Arterial hypertension is a leading modifiable cardiovascular risk factor. After d modifications, recent guidelines recommend single-pill, low-dose combinations as initial pharmacological strategy. We investigated the long-term feasibility and sustained effect of such a strategy in a remote rural area of Southern Rwanda, in sub-Saharan Africa.

Arterial hypertension was diagnosed using three sets of blood pressure measurements obtained according to European Society of Hypertension recommendations using a validated oscillometric device (OMRON M7 IT-HEM-7322-E). Individuals meeting diagnostic criteria were initiated on a single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan. Treatment dosage was reassessed and adjusted as needed at each outpatient clinic visit.

Fifty-seven Black African participants with confirmed uncomplicated, untreated hypertension (aged 65 [54-70] years; median and interquartile range) had follow-up data available for up to 24 months after inclusion. Blood pressure <140/90 mm Hg was achieved in 37 (65%) participants after 1 month, 51 (89%) after 3 months, 44 (77%) after 6 months, 43 (75%) after 12 months, and 47 (83%) after 24 months.

Long-term management of arterial hypertension with a once-daily single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan as initial therapy is feasible in a rural sub-Saharan African setting. Blood pressure reduction is sustained for at least 24 months. Single-pill combinations should be made accessible even in remote areas of low- and middle-income countries.

Background Overweight and obesity among adolescents have emerged as major public health concerns, particularly in urban India, due to rapid lifestyle transitions, unhealthy dietary practices, and increased sedentary behavior. Adolescence is a critical period during which excess weight often tracks into adulthood, increasing the risk of non-communicable diseases. However, city-specific data from metropolitan areas such as Chennai remain limited. Methods A school-based cross-sectional study was conducted from January 2025 to April 2025 among 222 adolescents aged 13-18 years in Chennai, Tamil Nadu. Data on socio-demographic characteristics and lifestyle behaviors were collected using a pre-tested structured questionnaire. Anthropometric measurements were recorded using standard procedures, and body mass index (BMI) was calculated and classified according to WHO BMI-for-age Z-scores (5-19 years). Associations were assessed using chi-square tests and odds ratios with 95% confidence intervals, followed by multivariate logistic regression to identify independent predictors. Results A total of 222 adolescents were included in the study. The overall prevalence of overweight and obesity was 21.7%, with 7.7% classified as overweight and 14.0% as obese. Female adolescents had significantly higher odds of being overweight or obese compared to male adolescents (OR = 6.11; 95% CI: 2.40-15.60). Excess daily screen time (>2 hours/day), frequent fast-food consumption (≥3 times/week), and late dinner timing (after 9 PM) were significantly associated with excess body weight on bivariate analysis. On multivariate analysis, female gender (AOR = 6.52), increased screen exposure (AOR = 2.46), and frequent fast-food intake (AOR = 2.58) remained independent predictors of overweight and obesity. Conclusions More than one-fifth of adolescents in this urban Chennai school were overweight or obese, highlighting a substantial and growing public health concern. Modifiable lifestyle factors, particularly screen exposure and fast-food consumption, play a significant role. Strengthening school-based and family-centered interventions focusing on healthy eating habits, physical activity, and reduced sedentary behavior is essential to address adolescent overweight and obesity and support long-term health and well-being.

The rising prevalence of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVDs) and type 2 diabetes mellitus, presents a significant challenge in Papua New Guinea (PNG), contributing to increased morbidity and premature mortality. However, epidemiological data and evidence on the implementation of targeted policies remain limited. This study aims to assess the burden of major NCDs, along with risk factors, and review national policies targeting NCD prevention and control in PNG.

A combined scoping and policy review was conducted. The scoping review involved a systematic search of PubMed, EMBASE and Google Scholar databases to identify peer-reviewed and grey literature published between 2004 and 2024. A total of 15 records were included, addressing NCD prevalence, mortality and risk factors in PNG. Narrative synthesis was performed to summarise these findings. For the policy review, nine national NCD prevention and control policies were retrieved. Thematic analysis was conducted using the WHO Health System Building Blocks Framework.

The findings highlighted an increasing burden of NCDs and prevalence of related risk factors, particularly hypertension, tobacco use, obesity, alcohol consumption and physical inactivity. The available, though limited, data suggested an increasing mortality trend, with CVDs and cancers as the leading causes of death. While some national policies address components of NCD prevention and control, significant gaps persist. These include inadequate integration of NCD services into primary healthcare, insufficient surveillance and health information systems, workforce shortages, lack of sustainable financing and weak decentralised governance structures.

Effectively addressing the burden of NCDs in PNG requires strengthening health system capacity through evidence-based planning, improved surveillance, targeted investments in prevention and care, and consistent implementation of NCD strategies across all levels of the health system. However, the limited and uneven quality of available data constrains firm conclusions, underscoring the urgent need for more robust and nationally representative NCD surveillance.

The rapidly growing burden of non-communicable diseases (NCDs) in sub-Saharan Africa necessitates a better understanding of access gaps along the care continuum. This study assessed the prevalence and inequality in unmet need for hypertension and diabetes care in Tanzania, South Africa, and Lesotho using a care cascade framework.

We conducted a cross-sectional analysis of nationally representative Demographic Health Survey (DHS) datasets from Tanzania (2022), South Africa (2016), and Lesotho (2023/24), focusing on adults aged 15 years and older. The study estimated the proportion of adults with hypertension or diabetes who had not been screened, diagnosed, treated, or achieved disease control. Inequality was assessed using Erreygers Normalized Concentration Indices (ENCI), stratified by sex and residence.

Hypertension prevalence was 12.6% (95% CI: 11.7-13.4) in Tanzania, 46.7% (95% CI: 45.0-48.4) in South Africa, and 15.4% (95% CI: 13.8-17.2) in Lesotho. In Lesotho, 9.1% (95% CI: 7.8-10.6) of adults had diabetes. Unmet need was substantial across all countries: 96.5% for hypertension in Tanzania, 84.2% in South Africa, 65.8% in Lesotho, and 84.2% for diabetes in Lesotho. The care cascade framework revealed critical bottle-necks at screening and treatment stages. Inequality analyses revealed strong pro-poor gradients, particularly in screening (ENCIs: Tanzania -0.19, South Africa -0.17, Lesotho hypertension -0.15, Lesotho diabetes -0.24; all p < 0.01), with poor men experiencing the most disparities.

Substantial and inequitable gaps exist in hypertension and diabetes care. Policy strategies should prioritize community-based screening, primary care integration, and equity-focused interventions targeting poor men to improve NCD outcomes in the region.

Short-term air pollution exposure is a known trigger for cardiovascular events, yet how this risk varies across different progression stages of hypertensive patients remains unclear.

This study sought to quantify the mortality risk and burden due to hypertensive diseases of different progression stages in association with air pollution.

We conducted a nationwide, individual-level, time-stratified, case-crossover study including >2.1 million hypertension-related deaths across mainland China (2013-2019). Daily concentrations of fine particulate matter (PM_2.5), inhalable particulate (PM₁₀), NO₂, and O₃ were estimated using high-resolution spatiotemporal models (1 × 1 km). Conditional logistic regression was used to quantify the associations.

We observed a clear, stepwise risk gradient. For PM_2.5, the mortality risk per interquartile range increase rose from 1.39% (95% CI: 0.55%-2.24%) in uncomplicated primary hypertension to 2.62% (95% CI: 2.20%-3.05%) in hypertensive heart disease and 3.03% (95% CI: 1.53%-4.56%) in hypertensive kidney disease, reaching 5.01% (95% CI: 1.96%-8.16%) in hypertensive heart and kidney disease with concurrent cardiorenal failure at lag 02 days (average of lag 0-2 days). This high-risk phenotype also had the highest attributable fraction, with 4.20% (95% CI: 3.55%-4.85%) of deaths attributable to PM_2.5. Furthermore, NO₂ consistently showed the strongest associations among 4 air pollutants. We observed that the exposure-response curves for all 4 pollutants demonstrated approximately linear relationships with hypertension mortality, with no apparent evidence of a threshold. Hypertensive patients of female sex, age ≥65 years, northern residence, lower educational attainment, and no spousal support, and patients during the cold season were more vulnerable.

Air pollution acts as an acute stressor superimposed on hypertensive patients, creating a mortality risk gradient determined by the severity of comorbidity. These findings highlight the need for targeted risk stratification, identifying patients with concurrent cardiorenal failure as a priority group for precision-based environmental health advisories and targeted clinical management.

Human T-Lymphotropic Virus Type 1 (HTLV-1), is responsible for serious diseases such as Adult T-cell leukemia/lymphoma (ATLL) and HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). This research aimed to explore the level of awareness and knowledge of HTLV-1 among healthcare professionals working at Imam Khomeini hospital complex in Tehran to compare their knowledge in different aspects of this virus including basic knowledge, transmission, pathogenesis, prevention and treatment.

This cross-sectional, descriptive-analytical study was conducted among healthcare personnel at Imam Khomeini Hospital Complex, Tehran, during 2023-2024. Data were collected using a validated questionnaire designed to assess knowledge and attitudes about HTLV-1. The questionnaire underwent expert review for validity and reliability testing, including a 2-week test-retest process with Cohen's kappa coefficient calculation. It included demographic data, binary knowledge questions about HTLV-1 transmission, symptoms, complications, prevention, and treatment.

A total of 220 healthcare workers and students (63.6% female, 36.4% male) from medical, paramedical, and service fields participated in the study. Participants' attitude and knowledge levels were assessed using correct response rates, revealing significantly higher attitude scores (64.81%) compared to knowledge scores (42.61%) based on the Wilcoxon test (p < 0.05). Gender-based comparisons showed no statistically significant differences in attitudes (p = 0.30) or knowledge (p = 0.95). Age-group analyses using Kruskal-Wallis tests identified significant differences in knowledge performance (p = 0.00015), with the 26-35 age group outperforming others. Job position comparisons showed no significant differences in attitude or knowledge scores (p > 0.05).

The study highlights a notable gap in knowledge about HTLV-1 among healthcare professionals at Imam Khomeini Hospital Complex, despite relatively positive attitudes. Significant differences in knowledge were observed across age groups, with the 26-35 age group demonstrating better awareness. These findings underscore the need for targeted educational programs to improve HTLV-1 knowledge, particularly among younger and less experienced staff, to enhance preventive and diagnostic capabilities.

Human T-lymphotropic virus Type 1 (HTLV-1) is a globally distributed, oncogenic retrovirus endemic in specific regions, including southwestern Japan, sub-Saharan Africa, the Caribbean, parts of South America (notably Brazil), Iran, and Indigenous communities in Australia. Although most infections are asymptomatic, a minority of carriers develop severe, life-altering conditions: adult T-cell leukemia/lymphoma (ATL) or HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). This narrative review presents a comprehensive analysis of epidemiological studies, clinical reports, and public health surveillance data. Data on HTLV-1 prevalence, incidence, clinical outcomes, proviral load associations, and public health measures were extracted and compared across major endemic and nonendemic regions. HTLV-1 exhibits extreme geographic heterogeneity. Hyperendemic foci include southwestern Japan (carrier population ∼534,000 in 2020), parts of Brazil (estimated 800,000 carriers), the Caribbean (e.g., Jamaica, general population prevalence ∼6.1%), and sub-Saharan Africa (estimated 2-5 million infections, the largest global burden). In Central Australia, prevalence among Indigenous adults over 45 reaches 49.3%, the highest recorded regional rate globally. Prevalence varies significantly within populations: In Brazil, it is highest in the north/northeast. In Gabon, rural prevalence is 8.7%, rising to 12.5% in rainforest provinces, with Pygmy ethnicity identified as an independent risk factor. In Iran, prevalence is concentrated in the northeast (2%-7%), whereas the rest of the country shows rates below 1%. In contrast, prevalence is very low in nonendemic areas such as the United States and most of Europe (< 0.01% in Spain and Italy), except for Romania (5.3 per 10,000 donors) and areas with migrant populations. Incidence data are sparse but informative: In Japan, the annual incidence among blood donors is 6.88 per 100,000 person-years for women and 2.29 per 100,000 person-years for men. In the United Kingdom, the incidence of HAM/TSP among HTLV-1 carriers is 1.98 per 1000 person-years. A Brazilian cohort reported an HAM/TSP incidence of 1.47% over 3 years, substantially higher than Japan's lifetime risk of 0.25%. HTLV-1 remains a significant yet profoundly neglected global pathogen, exhibiting extreme geographic heterogeneity in prevalence, clinical outcomes, and transmission dynamics, driven by complex interactions of viral genetics, host factors, and disparities in public health infrastructure. Although proven cost-effective interventions such as universal antenatal screening in Japan have demonstrably reduced transmission, the persistent "silent" spread in endemic, low-resource regions particularly sub-Saharan Africa and Indigenous Australia demonstrates a critical global health inequity demanding urgent, region-specific strategies for screening, prevention, and patient care to mitigate its substantial burden of morbidity and mortality.

Cognitive impairment is associated with people with diabetes-related foot ulcers (DFU). However, it is unclear if cognitive impairment is associated with the ulcer itself or other co-existing diabetes-related complications such as peripheral neuropathy. We aimed to investigate cognition in people with diabetes-related peripheral neuropathy and compare those with DFUs to those without DFUs. In this age- and sex-matched, multicentre, case-control, observational study of 89 participants with Type 2 diabetes and peripheral neuropathy, we compared 49 participants with DFUs (cases) to 40 without DFUs (controls). Global cognition scores were assessed using the Montreal Cognitive Assessment tool. Participants with DFUs had similar characteristics to those without DFUs (all, p > 0.05), except for lower body mass index (p = 0.028). Participants with active DFUs had significantly lower global cognition scores compared to those without DFUs (median [IQR] 24.0 [21.0-25.0], 26.0 [24.0-28.0]; p < 0.001). After adjusting for other diabetes-related complications, lower global cognition was independently associated with a DFU, peripheral artery disease, lower physical activity and no family history of diabetes (all, p ≤ 0.019). People with DFUs had lower cognitive scores than those without DFUs, suggesting that the DFU itself is independently associated with cognitive impairment. Future studies should explore causal pathways and targeted management strategies.