicians' strike. Methods. We conducted a retrospective interrupted time-series analysis of 12,184 admissions to 11 Kenyan neonatal units implementing with the NEST360 Alliance, recorded in the Neonatal Inpatient Dataset from December 2023 to August 2024. Weekly admissions and inpatient mortality were modeled over a 72-week window (27,638 admissions) using hospital-clustered generalized estimating equations with seasonal terms. Care processes, case fatality, and birthweight-specific mortality were compared across study periods. Results. Weekly admissions fell from 413 to 189 during the strike (incidence rate ratio (IRR) 0.49, 95% confidence interval (CI) 0.31-0.75), approximately 1,700 fewer admissions than expected, and returned to baseline afterward (IRR 1.00, CI 0.81-1.23). Newborns admitted during the strike were of lower birthweight, more often premature, and more often outborn. Admissions fell across all birth-location categories, most steeply among inborn neonates. No measurable change was detected in documented inpatient coverage of care measures, in crude mortality (12.5% to 14.9%; risk ratio (RR) 1.07, CI 0.85-1.33), or in trend-adjusted mortality (IRR 0.88, CI 0.53-1.45). Case fatality among neonates with recorded infection doubled, from 4.7% to 9.6% (RR 2.06, CI 1.18-3.58; adjusted p = 0.047). Conclusions. The 2024 physicians' strike was associated with severe disruption to neonatal service utilization, with admissions returning to baseline when the strike ended. Among newborns who continued to reach care, inpatient mortality did not change measurably, but case fatality among those with recorded infection doubled. This analysis was confined to inpatient data; hence, the outcomes of newborns who did not reach the hospitals were not captured. Both inpatient and population-level data are needed to assess the full impact of the strike. Mitigating harm during future labor disruptions requires interventions such as resilient care models, formalized task-shifting protocols, and minimum service coverage agreements.

Background Street food vending is a major source of food supply in Nepal. Poor food hygiene practices among street food vendors pose a health risk by increasing the risk of foodborne diseases. Studies regarding food hygiene knowledge and practices are needed to improve public awareness. Therefore, this study aimed to assess food hygiene knowledge and practice among street food vendors and their associated factors in selected districts of Bagamati Province. Methods A community-based cross-sectional analytical study was carried out among 186 street food vendors of Districts located in central Nepal. Face-to-face interviews were conducted using a semi-structured questionnaire and an observation checklist. Knowledge and practice levels were categorized as good and poor. Chi-square test, Fisher's exact test, odds ratio, and Mann-Whitney U test were applied for data analysis. Results Less than half (39.8%) of the vendors had good food hygiene knowledge, while 91.4% of the respondents reported good food safety and hygiene practices. The education level of street food vendors was significantly associated with food hygiene knowledge (p = 0.001) and food safety and hygiene practices (p = 0.042). Significant association was not seen between overall food hygiene knowledge and overall food safety and hygiene practices levels. Conclusion The study identified a gap between food hygiene knowledge and self-reported food hygiene practices among street food vendors. Education, infrastructure, and regulations among street food vendors play a key role in good food hygiene practices more than knowledge alone. Policymakers should focus on training of food vendors, regular supervision, and monitoring of vending sites to enhance food safety.

Healthcare workers face substantial occupational demands and exposure to respiratory infections during winter, but evidence that probiotics improve their health and wellbeing remains limited. This exploratory, double-blind, randomised, placebo-controlled trial assessed whether daily Lab4 supplementation affected upper respiratory tract infection (URTI) frequency and supported wellbeing in 104 healthcare workers. Daily diaries recorded symptoms defining URTI episodes, general-practitioner visits, illness-related work absence and antibiotic use. Wellbeing was assessed at baseline and weeks 8 and 16, and faecal microbiota were assessed using 16S rRNA gene sequencing. Participants receiving Lab4 reported better wellbeing than those receiving placebo. For probiotic versus placebo, the risk ratio (RR) for URTI occurrence was 0.60 (95% confidence interval [CI]: 0.30-1.20; p=0.1477), the incidence rate ratio (IRR) for episodes was 0.58 (95% CI: 0.27-1.23; p=0.1581), and the mean ratio for episode duration was 0.98 (95% CI: 0.72-1.32; p=0.8776). For general-practitioner visits, the RR for at least one visit was 0.48 (95% CI: 0.21-1.07; p=0.0737) and the IRR was 0.44 (95% CI: 0.18-1.06; p=0.0677). For illness-related work absence, the RR for at least one day absent was 0.75 (95% CI: 0.18-3.22; p=0.6991) and the IRR for absence days was 0.74 (95% CI: 0.16-3.32; p=0.6914). For antibiotic use, the RR for any use was 0.48 (95% CI: 0.20-1.18; p=0.1111) and the IRR for antibiotic-use days was 0.42 (95% CI: 0.16-1.12; p=0.0820). No significant between-group differences in gut microbiota were detected in the subset providing faecal samples. Illness-related estimates generally favoured Lab4, although between-group differences were not statistically significant. These exploratory findings support evaluation in a larger, prospectively powered trial.

PurposeTo identify dietary patterns among adult childhood cancer survivors (CCSs), examine their determinants, and assess whether they differ according to cardiovascular disease (CVD) risk profiles. MethodsCCSs from the Swiss Childhood Cancer Survivor Study diagnosed before age 21 years (1976-2005), surviving [&ge;]5 years and aged [&ge;]18 years in 2017, completed a food frequency questionnaire (SCCSS-Nutrition). Factor and hierarchical cluster analyses of 52 food groups identified dietary patterns. We categorised CCSs as having CVD, CVD risk factors (obesity, hypertension, diabetes, high cholesterol), or being CVD risk-free. Multinomial logistic regression assessed associations between dietary patterns and CVD risk profiles. ResultsAmong 802 CCSs (median age: 35 years; IQR: 29-41; 50% male), we identified five dietary patterns: Mediterranean-inspired diet (22%), Western indulgence diet (38%), Western sweet & fatty diet (26%), restrained indulgence diet (9%), plant-based & alcohol-rich diet (6%). Male sex, younger age, German-speaking region, smoking, and living with others were associated with Western indulgence, Western sweet & fatty, and restrained indulgence diets. Higher Swiss socioeconomic position (Swiss-SEP) and education, and not having children, were associated with the plant-based & alcohol-rich diet, higher Swiss-SEP was also associated with the Western indulgence diet. No associations were observed between dietary patterns and CVD risk profiles. ConclusionsDietary patterns among adult CCSs were socially patterned and differed according to sociodemographic and lifestyle characteristics, but were not associated with CVD risk profiles. Implications for Cancer SurvivorsDietary counselling and broader lifestyle support should be considered as part of long-term survivorship care for CCSs.

Background Non-communicable diseases (NCDs) impose substantial population burden. Their polygenic architecture informs early risk stratification through polygenic risk scores (PRS). Previous studies reported elevated-PRS burden comparable to some modifiable risk factors (MRFs), yet evidence remains confined to European populations. We quantified the PRS-attributable NCD burden in Taiwan. Methods Linking Taiwan Biobank and National Health Insurance Research Database (N = 140K), we analyzed 42 high-burden NCDs. Elevated genetic risk (PRSe; top 10%) was assessed using Cox models. We estimated population attributable fractions (PAFs) and disability-adjusted life years (DALYs) using Taiwan-specific estimates from Global Burden of Disease 2023, and examined associations between an integrated PRS (iPRS) and healthcare utilization. Findings Strongest PRSe associations occurred for atrial fibrillation (AFib; HR = 3.56 [95% CI: 3.23-3.92]) and gout (2.41 [2.33-2.49]), yielding PAFs of 20% and 12%, respectively, while population-level attributable DALYs were largest for type 2 diabetes (T2D), intracranial hemorrhage (ICH), and lung cancer. At the individual level, PRS_e corresponded to 1.50 [1.42-1.57] healthy life-years lost for T2D and 0.57 [0.40-0.76] for ICH, approaching 2.4 years for the top 1% PRS. Polygenic attributable burden was overall greater in men. For several diseases, PRS_e-associated PAF and DALYs exceeded those of individual MRFs (e.g., smoking, alcohol use). Top-decile iPRS was linked to 23.9% (15.0-33.6%) more hospital days, 19.1% (13.2-25.3%) more inpatient visits, and 9.6% (6.9-12.4%) more outpatient visits. Interpretation Polygenic risk accounts for a measurable--and for several diseases, MRF-comparable--share of NCD burden in Taiwan, providing a quantitative foundation for integrating genetic liability into preventive care and health planning.

Encephalopathy is a lethal manifestation of global cerebral dysfunction spanning hypoxic, metabolic, toxic, and vascular etiologies, yet its population burden is difficult to quantify because it predominantly appears as a contributing rather than underlying cause of death. Here, we analyzed US multiple-cause death records from 1999 through 2024 using harmonized CDC WONDER datasets. A longitudinally consistent core definition of 10 ICD-10 codes identified 953,846 encephalopathy-associated deaths. The national age-adjusted mortality rate increased 28.4%, from 9.143 per 100,000 in 1999 to 11.738 in 2024, after peaking at 14.391 in 2021. Segmented log-linear regression identified four temporal phases: 1999-2004 (annual percent change [APC],-1.76%), 2004-2018 (APC, 2.57%), 2018-2021 (APC, 6.54%), and 2021-2024 (APC, -5.98%). Encephalopathy was listed as the underlying cause in only 21.6% of deaths in 2024. Unspecified encephalopathy surged more than 3.6-fold, while anoxic brain injury remained stable. Mortality remained higher in males than females (13.973 versus 9.778 per 100,000), and rates among non-Hispanic Black individuals were 1.90-fold those of non-Hispanic White individuals. Geographically, mortality clustered in the Midwest and South (13.144 and 13.120 per 100,000 in 2024), with persistent state-level dispersion across the study period. COVID-19 accounted for 10.9% of associated deaths in 2021 before falling to 1.4% in 2024. These findings reveal a nonlinear trajectory shaped by diagnostic shifts, pandemic disruption, and persistent demographic and geographic disparities.

Background: Childhood lead exposure is a major global health concern. The 2025 Bangladesh Multiple Indicator Cluster Survey (MICS7) measured blood lead in a nationally representative sample of children aged 12-59 months for the first time. Preliminary reports suggested elevated blood lead was more common in wealthier urban households, contrary to the usual assumption. Methods: We analysed 10,622 children with a valid blood lead result (10,458 with complete covariate data for regression models). Elevated blood lead was defined as >=5 ug/dL. Prevalences are survey-weighted with design-based confidence intervals. Associations were estimated with survey-weighted logistic regression using stratified-cluster (Taylor-linearised) variance, and checked with a stratified bootstrap of primary sampling units and Benjamini-Hochberg false-discovery-rate control. Sensitivity analyses varied the outcome definition, the sample, and the weighting. Results: Survey-weighted prevalence of elevated blood lead was 38.5% (95% confidence interval [CI] 37.2-39.9%). Prevalence rose monotonically from 30.2% in the poorest to 51.9% in the richest wealth quintile. In the fully adjusted model, each wealth quintile was associated with 23% higher odds (adjusted odds ratio [AOR] 1.23, 95% CI 1.16-1.30), each level of maternal education with 20% lower odds (AOR 0.80, 95% CI 0.76-0.84), and urban residence with 37% higher odds (AOR 1.37, 95% CI 1.18-1.59). Household crowding was associated with higher odds (AOR 1.17 per person per room, 95% CI 1.10-1.24). The wealth-education interaction had AOR 0.95 (95% CI 0.92-0.98). In an exploratory contrast, weighted prevalence was 76.2% among children in the richest quintile with mothers having at most primary education versus 19.5% among those in the poorest quintile with mothers having higher secondary or tertiary education (prevalence ratio 3.9, 95% CI 2.6-6.0). Adjusted odds relative to Barishal ranged from 0.39 in Rajshahi to 3.29 in Dhaka. Conclusions: In this cross-sectional survey, elevated blood lead was more prevalent among wealthier and urban households and among children of less educated mothers, with large geographic variation. Lead prevention and source-identification efforts should therefore not be restricted to poor communities; prevalence remained high even in the poorest quintile. Interpretation is limited by substantial missing blood lead results and coding uncertainty.

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants with the potential to disrupt metabolic processes and contribute to carcinogenesis; however, molecular evidence linking alternative and emerging PFAS to ovarian cancer (OC) remains limited. We conducted a biomarker-based case-control study integrating exposureomics with multi-omics profiling. Plasma samples from 128 patients with OC and 128 controls were analyzed for 26 PFAS, untargeted metabolomics, lipidomics, and clinical phenotypes, while urine samples from an additional 100 patients and 100 controls underwent untargeted metabolomic and clinical profiling. Single-compound, burden-based, and mixture models were integrated with PFAS-omics association scans, cross-matrix metabolite prioritization, observational exposure-omics-clinical association-chain analyses, and repeated internal cross-validation. Higher PFAS burdens were consistently associated with OC case status, and DONA, GenX, PFNA, PFPeS, PFUdA, and PFTrDA constituted an OC-prioritized six-PFAS mixture. DONA and GenX exhibited the broadest lipid-related bridging signals, particularly across phospholipids, lysophospholipids, sphingolipids, neutral lipids, and acylcarnitines. Integrated plasma and urine analyses further identified five shared metabolites-elaidic acid, hippuric acid, betaine, corticosterone, and taurocholic acid-that provided incremental and complementary discrimination beyond reference models based on clinical variables and tumor markers in internal cross-validation. Collectively, these findings demonstrate that both alternative and emerging PFAS are associated with a distinct OC-related molecular phenotype involving coordinated lipidomic, metabolomic, and hematologic alterations, while highlighting DONA and GenX as the most prominent exposure-related signals.

Growing evidence links ultra-processed food intake according to the Nova classification with poor health, yet no comprehensive database of additives and food substances of non-culinary use that are markers of ultra-processing exists for the UK. Building the database involved seven steps: (1) obtaining all approved additives in the UK, (2) retrieving all of their technical functions, (3) coding each technical function as cosmetic (marker of ultra-processing) or non-cosmetic (not a marker of ultra-processing), (4) adding 'flavour extracts', 'natural flavourings', and 'flavourings', (5) excluding additives as ultra-processing markers if they served fortification purposes, or were a herb/spice, and (6) adding food substances of non-culinary use defined as markers of ultra-processing in the Nova classification. Lastly, (7) two UPF definitions were constructed based on the ambiguity/overlap of additive technical functions from previous approaches. The database is freely accessible for researchers to improve consistency in using the Nova classification in the UK.

Background: The incidence of early-onset colorectal cancer (EOCRC), defined as CRC diagnosed age <50, is rising in the United States and is the leading cause of cancer death in among those with early-onset cancer. Epigenetic exposure signatures based on methylation risk scores (MRS) offer a novel approach to identify long-term exposures that may contribute to EOCRC risk. We sought to replicate findings from a recent study in a racially and geographically diverse CRC cohort. Methods: We computed weighted MRS across lifestyle, air pollution, and pesticide exposome traits in 146 participants from the Disparities and Cancer Epidemiology (DANCE) cohort, a diverse population-based CRC study, applying the Maas et al. (2026) framework to tumor tissue. Associations between MRS and age at CRC onset (EOCRC, n=29; intermediate-onset (IOCRC) 50-64 years, n=69; late-onset, [&ge;]65 years, n=48) were evaluated using linear and polytomous regression, with adjustment and stratification for race, geography, Area Deprivation Index (ADI), and Multi-Environmental Exposure Index (MEEI). Spearman correlations were calculated between MRSes and observed exposures. Results: EOCRC cases were predominately Black (65.5% vs. 31.3% among LOCRC) and resided in higher-deprivation neighborhoods. We found higher odds of EOCRC associated with epigenetic exposure signatures for 2,4-D herbicide, heptachlor, coarse particulate matter (PM), Mediterranean Diet Score, and smoking, and borderline associations for fine PM and nitrogen dioxide. IOCRC was associated with signatures for 2,4-D, lindane, and obesity. Heterogeneity was observed by race and area-level factors, though associations were largely consistent across strata. ADI and MEEI were correlated with multiple pesticide and pollutant epigenetic signatures. Conclusions: In a diverse US cohort, epigenetic exposure signatures distinguish CRC cohorts, particularly EOCRC from later-onset disease, with associations consistent with but not identical to previous research. EOCRC in DANCE was characterized by higher epigenetic exposure signatures for air pollution, smoking, and distinct pesticide exposure profiles. IOCRC had overlapping characteristics with early- and late-onset and were the only group with a significant obesity signature. These findings support the hypothesis that exposome-driven epigenetic changes contribute to EOCRC risk and highlight the importance of studying diverse populations to characterize the full spectrum of environmental risk factors.