The global COVID-19 vaccine rollout faces challenges from persistent hesitancy, especially in rural and underserved regions. Alaska's unique geographic, cultural, and infrastructural challenges create complex dynamics for vaccine uptake.

This study uses machine learning on survey data to identify key sociodemographic and attitudinal predictors of hesitancy, informing targeted public health strategies.

This study surveyed 720 Alaska adults, selected via targeted sampling to capture diverse COVID-19 vaccine attitudes across demographics and regions. A structured questionnaire assessed hesitancy through 17 indicators. We applied extreme gradient boosting, random forest, and K-nearest neighbors models for both regression and classification, and interpreted classification results via Shapley Additive Explanations values.

Analysis of 720 respondents showed that in Alaska, 1.8% (13/720) of surveyed individuals completed the full primary vaccination series (doses 1-3) and received all 3 booster doses. A vaccination rate of 63.47% (at least 1 dose), with Pfizer preferred over Moderna. A total of 34% (238/720) of participants reported receiving the first dose of the COVID-19 vaccine, 43% (310/720) received the second dose, 18% (130/720) received a third dose, 22% (158/720) received the first booster, 13% (94/720) received the second booster, and only 4% (29/720) received a third booster. Geographic data revealed higher uptake in urban centers and variability in rural areas. Young adult males exhibited the highest hesitancy, while lesbian, gay, bisexual, and transgender individuals showed the lowest. Trust in the health care system was the strongest predictor, confirmed by machine learning analyses.

Focusing on a geographically and demographically distinct US population, this study advances the scientific understanding of vaccine hesitancy while informing context-sensitive public health strategies. The findings offer actionable evidence to guide targeted communication, equitable outreach, and data-driven policy in Alaska and similarly underserved regions across the United States, underscoring the importance of culturally tailored, trust-centered interventions to promote vaccine uptake and health equity.

A female infant born at 23 0/7 weeks' gestation with a birth weight of 570 g was admitted to the NICU due to extreme prematurity, extremely low birth weight, and respiratory distress syndrome. At approximately 2 weeks of life, she underwent an evaluation for late-onset sepsis because of escalating respiratory support requirements. Empiric antibiotics were initiated while awaiting culture results. Sequential broadening of antibiotic coverage occurred in response to worsening clinical status. Despite maximal medical therapy, the infant continued to deteriorate and ultimately died following an acute bradycardic/desaturation event requiring CPR. Blood culture results returned after her death revealed Gram-negative bacteremia. This case emphasizes the treatment challenges of late-onset sepsis in periviable infants, in whom rapid decompensation from infection can occur even with aggressive antimicrobial therapy.

We present a case of a male in his fifties who attended with wheezing, dysphonia and shortness of breath. He was under investigation for asymmetrical muscle weakness in the absence of a sensory deficit for the preceding 1 year. Spirometry (flow volume loop) suggested extra-thoracic restriction and bronchoscopy confirmed bilateral vocal cord palsy. Due to clinical presentation and a positive anti-GM1, a diagnosis of multifocal motor neuropathy (MMN) with bilateral vocal cord palsy was made. The patient was initiated on intravenous immunoglobulin therapy with good effect on his general muscle weakness and respiratory symptoms, lung function and vocal cord abductor function. MMN with conduction block is a rare autoimmune condition, and vocal cord paresis from bilateral Xth cranial nerve involvement (recurrent laryngeal) is a very rare presentation of an MMN. Early diagnosis led to good patient outcomes.

Rapid sequence induction (RSI) is widely used in patients at risk of pulmonary aspiration but may be associated with haemodynamic instability and intubation difficulties. It remains unclear whether patients with moderately increased risk of aspiration benefit from RSI compared with standard induction including mask ventilation.

This multicentre, randomised, controlled, parallel-group, patient-blinded trial will enrol 792 adult surgical patients with moderately increased risk of aspiration. Participants will be randomised 1:1 to RSI (no mask ventilation, rocuronium 1.0-1.2 mg/kg) or standard induction (mask ventilation with rocuronium 0.5-0.6 mg/kg until adequate neuromuscular blockade before intubation). The primary outcome is clinically relevant hypotension within 15 min after induction (peri-induction period), defined as mean arterial pressure <65 mm Hg for >1 min, a decrease >20% from baseline or vasopressor administration. Secondary outcomes include oxygen desaturation, pulmonary aspiration, intubation difficulty (first-pass success and Cormack-Lehane grade), residual neuromuscular blockade and postoperative sore throat. Recruitment is planned over approximately 3 years and is ongoing. All analyses will follow the intention-to-treat principle.

The study has been approved by the Ethics Committee of the Medical Faculty, University of Leipzig, Germany (reference number: 193/23-ek). Results will be disseminated through peer-reviewed publications and presented at scientific conferences.

DRKS00031940.

Asian Americans (AAs) are the only racial/ethnic group in the USA for whom cancer and not heart disease is the leading cause of death in men and women, and foreign-born immigrants are more likely to be diagnosed at an advanced stage than their native-born counterparts. While there is a growing literature on the development of culturally grounded interventions for AA and immigrant populations in cancer care, there is limited knowledge of researchers' experiences recruiting AAs to cancer research studies.

Between August 2023 and May 2025, trained bilingual research staff recruited eligible patients from an NCCN-designated cancer center in the Northeast to two trials piloting a counseling intervention adapted for Chinese Mandarin-speaking patients with advanced cancer. Research staff documented qualitative notes regarding contact with patients and family members in study contact logs. Contact logs of participants who declined to participate (n = 97), in addition to research reflections and amendments to the study protocol, were reviewed and coded to summarize main challenges in recruiting eligible patients to the study.

Thematic analysis yielded six main challenges encountered during the recruitment process: (1) family member involvement, (2) limited prognostic awareness, (3) mistrust and scam concerns, (4) uncertainty and unfamiliarity with counseling and psycho-oncology, (5) unmet health-related social needs, and (6) communication difficulties related to language/dialect. Details of how the recruitment processes were modified to address challenges and facilitate study participation are described.

Several recommendations are proposed for future research studies with Chinese immigrant cancer patients. During initial contact, research staff's approach with family caregivers is a major determinant of Chinese patients' willingness to participate. Social drivers of health (e.g., barriers to linguistically appropriate health care access, mistrust), health-related social needs (e.g., patients' and families' financial instability), and culturally rooted differences in prognosis sharing also affect patient engagement with research staff. Patient engagement processes should be flexible to respond to patient and caregiver needs. Culturally grounded recruitment strategies can improve rapport, build trust, and increase likelihood of recruitment and retention among Chinese immigrant cancer patients. Trial registration NCT02112188, registration date: August 30, 2023.

Limited access to preventive healthcare in rural and remote areas poses a persistent challenge for early identification of non-communicable disease (NCD) risk. We evaluated the feasibility and acceptability of HealthD, a telehealth-supported platform that enables Community Health Leaders (CHLs) to conduct community-based NCD risk assessment and facilitate follow-up in rural northern Thailand.

We conducted a prospective, single-arm feasibility and acceptability study from June to November 2023 in Chiang Mai Province, Thailand. A total of 120 adults aged 30-70 years without a prior recorded diagnosis of the target NCDs were enrolled. Trained CHLs used HealthD to perform community-based assessment for diabetes mellitus (DM), cardiovascular disease (CVD), and respiratory symptom/functional limitation screening using guideline-informed algorithms and field-based measures, followed by risk-tailored counseling or teleconsultation at two- and four-month follow-up. Feasibility was assessed through recruitment, retention, CHL competency, workflow delivery, and acceptability among CHLs and participants.

Of 126 individuals approached, 120 were enrolled (recruitment rate 95.2%), and 119 completed follow-up (retention rate 99.2%). CHL competency improved after training, with mean assessment scores increasing from 8.4 to 9.3 (p= 0.010). Acceptability was high among CHLs (92%) and participants (97%). The HealthD workflow, including in-person assessment, point-of-care testing, digital data entry, algorithm-based risk-output generation, and teleconsultation follow-up, was implemented in the study setting. NCD-related risk outputs are presented as descriptive, exploratory findings. At baseline, 73% of participants were classified for DM-related risk, 3% for CVD-related risk, and 9% for respiratory symptom/functional limitation category. Across follow-up visits, DM-related risk categories changed, whereas CVD- and respiratory symptom/functional limitation categories remained relatively stable.

This prospective study suggests that HealthD is feasible and acceptable for CHL-led, telehealth-supported community-based NCD risk assessment and follow-up in a rural Thai setting. These findings are preliminary and are intended to inform workflow refinement and the design of larger studies evaluating effectiveness, implementation outcomes, and sustainability.

Non-communicable diseases are leading causes of morbidity and mortality worldwide. Lifestyle behaviors, such as poor diet, physical inactivity, and tobacco use, contribute substantially to this burden. Lifestyle medicine (LM) emphasizes evidence-based behavioral interventions to prevent and manage chronic diseases. However, little is known about LM education among family medicine residents in Saudi Arabia, particularly in the Jazan region. This study aimed to assess the effects of a structured LM educational intervention on the knowledge and attitudes of family medicine residents in the Jazan region.

A pilot pre- and post-intervention design was implemented among 67 residents enrolled in a post-graduate family medicine program in the Jazan region during May 2025. A validated questionnaire covering eight knowledge domains and five attitude dimensions related to LM was administered before and after training. The intervention was performed in a single day. An 8-h intensive program provided a comprehensive introduction to LM and health coaching through a blended learning approach incorporating lectures, workshops, and case-based scenarios. Facilitated by International Board of Lifestyle Medicine-certified consultant family physicians, the curriculum leveraged expert instruction and multimedia tools to deliver evidence-based training on the Six Pillars of Lifestyle Medicine. Data were analyzed using descriptive and comparative statistics to evaluate the changes between pre- and post-intervention responses.

The median total knowledge score increased from 23.0 (IQR 19.0-29.0) at baseline to 29.0 (IQR 27.0-31.0) following the intervention. Knowledge improved across the majority of domains, notably nutrition, physical activity, and health coaching. Knowledge improved among 82.1% of participants. A total of 56.7% demonstrated a positive shift in attitudes toward LM principles, which may translate into greater willingness to counsel patients on lifestyle modification and prioritize preventive care during routine clinical encounters.

The educational intervention significantly improved residents' knowledge and moderately enhanced their attitudes toward LM. The findings of this pilot study underscore the importance of incorporating structured LM training into family medicine residency programs nationwide to strengthen preventive care competencies and support the goals of Saudi Vision 2030.

Regional health disparities have been reported in many countries, including Japan. As rehabilitation needs increase worldwide owing to population aging and the epidemiological shift from communicable to non-communicable diseases, addressing unmet rehabilitation needs is crucial.

To analyze and compare rehabilitation resources and service provision for older adults across secondary healthcare regions in Japan.

A quantitative, analytical cross-sectional design was used in this study.

Nara Prefecture, a representative region in Japan comprising five secondary healthcare regions, was selected as the study setting. Data relevant to rehabilitation were obtained from routine national surveys and the Kokuho local government database for the period April 2019 to March 2020, and retrospectively analyzed as secondary data. The Kokuho database includes medical insurance claims for 213,933 residents aged ≥ 75 years, covering the entire prefectural population in this age group. A descriptive regional comparison was conducted using aggregated administrative data, including age-standardized claims ratios for rehabilitation sessions, to compare secondary healthcare regions.

The southern secondary healthcare region, characterized by the smallest population and lowest population density, showed distinctive features. It had the lowest per capita number of rehabilitation beds and professionals across all medical institutions within the region among the secondary healthcare regions. Although the proportion of individuals receiving rehabilitation services was the highest, the overall volume of services provided was the lowest, even after adjusting for age and population size. Notably, the provision of outpatient rehabilitation services across all providers within the region was particularly low compared with that in other regions.

This study revealed regional disparities in rehabilitation resources and service provision in secondary healthcare regions, highlighting the need for more equitable access. These findings underscore the value of routinely collected administrative and claims data for regional need assessment, particularly for informing evidence-based planning and resource allocation.

Background: The World Health Organization's (WHO) Eastern Mediterranean Region (EMR) is marked by socioeconomic diversity, political instability, displacement, and environmental risks. With nearly 745 million people across 22 countries, the region faces a complex "triple burden" of non-communicable diseases (NCDs), communicable diseases (CDs), and injuries. Objective: This paper provides an updated overview of the epidemiological landscape of the EMR by linking current disease burdens with socioeconomic, behavioural, environmental, and health system determinants. It highlights regional disparities and identifies priority areas for health system strengthening. Methods: A descriptive narrative review of secondary data and published literature was conducted. Publicly available datasets, institutional reports, and peer-reviewed sources were purposively selected from WHO, WHO-Regional Office for the Eastern Mediterranean (WHO EMRO), the World Bank, Global Burden of Disease/Institute for Health Metrics and Evaluation (GBD/IHME), and related literature. The review focused mainly on data published between 2015 and 2022 and included indicators on demographics, mortality, disease burden, risk factors, health system capacity, and health financing across EMR countries. Findings were organised narratively to describe regional patterns, disparities, and policy-relevant gaps. No systematic review, meta-analysis, or inferential statistical modelling was undertaken. Findings: The review shows substantial health inequalities across income groups. Life expectancy reaches 79.7 years in high-income countries but only 63.7 years in low-income countries. NCDs are now the leading cause of death, driven by obesity, hypertension, tobacco use, and other behavioural risks. Meanwhile, CDs and injury-related mortality remain major challenges, particularly among young people and populations affected by conflict and displacement. Health systems are constrained by fragility, high out-of-pocket expenditure, and a projected workforce shortfall of 2.1 million by 2030. Conclusion: Addressing the EMR's epidemiological challenges requires stronger primary healthcare and progress towards universal health coverage through integrated strategies targeting social determinants, sustainable financing, and improved surveillance.

Sub-Saharan Africa faces a syndemic of HIV and non-communicable diseases (NCDs), particularly diabetes and hypertension. Integrated care models have been promoted to improve service efficiency and patient outcomes; however, evidence on their effectiveness, implementation and real-world applicability remains fragmented.

This systematic review aimed to assess the clinical and service delivery effectiveness of integrated HIV-diabetes-hypertension care models in sub-Saharan Africa and to identify key implementation barriers and facilitators, and sustainability considerations.

We conducted a systematic review of studies published between January 2016 and June 2026 following PRISMA 2020 guidelines. PubMed, Scopus and African Index Medicus were searched. Eligible studies included randomized controlled trials, observational, qualitative and mixed-method studies evaluating integrated care models for HIV and NCDs in sub-Saharan Africa. Data were synthesized narratively, guided by implementation science frameworks.

Sixteen studies from eight sub-Saharan African countries were included. Integrated care models, such as one-stop clinics, nurse-led service, adherence clubs and decentralized drug distribution, were consistently associated with high retention in care for people living with HIV (generally >80%) and sustained viral suppression (> 90%). Retention for diabetes and hypertension care was lower (70%-78%), and improvements in blood pressure and glycaemic control were reported but remained inconsistent and frequently suboptimal. Integrated care models improved service delivery outcomes, including appointment adherence, continuity of care and patient acceptability. Key implementation facilitators included task-shifting, co-located services, leadership support and leveraging existing HIV infrastructure. Common barriers were drug stockouts for NCDs, workforce shortages, fragmented data systems, stigma and confidentiality concerns, and long waiting times. Limited economic evidence indicates that personnel costs constituted the largest share of programme expenditure. While integrated care models were feasible and acceptable in routine settings, scalability and long-term sustainability were constrained by donor dependence, supply chain weaknesses and variable health system readiness.

Integrated HIV-diabetes-hypertension care models in sub-Saharan Africa effectively maintain HIV treatment outcomes and improve service delivery, but clinical control of NCDs remains suboptimal. Sustainable and equitable integration will require deliberate strengthening of NCD-specific supply chains, workforce training and context-adapted implementation strategies aligned with health system readiness. Policy and programming should support differentiated, patient-centred integration that addresses both clinical and systemic barriers.