To examine whether the association between child marriage and maternal healthcare utilization differs between conflict and non-conflict settings, and whether armed conflict amplifies the negative effects of child marriage on maternal healthcare utilization.

Armed conflicts hinder progress in reproductive and maternal health, particularly in low- and lower-middle-income countries, by weakening health systems, disrupting access to care, and increasing gender-based vulnerabilities. Child marriage, which is common in such contexts, may further limit women’s ability to seek adequate maternal healthcare. While both conflict exposure and child marriage are known to adversely affect maternal health outcomes, evidence on their intersection remains limited. Understanding their combined influence is essential for designing effective primary healthcare and humanitarian interventions.

We used data from 82 Demographic and Health Surveys (1994–2020) across 49 countries, linked spatially and temporally with armed conflict information from the Uppsala Conflict Data Program. The sample included 452,192 women aged 15–49. Maternal healthcare utilization was measured using continuum-of-care indicators: at least one antenatal care (ANC) visit, four or more ANC visits, four or more ANC visits with institutional delivery, and four or more ANC visits with institutional delivery and postnatal care (PNC). Associations were estimated using binomial logistic regression models, with robustness checks including interaction effects, macro-level analyses, and mediation analyses.

Women married before age 18 had significantly lower odds of utilizing maternal healthcare compared to those married at 18 or older. These disparities were strongest in conflict-affected areas, where child brides consistently showed the lowest utilization of ANC, institutional delivery, and PNC. Maternal education, household wealth, urban residence, and media exposure partially mitigated these associations. Additional analyses confirmed the robustness of findings across alternative model specifications, conflict measures, and subgroups.

Shone complex is a rare congenital cardiovascular anomaly characterized by multiple left-sided obstructive lesions. Adult presentation is uncommon and may result in atypical clinical manifestations, particularly when complicated by infective endocarditis. Coarctation of the aorta–associated infective endocarditis is especially rare and carries significant clinical risk.

We report a 25-year-old male with partial Shone complex consisting of a parachute mitral valve, mitral stenosis, and coarctation of the aorta. The patient presented with persistent high-grade fever and was diagnosed with methicillin-sensitive Staphylococcus aureus infective endocarditis based on positive blood cultures. Transthoracic and transesophageal echocardiography revealed obstructive left-sided lesions, mitral valve pathology, and moderate aortic regurgitation. Positron emission tomography demonstrated intense hypermetabolic activity at the coarctation site, consistent with active infection and confirming a saccular aneurysm. The patient underwent prolonged intravenous cefazolin therapy followed by surgical repair. The early postoperative course was stable; however, seven months later he re-presented with recurrent fever. Repeat imaging demonstrated graft infection, vegetation on the prosthetic material, and a perforated mitral leaflet. A second course of intravenous antibiotics (cefazolin and rifampicin) was administered, followed by long-term suppressive oral therapy. Subsequent follow-up showed persistent moderate-to-severe mitral regurgitation with stable postoperative anatomy.

This case highlights a rare adult manifestation of partial Shone complex complicated by coarctation of the aorta-site methicillin-sensitive Staphylococcus aureus infection, saccular aneurysm formation, and recurrent graft-associated infective endocarditis. The clinical course underscores the importance of vigilant multimodality imaging, early multidisciplinary evaluation, and long-term follow-up in adults with complex CHD, particularly when infectious complications are present.

Ethiopia has been working to achieve universal health coverage through optimizing the Health Extension Programme (HEP). The HEP optimization aspires to increase health service access, quality, and equity through different strategies, including establishing HEP units in health centres and primary hospitals. Therefore, understanding the processes of the HEP unit and its implementation experience is crucial for scale-up and sustainability.

This paper aims to document and share the lessons learned from implementing the HEP unit.

This research collected qualitative data from 14 districts/woredas in 2023. Forty-three in-depth interviews (IDIs) and four focus group discussions (FGDs) were conducted. Audio-recorded data were transcribed verbatim and translated. A thematic analysis approach was used to analyze the data, and direct quotations were used to present the findings.

In the Improve Primary Health Care Service Delivery (IPHCSD) project implementation sites, all 64 health centres, and primary hospitals established HEP units. Setting up the unit improved healthcare provision by promoting collaboration and teamwork, enhancing their skills, coordination, technical support to the catchment health post and increased access to healthcare services through outreach delivery. However, challenges such as a shortage of human resources, dedicated offices for the unit coordinators and team members, inadequate stakeholders’ engagement in the establishment processes, and insufficient tools and supplies were identified.

The HEP unit has improved community-level health services, enhanced health professionals’ skills and teamwork, and technical support to catchment health posts. Strengthening community engagement, advocacy, mentorship, training, and ensuring sufficient staffing, infrastructure, and supplies are essential for the programme’s scale-up and sustainability.

To develop strategies to lower barriers to sexual and reproductive health (SRH) care for migrant women (MW) in Milan, Lombardy, Italy.

SRH is a fundamental human right, yet MW experience poorer SRH outcomes than non-MW due to cultural, linguistic, legal, and financial barriers. Despite Italy’s universal healthcare system (Servizio Sanitario Nazionale, SSN), disparities persist.

Quantitative SRH data from the health information system of a non-governmental organization (NGO) clinic in Milan was used to describe the demographic, socioeconomic, and administrative profile of MW with SRH needs, and to examine factors associated with SRH-related consultations. Qualitative data were collected through semi-structured interviews with 29 stakeholders, including MW, healthcare workers, NGO representatives, and policymakers. Thematic analysis was guided by a socio-ecological framework across individual, organizational, societal, and policy levels.

SRH needs were the most frequent presentations among MW accessing the clinic. Most MWs came from Romania, Morocco, and Peru. Nearly half of those eligible for SSN registration were not enrolled, primarily due to lack of awareness. Economic vulnerability was strongly linked to SRH needs, while language proficiency alone showed no significant effect. Interviews underscored the importance of culturally sensitive care and mental health support. They also emphasized the inconsistent enforcement of regulations across government facilities and legislative gaps that leave certain groups, particularly undocumented EU nationals, without essential services. Community networks and stronger coordination across providers - including formal collaboration between NGOs and the SSN - were identified as promising levers to improve SRH access and equity in Milan and similar settings.

Food brand marketing is one of the techniques used by the food industry to create positive images and enhance brand recall among children. The objectives of this study were to assess food and beverage brand recall and to examine the sociodemographic characteristics associated with food brand recall, as well as the purchasing and consumption of branded foods among Thai children.

Cross-sectional analysis of secondary data from the 2024 Monitoring on Food and Beverage Marketing to Children in Thailand survey. A validated and reliable questionnaire was used for data collection. Descriptive statistics were used to summarise sociodemographic characteristics, food and beverage brand recall, and purchasing behaviours. Associations between brand recall and purchasing behaviours were examined using multivariable logistic regression models.

Eleven provinces across Thailand.

A total of included 2,113 children aged 10-18 years.

Nearly 40% of children recalled sweetened beverage brands, while 35% recalled snack brands. Food and beverage brand recall was statistically associated with purchasing and consumption of branded foods across several product categories after adjustment for sociodemographic characteristics.

Food and beverage brand recall was commonly reported among Thai children and showed statistically significant associations with purchasing and consumption behaviours. These findings contribute to the evidence base on food marketing exposure among children in Thailand.

CHD affect approximately 1% of live births globally and are the most common congenital anomaly. Contemporary data on CHD risk in offspring of affected mothers remains limited. This study evaluated CHD incidence in offspring of mothers with CHD at a southeastern U.S. academic medical centre.

We conducted a retrospective review of patients with CHD who received prenatal care between 2015 and 2023 at a multidisciplinary Cardio-Obstetrics clinic. Patients with acquired heart disease, syndromic or inherited CHD, and deliveries at outside hospitals with missing delivery data were excluded. The primary outcome was infant CHD incidence, confirmed by postnatal echocardiography. Secondary outcomes were neonatal intensive care unit admission, early in-hospital cardiac surgery, and in-hospital infant mortality.

A total of 186 mothers with 195 pregnancies and 198 infants were included. CHD was diagnosed in 16 infants (8.1%), most commonly ventricular septal defect. Of affected infants, none required early in-hospital surgery, and one experienced in-hospital mortality, though this infant had severe extracardiac anomalies concerning an underlying genetic syndrome.

The incidence of CHD among offspring of mothers with CHD in our cohort was higher than the general population; however, the majority of defects were non-critical and did not require early intervention. These findings offer important context for prenatal counselling and tailored fetal/neonatal echocardiography screening in this high-risk population.

People with serious illnesses often experience spiritual and emotional pain, manifesting in conditions such as depression, anxiety, and demoralization. Emerging research in psychedelic-assisted therapy has shown efficacy in treating these conditions. Despite evidence that psychedelics frequently occasion mystical/spiritual experiences in participants, there has been little research on support for spiritual, existential, religious, and theological needs, including the use of chaplains on therapeutic teams. Spiritual wellbeing outcomes have been inconsistently used and reported on in current psychedelics studies. The aims of this article are to identify and review patient-centered outcome measures focused on spiritual wellbeing for use in psychedelic research.

A literature review of instruments was conducted, with 286 articles included, identifying spiritual wellbeing measures within the palliative care population.

Three measures were selected for inclusion: Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12- Item Scale (FACIT-Sp-12), European Organization for Research and Treatment of Cancer Quality of Life Spiritual Well-being Questionnaire (EORTC QLQ-SWB-32), and the National Institutes of Health Healing Experience of All Life Stressors (NIH-HEALS). Instrument development, psychometric properties, and use in research for each are discussed.

Suitability in the context of psychedelic-assisted therapy with the palliative care population includes strong reliability and validity, and they should be accessible to people with various spiritual traditions, practices, and sources of connection. They should be patient-centered in their development, involve multiple stakeholders, and be appropriate for use with palliative care populations. According to these criteria and its orientation toward identifying spiritual change in the context of serious illness, the NIH-HEALS is recommended for wider use in psychedelic-assisted therapy.