Mental health conditions, including anxiety disorders, are a major cause of morbidity across Sub-Saharan Africa. There are scarce mental health resources and providers in Madagascar, which substantiates a need for clear and accessible assessment tools for assessing mental health conditions. Yet, before this study, there were no validated scales to measure anxiety disorder symptoms in Madagascar. We assessed the psychometric properties of the culturally adapted 10-item Hopkins Symptom Checklist (HSCL-10-SW) anxiety subscale in the Bay of Ranobe region, in southwestern Madagascar. The study participants were part of the ongoing HIARA cohort study. The HSCL-10-SW includes the original HSCL-10 anxiety subscale in addition to three culturally relevant items that were derived through qualitative research: irritability, lost in thoughts/overthinking and forgetfulness. We administered the HSCL-10-SW to 809 participants (41.2% males) aged 16 years (mean age 36.9) and above in October 2023. Our exploratory factor analysis supported a two-factor structure: Fear Anxiety and Cognitive-Somatic Anxiety. We found discriminant validity between Fear anxiety and Depression factors. Although the HSCL-10-SW demonstrated acceptable psychometric validity, we suggest that additional qualitative studies should be conducted to explore the local conceptualization of anxiety disorders in southwestern Madagascar.

Scientific discoveries and precision medicine research, especially efforts to identify individually tailored approaches to healthcare considering individual variability in genetics, environmental, and lifestyle factors, have the potential to transform health. This goal is especially critical for those who experience social injustices and substantial health disparities. Yet the inclusion of adults with intellectual disability in precision medicine research, a growing field in clinical and translational genomic research, raises ethical, social, and legal concerns about their ability to make informed decisions to participate, and subsequently whether this population should be excluded altogether or enrolled only via proxy consent. Both practices demand scrutiny and are sometimes without legal or ethical justification. Supported decision-making, a reasonable accommodation and relatively recent legal and ethical construct, can facilitate first-person consent and maintain the prospective participant’s position as the decision-maker. As such, supported decision-making is a promising development with critical implications for consent to precision medicine research. Using findings from our national survey with adults with intellectual disability and a legal analysis, our academic-community research partnership developed recommendations and a tool for using supported decision-making for enrollment in precision medicine research. We conclude with persistent challenges that need resolving to ensure the responsible inclusion of adults with intellectual disability in precision medicine research, and clinical research more generally.

Lizards represent a diverse group, adapted to a wide variety of environments, and interact with a wide range of parasites. The composition of a parasitic community can be influenced by several factors, including the host, the environment, and the parasite itself. This study evaluated the composition of the helminth community in three species of lizards of the genera Ameiva, Ameivula, and Tropidurus, from a Carrasco habitat in Chapada do Araripe, Brazil. Carrasco is a little-explored environment in which the diversity of hosts and parasites is still poorly understood. The composition of the helminth community associated with lizard species was evaluated by comparing richness, evenness, dominance, and diversity among component communities, including host sex and size as influencing factors, using different statistical comparison tools. The community consisted of 12 taxa from eight genera of parasitic helminths, seven of which were Nematoda and one Cestoda. The factors analysed had different influences on the different parasitic communities of each host species. It was possible to determine the dissimilarity between host populations based on their parasitic communities, and it was observed that the host species itself represented the most important factor in the structuring of helminth communities. The information recorded here converges with other results obtained in different studies with lizards, but points to patterns in the helminth community that differ from those observed in other areas of the Caatinga. The results obtained reveal complex patterns of association between parasites and hosts, demonstrating the existence of ecological relationships that can be shaped by specific factors.

Individuals from refugee backgrounds may experience higher rates of mental and physical health problems compared to the general population, yet the interdependence of these outcomes within couples remains poorly understood. This study aims to understand the relationship between post-traumatic stress disorder (PTSD), socio-economic status and self-rated general health (SRGH) among couples from refugee backgrounds living in Australia. Couples were nested within dyads using multi-level frameworks and mixed-effects logistic regression (n = 436 dyads). In respondents with likely PTSD, 61% of their partners were also likely to have PTSD compared to only 26% of partners in refugees with unlikely PTSD. After controlling for socio-economic factors, respondents with likely PTSD were significantly less likely to rate their health as ‘excellent/very good’ (OR = 0.20), compared to those with unlikely PTSD. Partners with likely PTSD were also less likely to rate their health as ‘excellent/very good’ (OR = 0.54). Individuals who were older, female, born in the Middle East, experienced less community support or more economic stressors were at greater risk of poorer SRGH. PTSD and SRGH had an interdependent effect within couples from refugee backgrounds. Familial and psychosocial contexts must be considered when developing health promotion and policies for refugee communities.

This study aimed to evaluate adherence to the Mediterranean diet, a recognised healthy eating pattern, and the tendency towards orthorexia nervosa in professional athletes, and to examine their relationship with physical activity levels. The study was conducted with athletes (n 134) at the Turkish Olympic Preparation Center (TOHM). Data were collected using a questionnaire covering sociodemographic information, dietary habits, anthropometric measurements, the Mediterranean Diet Quality Index (KIDMED), the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Orthorexia-11 (ORTO-11) scale assessing orthorexic tendencies. Of the participants, 17·2 % had poor dietary quality, 60·4 % moderate and 22·4 % good dietary quality. According to the ORTO-11 (cut-off ≤ 25 points), 30·6 % of athletes exhibited orthorexic tendencies. Athletes adhering to a diet had significantly higher orthorexia tendencies compared with non-dieters (P < 0·05). A significant association was found between athletic experience and orthorexic tendencies, particularly among those with 4–8 years and ≥8 years of experience (P < 0·05). Moreover, athletes consuming three main meals had significantly higher KIDMED and ORTO-11 scores than those consuming two meals (P < 0·05). No statistically significant correlation was found between the KIDMED score, ORTO-11 score and physical activity level (P > 0·05). Professional athletes showed moderate adherence to the Mediterranean diet, while certain groups displayed higher orthorexia tendencies. Diet quality and orthorexic tendencies differed significantly with eating habits such as athletic experience and meal patterns, whereas physical activity level had no effect. These findings highlight the importance of multidisciplinary nutrition strategies focusing on both performance and sustainable healthy eating behaviours.

Panic disorder is among the most common mental disorders, characterised by recurrent, unexpected panic attacks that are highly distressing and further lead to pervasive anxiety about future attacks and maladaptive behavioural changes. Existing pharmacological and psychological treatments often fail to produce lasting improvement, and relapse is common. Neither antidepressants, the current first-line drug treatments, nor benzodiazepines exert their actions sufficiently rapidly to head off panic attacks between the initial indications of panic symptoms and the fully developed panic attack. Therefore, there is a clear need for new pharmacological compounds, particularly those that could be administered at the first warning signs of an impending panic attack, to disrupt its genesis. Here we discuss the acid-sensing ion channel (ASIC) as a therapeutic target and the potential of amiloride, an ASIC antagonist administered via nasal spray, for rapid access to the brain, as a compound with potential to fill this need. We summarise relevant preclinical studies, including a demonstration of nebulised amiloride’s ability to normalise responses to carbon dioxide, a panicogenic, brain-acidifying agent. Following existing safety, stability and pharmacokinetic studies, clinical trials are needed to test the efficacy of this compound in individuals with panic disorder and/or recurrent panic attacks.

International access to and sharing of biospecimens is critical to answer important questions about complex diseases, and to ensure the diversity in biospecimen collection necessary to advance science and develop therapies that benefit all. However, many challenges exist. These include the lack of harmonized ethical, legal, and policy frameworks regarding secondary uses of biospecimens and associated data; regulatory and policy hurdles; and differences in cultural perspectives and practices across regional and national jurisdictions.

In this manuscript, a set of ethical principles is presented with the intent to address some of these challenges by ensuring better alignment in ethical practices related to biobanking and the global use of human biospecimens. In addition, these principles could serve as a basis for promoting more consistency among national regulations and policies. The ultimate goal is to develop an international framework for global biospecimen and data sharing.

Health technology assessment (HTA) is increasingly recognized as a critical tool for evidence-informed decision-making in Eastern Europe and Central Asia (EECA), a region characterized by substantial diversity in health system maturity, financial resources, and institutional capacities. Building on the previous Eurasian HTA Initiative conducted a decade earlier, this study aimed to update the regional assessment of HTA implementation, expand country representation, and identify evolving strengths, weaknesses, opportunities, and threats affecting the advancement of HTA across the region. An online multilingual survey, informed by the original SWOT framework, was disseminated between August and October 2025 to experts from national authorities, HTA agencies, academia, and health sector stakeholders across eleven EECA countries. Twenty-two responses were analyzed descriptively. Key strengths included strong regional collaboration interest, growing availability of online HTA resources, and sustained global support. Major weaknesses centered on the limited trained HTA/EBM personnel and the absence of standardized national training programs. Opportunities reflected expanding interest in EBM, pressure from rising healthcare costs, and prospects for regional advocacy, educational exchanges, and international collaboration. Principal threats involved insufficient funding for capacity building, low policy-maker and clinician awareness, commercial influence from industry, and limited incentives for EBM uptake. Overall, respondents emphasized gradual progress in selected areas but persistent structural barriers requiring coordinated national and regional action.

The 2022 and 2025 floods in Pakistan forced more than 33 million people to flee from their homes, destroyed medical facilities across a large portion of Punjab, Khyber-Pakhtunkhwa, Sindh, and Balochistan, and revealed major deficiencies in government management, healthcare systems, environmental protection, and climate preparedness. Pakistan emits <1% of worldwide greenhouse gases, yet remains among the most climate-sensitive nations, reflecting global inequities in climate impact. Floods destroyed basic health determinants, thus contributing to infectious disease epidemics, malnutrition, and mental health problems. To evaluate the short- and long-term flood impacts, this article applies the Disaster Management Cycle, along with the One Health, Planetary Health, and Doughnut Economy frameworks. The framework demonstrates the impact of floods on the health and healthcare system while simultaneously eroding the ecosystem and making the population more susceptible. The article identifies priorities for climate-adaptive health care infrastructure, environmental recovery, equity-centered disaster preparedness, and integration of One Health principles into medical education.

The role of Law enforcement agencies (LEA) is significant in suicide prevention efforts as first responders. Nevertheless, no published study to date has systematically compiled the body of knowledge about suicide prevention efforts involving LEA. The current scoping review aims to methodically map and examine the peer-reviewed literature and grey literature on the role of LEA in suicide prevention. Electronic searches of the databases like Medline, PsycINFO, Google Scholar, Web of Science, Scopus, CINAHL and Google were conducted using a comprehensive search strategy to identify relevant resources. Grey literature was searched searches were undertaken on relevant databases and, as well as government and organisational websites. The reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The inclusion criteria comprised research articles, reports, and guidelines/policy documents on the role of law enforcement agencies (LEAs) in suicide prevention. Studies on prevalence, custodial settings, non-English publications, and reviews were excluded. Inclusion criteria comprised research articles, reports and guidelines/policy documents focusing on law enforcement’s role in suicide prevention. Studies focusing solely on prevalence or epidemiology, studies confined strictly to custodial settings, publications not in English and systematic reviews or meta-analyses were excluded. Out of 3,327 records screened, the full texts of 82 resources were included in the review. All the resources identified were categorised between peer-reviewed literature and grey literature. Resources were thematically categorised based on functional roles into- I. Strategic and System-Embedded Roles of LEA, II. Capacity Building and Training Oriented Engagements, III. Surveillance Reporting and Data Systems Role, IV. Community Facing and Preventive Engagement, and V. Means Restriction and Environmental Prevention Roles. The chronological development of the resources was inconsistent. Most resources were from high-income countries, focusing on the evaluation of training, capacity building programmes, surveillance initiatives and the exploration of varied roles of LEA across custodial, community and crisis settings and other interdisciplinary collaborations. Notably, the resources show increased disparity in quantity and research methodological approaches across geographies. The review highlights substantial heterogeneity and a limited resource base from low- and middle-income countries on the role of LEA in suicide prevention, with a dearth of structured, evidence-based, scalable models in these settings. These gaps point to an urgent need for locally relevant and cross-sectoral models that position law enforcement as integral partners in suicide prevention efforts, especially where these agencies play a major role as first responders.