After years of focussing on infectious and degenerative illnesses, U.S. public health turned to the problem of accidents. Over the course of the twentieth century, safety practitioners repurposed the models of infectious disease control, risk-factor medicine, and biomechanics to improve the precision of injury data and to guide its applications. The resulting set of frameworks, methods, and practices, collectively referred to as ‘the epidemiology of accidents’, changed how health professionals analysed injuries but never produced a lasting consensus on appropriate safety interventions. This article uses the understudied history of home accident prevention to explain why mid-twentieth-century public health failed to prioritise injury control and what made home accidents especially intractable. During the 1940s, the American Public Health Association and U.S. Public Health Service collected statistics from communities across the country to determine the causes of home accidents and to inform local safety campaigns. These investigations were comprehensive but nonspecific, seeking to educate families about all the dangers of domestic space. After John Gordon published his influential study on accidents in 1949, this approach shifted from counting cases associated with risky behaviours and conditions to quantifying the extent to which isolable risk factors contributed to injuries. From the 1960s to 1970s, William Haddon changed accident prevention again, defining injuries as ‘abnormal energy exchanges’ and finding ways to minimise harm when accidents happened. Across these iterations, the epidemiology of accidents tried to identify, classify, quantify, and control the causes of home injuries but fell short of translating research into policy.

Malaria transmission is associated with climatic variability and vector control interventions, and understanding their long-term and lagged associations is critical in regions approaching elimination. This 23-year retrospective study (2001–2023) examined associations between climatic factors and malaria incidence in eight base counties of Sistan and Baluchestan Province, southeast Iran. Negative binomial and zero-inflated Poisson regression models were applied to account for overdispersion and excess zeros, incorporating 1–3 month lagged exposures. Seasonal patterns were assessed using linear mixed-effects models, and the impact of indoor residual spraying (IRS) population coverage (2013–2023) was evaluated using a negative binomial generalized linear model. Malaria incidence declined during the elimination phase but resurged in 2022–2023. Across counties analysed with negative binomial models, a 1 °C increase in mean temperature (1–3 month lag) was associated with a ∼ 16% increase in incidence (IRR = 1.16), highlighting a consistent positive effect. Relative humidity showed heterogeneous but generally positive associations, whereas precipitation effects were weak and inconsistent. Incidence was higher in spring (4.6-fold), summer (7.9-fold) and autumn (6.8-fold) compared with winter. Increased IRS population coverage was positively associated with malaria incidence (IRR = 4.15 per 10% increase; 95% CI: 2.06–8.34), likely reflecting reactive spraying in response to higher transmission. Malaria transmission in southeast Iran is shaped by temperature-driven climatic variability and seasonal dynamics. Programmatic vector control responds to changes in transmission, emphasizing the need for integrated, climate-informed planning. Further research incorporating lagged predictive modelling and human mobility data is warranted to enhance elimination strategies.

Streptococcus uberis is currently the most notable emerging mastitis pathogen in South Africa. Multilocus sequence typing (MLST) was used to investigate the sequence types (STs) of S. uberis isolated from bovine milk and their epidemiological patterns of occurrence. This retrospective, longitudinal study was conducted on a pasture-based herd of 1005 lactating cows, on which slurry-spreading had been recently introduced. Composite cow milk samples were collected quarterly during routine whole herd sampling and from clinical mastitis cases (monthly) during 2021. Streptococcus uberis isolates obtained from two routine samplings and clinical mastitis cases were stored at −80°C. In 2024, seven S. uberis isolates were added; these were from the same cows in consecutive samplings. The prevalence of S. uberis intramammary infection (IMI) was 7.44%, while 21.26% of clinical mastitis cases were caused by S. uberis. Based on conventional microbiology, 31.4% of S. uberis IMIs were recurring in consecutive samplings. A total of 42 S. uberis STs were identified from 70 isolates; 41 were novel and only 1 (ST 1613) had been previously reported in the PubMLST/GenBank database. Of the S. uberis isolates examined, 35.7% had known clonal complexes (CCs); of these, 60% were CC ST-5. Owing to the high heterogeneity, no predominant STs were observed; ST 1613 was isolated six times but did not cause clinical cases. When S. uberis was isolated from a cow more than once, only 50% of the isolates had similar STs. Where cows had multiple infections in an udder, quarters infected had different STs. In summary, this herd showed significant heterogeneity in S. uberis, with all but one ST being novel variants. Results indicate that S. uberis IMI in this herd was transient, possibly of environmental origin rather than persistent udder infections, making a point-source of infection less likely.

The debate on euthanasia for mental suffering in young people in The Netherlands has become highly polarised, with a novel, apparently epidemiological argument taking centre stage: that psychiatric euthanasia is necessary to prevent suicide. This article evaluates that claim. Using data from 353 young applicants (annual suicide risk 2.9%) and optimistic assumptions (80% sensitivity and specificity), the number needed to treat was 10 and the number needed to harm 9. Thus, ten youths would need to undergo assisted dying to prevent one suicide, and nine would die without a preventive purpose having been served. Empirically and ethically, the prevention argument does not appear to hold; real prevention requires other, previously well-debated factors such as relational continuity, trauma-informed care and social inclusion in response to mental suffering.

Malnourished infants under six months (u6m) are a vulnerable but insufficiently prioritised group, with low levels of consolidated evidence to guide outpatient and community-based care. This study synthesised evidence on outpatient and community-based management of malnourished infants u6m, focusing on intervention strategies, outcomes, barriers, and policy implications. Following the JBI framework and PRISMA guidelines, this review included information published in English between 2007 and 2025 about the outpatient or community-based management of malnourished infants u6m or mother–infant dyads. Four databases and multiple institutional websites were searched, supplemented by grey literature. Data were extracted on various study features, interventions, and outcomes. A total of 26 studies were included, with only five published since the 2023 updated guidelines of the World Health Organization (WHO). Evidence was concentrated in studies from sub-Saharan Africa and South Asia. Several studies described outpatient care as feasible and acceptable in multiple contexts, with reported recovery rates ranging from 65% to 91%; however, methodological heterogeneity limits comparability across studies. Breastfeeding support, maternal health, and culturally adapted interventions were described as important indicators. Tools such as the MAMI clinical care pathway, MUAC, and the MAMI WAZ look-up chart were described as effective, but require further validation and contextual testing. Major barriers that were mentioned included shortages of trained staff, inconsistent protocols, and policy reluctance to scale outpatient models. Outpatient and community-based care for malnourished infants u6m aligns with recent WHO guidance on managing ‘at-risk’ infants. However, widespread adoption requires stronger evidence-based management or tools, integration into health systems, and national policies. Strengthening research and programmatic consensus will be essential to improve outcomes for this vulnerable population.

While chrono-nutrition behaviours are inter-related, few studies examined patterns of chrono-nutrition behaviours using a comprehensive set of these behaviours. This study aimed to identify chrono-nutrition behaviour patterns and examine their associations with sociodemographic characteristics, diet quality and obesity. This cross-sectional study included 1047 Japanese adults aged 20–69 years. Using 11-d diaries of eating, chrono-nutrition behaviours (such as frequency and timing of eating) were evaluated for workdays and non-workdays separately. Principal component analysis identified four patterns: ‘early, large breakfast on workdays’, ‘skipping breakfast on non-workdays’, ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’. Female sex was associated with the ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’ patterns; male sex was associated with the ‘skipping breakfast on non-workdays’ pattern. Age was positively associated with the ‘skipping breakfast on non-workdays’ and ‘early last eating with large lunch’ patterns. Having a full-time paid job was associated positively with the two patterns characterised mainly by breakfast but inversely with the remaining two patterns. After adjustment for potential confounders, none of the four patterns were significantly associated with diet quality (Healthy Eating Index-2020 score), general obesity (BMI ≥ 25 kg/m2) or abdominal obesity (waist circumference ≥ 90 cm for males; ≥ 80 cm for females). In conclusion, this study suggests that different chrono-nutrition behaviour patterns were differentially associated with sociodemographic characteristics, but not with diet quality or obesity. Further research is needed to clarify if the patterning approach is useful to comprehensively interrogate chrono-nutrition behaviours.

Genomic epidemiology was essential for characterizing SARS-CoV-2 transmission during the early COVID-19 pandemic. This systematic review examined how whole-genome sequencing was used in local outbreak investigations published between March 2020 and March 2021. Searches of PubMed, Scopus, and Web of Science identified 32 studies from 18 countries that integrated genomic and epidemiological data for local outbreak investigations. Most studies were conducted in healthcare settings or in high-income countries. A limited number of studies were conducted in low- and middle-income countries, except for China and Vietnam. Illumina or Oxford Nanopore platforms and tiled-amplicon protocols were the most common sequencing methods. Phylogenetic trees were the most common genomic epidemiology analytical approach. Genomic data enabled confirmation of suspected transmission links, detection of multiple introductions, and identification of asymptomatic or presymptomatic transmission. Important enablers of early implementation included open-access genomics databases, standardized protocols (e.g. ARTIC), open-source tools (e.g. Nextstrain), and cross-sector partnerships and funding. Study quality and adherence to common observational study reporting guidelines varied widely. Familiarity with the STROME-ID guidelines for molecular epidemiology studies would have improved overall quality. These findings highlight the utility of genomic epidemiology in outbreak response and support its continued integration into public health surveillance systems.

This editorial examines the current debate surrounding attention-deficit hyperactivity disorder prevalence, the perceived surge in diagnoses and the growing pressure on healthcare services. It discusses the wide methodological variation in recent studies, the limited pool of high-quality evidence and the challenges this creates when trying to understand true population rates. The article highlights the gap between stable epidemiological estimates and the marked rise in referrals, waiting lists, private assessments and prescribing. It explores how increased awareness, evolving diagnostic criteria and improved detection of previously unrecognised cases contribute to the overall picture, along with the role of social media and shifting societal attitudes. Implications for policy and clinical practice are outlined, emphasising the need for efficient clinical pathways, better-quality data and more comprehensive, multi-informant assessments.

Fasciola hepatica infections in cattle often lead to significant production losses. Infection rates are expected to increase due to environmental changes at regional and global level which favour the life cycle of F. hepatica. This study aimed to identify environmental and herd factors associated with F. hepatica antibody positivity in bulk tank milk (BTM) of Dutch dairy cattle herds. In total, 10403 BTM samples were collected yearly in October, from 2018 till 2023. For each farm, monthly averages of weather factors and soil moisture level were obtained for the twelve months preceding October, along with soil type and number and grazing of dairy cows. Logistic regression analyses were performed retrospectively using generalized estimating equations, with continuous variables analysed as quartiles. The odds of F. hepatica antibody positivity in BTM are higher for farms on peat (OR 1.69, 95% CI [1.27, 2.24]) and heavy clay soils (OR 1.75, 95% CI [1.30, 2.35]) compared to those on sand soil. In addition, the odds of antibody positivity increased with higher monthly temperatures (December: ORQ1-Q4 2.94, 95% CI [1.94, 4.46]) and rainfall (November: ORQ1-Q4 2.33, 95% CI [1.62, 3.34]) at the end of the previous grazing season. Stratified analyses by soil type yielded results consistent with those across soil types. Weather patterns that favour the number of overwintering snails infected with F. hepatica seem to increase the infection risk for dairy cattle in the next grazing season, which highlights the potential of prediction tools that facilitate early detection of new F. hepatica infections.

In this nationwide cohort study, we assessed the long-term risk of major cardiovascular events following intensive care unit (ICU) treatment for community-acquired sepsis and septic shock, compared to the general population. We included 20313 adults admitted to Swedish ICUs between 2008 and 2019, identified through national healthcare registries, and matched each case to 20 randomly selected population controls. Entropy balancing adjusted for baseline co-morbidities, healthcare utilization, and socio-demographics. The association between sepsis and subsequent cardiovascular events (hospitalizations or deaths due to myocardial infarction, heart failure, or cerebral infarction) was analysed using Cox proportional hazards models. Sepsis was associated with increased cardiovascular risk, particularly during the first year (days 0–30 adjusted hazard ratio [aHR] 6.1 (95% CI 4.7–7.9); days 31–90; aHR 2.4 (95% CI 1.8–3.2); days 91–365 aHR 1.4 (95% CI 1.2–1.6)), with risk persisting through years 2–5 (aHRs 1.1–1.3). Heart failure risk remained elevated across all intervals, while risks of myocardial and cerebral infarction were mainly short term. The highest relative risks were observed in patients without prior heart disease or with low baseline cardiovascular risk. These findings suggest that sepsis might be an independent and under-recognized driver of long-term cardiovascular disease, highlighting the need for preventive strategies.

Sexual-identity disparities in substance use among U.S. veterans, and whether mental-health treatment mitigates risk for those with depression, remain under-examined. Using data on veterans from the 2021–2023 National Survey on Drug Use and Health (NSDUH; N = 7,212), disparities were estimated in past-30-day nicotine, marijuana, binge drinking, and polysubstance use, as well as severe psychological distress (K6≥13) and past-year suicidal ideation. Guided by a biosocial/minority-stress framework, multiple imputation was applied (m = 20) and survey-weighted logistic regression adjusting for age, year, race/ethnicity, sex, education, metro status, insurance, marital status, employment, and income; among veterans with a past-year major depressive episode (MDE), interactions were tested between sexual identity and (a) depression-related clinical contact (DRC) and (b) prescription medication for depressive feelings. Bisexual veterans showed the highest prevalence of marijuana (33.5%) and polysubstance use (30.6%), exceeding that of heterosexual (11.8%, 14.9%) and gay/lesbian veterans (24.0%, 18.8%). Models restricted to veterans with MDE, past-year DRC (DRC defined as any visit or conversation with a health professional about depressive feelings) moderated risk for gay/lesbian veterans, with DRC associated with lower odds of binge drinking and polysubstance use; prescription medication showed a similar moderating pattern for nicotine and polysubstance outcomes. Findings for severe psychological distress and suicidal ideation were mixed and consistent with confounding by indication. Results should be interpreted cautiously given the cross-sectional data, self-report, small sexual-minority subgroups, and non-aligned recall windows (past-year mental health/treatment vs past-30-day substance use). Overall, sexual-identity disparities in substance use are evident, with bisexual veterans bearing the greatest burden, and engagement in DRC and medication among veterans with MDE, particularly gay/lesbian veterans, showing associations consistent with a buffering effect of affirming care. Longitudinal and qualitative studies are needed to test causal pathways and to illuminate lived experiences, and policy/clinical efforts should expand culturally competent, integrated services and routine SOGI data collection to monitor and reduce inequities.

Cytomegalovirus (CMV) is a ubiquitous virus with significant public health implications, including severe morbidity and mortality in neonates and immunosuppressed individuals. Substantial variation in CMV prevalence has been reported globally, and local epidemiological data are important to inform public health interventions. In this study, we estimated CMV seroprevalence and seroconversion rates among blood donors to provide baseline data on CMV epidemiology in Ireland. Seroprevalence was estimated in 74,821 donors, and seroconversion rates were calculated among returning donors, with associations assessed by demographic and geographical factors. Overall CMV seroprevalence in 2020 was 26.0% [95%CI: 25.7–26.3]. Female donors had higher odds of seropositivity than males (adjusted OR: 1.38, [95%CI: 1.34–1.43]). Among first-time donors, CMV seroprevalence was 23.82% [95% CI; 22.79–24.86], whereas within Sample Only New Donors (SOND), who are first-time donors born outside of Ireland and the UK, the seroprevalence was significantly higher, at 46.49% [95% CI; 40.41–52.98, p < 0.001]. The estimated annual seroconversion rate was 0.76% [95% CI: 0.68–0.85], with CMV DNA detected in 6.5% of seroconverters. These findings highlight a low CMV seroprevalence in Ireland, suggesting increased susceptibility to primary infection. Analysis of blood donor CMV data is a useful epidemiological tool to assess population-level risk.