The impact of stunting, thinness and obesity on depression and anxiety during challenging times, such as COVID-19, has not been adequately explored. This study aimed to estimate these relationships using longitudinal data from the four countries: Ethiopia, India, Peru and Vietnam.

We conducted an analysis using data from the Younger Cohort of the Young Lives study, which tracked 8000 children from 2002 to 2021. The first five rounds of the study assessed nutrition (stunting, thinness and obesity). The sixth round evaluated outcomes at three different time points. For the analyses, we employed a random effects ordered logistic regression model.

During the COVID-19 pandemic, experiencing stunting in a previous assessment round was associated with higher levels of depression (OR=1.34, p=0.025). Each additional year of stunting duration was linked to a greater severity of depression (OR=1.08, p=0.018). Additionally, longer durations of thinness were associated with an 11% increased risk of depression (OR=1.11, p=0.021). Meanwhile, experiencing stunting at least once over the five assessment rounds and the duration of stunting showed a weaker association with anxiety (OR=1.18, p=0.090) and (OR=1.06, p=0.065), respectively.

Stunting and thinness are linked to increased rates of depression and anxiety during the COVID-19 pandemic. These findings highlight the importance of ongoing health investments and the need to incorporate child nutrition programmes into disaster preparedness plans to address the long-term effects of malnutrition.

The COVID-19 pandemic exposed critical care disparities in low-resource settings. In Ethiopia, intensive care unit (ICU) expansion had begun prior to COVID-19 but accelerated during the pandemic with substantial new investment. This study provides the first nationwide assessment of ICU capacity, service readiness and patient characteristics across both public and private hospitals.

A cross-sectional survey was conducted in 2024 across all Ethiopian hospitals with operational ICUs, using site visits and standardised tools to assess facility capacity, staffing, equipment and preparedness. Patient-level data were collected for admissions on the survey day. Results were compared with pre-COVID-19 data to evaluate progress.

A total of 159 hospitals (117 public, 42 private) were surveyed, encompassing 1028 ICU beds. Public ICU facilities increased from 51 to 117 since COVID-19, with beds rising from 324 to 762. Private facilities added 266 beds (25.9% of the total). Improvements included 24/7 ICU-trained physician availability (52.1% vs 29.0% pre-COVID-19) and disaster preparedness plans (21.4% vs 6.0%). Persistent gaps were evident in advanced haemodynamic monitoring (available in <10 facilities) and organ support (9/117 public ICUs). Among 279 admissions (mean age 39.1 years; 55.2% male), neurological (32.1%) and respiratory (25.8%) conditions predominated, with sepsis observed in 29.4% of patients. Hypertension (25.1%) and diabetes (17.2%) were common comorbidities.

Ethiopia's ICU capacity has tripled since 2019, with a more balanced regional distribution and improved workforce coverage; however, deficits in advanced monitoring, organ support and referral coordination limit the system's readiness. The high burden of sepsis among ICU patients highlights systemic gaps in early recognition and supportive care; this supports scaling Essential Emergency and Critical Care as a foundational platform, alongside targeted improvements in infection management and antimicrobial stewardship. Strengthening public-private integration, standardised referral systems and cost-effective, high-impact interventions will be key to improving equity and outcomes in Ethiopia and comparable settings across sub-Saharan Africa and other low-resource contexts.

Community health worker (CHW) programmes are central to primary healthcare (PHC) in sub-Saharan Africa (SSA). Yet who pays for them, how much, and whether funds favour vertical (single-disease) or horizontal (broader-focus) programmes remains unclear. This study examined trends in donor and government financing for CHW programmes across SSA.

We conducted a secondary analysis of publicly available data. Organisation for Economic Co-operation and Development Creditor Reporting System (2002-2022) projects were screened and classified as vertical or horizontal through standard definitions and manual review. Government spending in 37 SSA countries (using WHO Global Health Expenditure Database (2016-2022) was estimated by applying maturity-based allocation percentages to preventive and outpatient curative functions. We described trends, donor composition, vertical-horizontal shares and the annual financing gap against published cost benchmarks.

Between 2002 and 2022, global external assistance for CHW programmes totalled US$14.4 billion, SSA receiving 76% (US$11.0 billion). Of donor funds to SSA, 76.4% supported vertical programmes, although these made up fewer than 20% of projects; horizontal programmes received just 14.7%. Annual external assistance rose from ~US$0.28 billion (2016-2019) to ~US$1.83 billion (2020-2022), with over 90% directed to vertical or COVID-19-related efforts. Government spending across 37 SSA countries totalled ~US$1.4 billion (2016-2022). This represented less than 20% of total CHW funding but a greater share directed to horizontal services (54.6%). The annual financing gap remained between US$4.7 billion and US$4.3 billion.

CHW financing in SSA is donor-dominant and vertically oriented; domestic allocations are limited but relatively more horizontal. Closing the funding gap will require larger, predictable government budgets for CHWs, better-aligned partner support and stronger expenditure tracking to sustain PHC and advance universal health coverage.

Patient surveys often include closed- and open-ended responses that are usually reported separately, and links between them rarely explored, limiting interpretive depth. We outline a strategy that integrates quantitative and qualitative survey data in a joint display which enables combined analysis and findings to inform and improve programs for patients.

Data were drawn from a patient experience survey implemented in Alberta's long COVID Inter-professional Outpatient Program (IPOP). A joint display of Likert-scale satisfaction ratings and themed open-text feedback was developed to examine connections between the structured responses and qualitative insights.

We integrated quantitative survey satisfaction ratings with themes from the qualitative analysis of open-text comments in a joint display. Examining these data sets together added an analytical layer and uncovered nuanced experiences not evident in Likert-scale responses alone. By aligning satisfaction scores with themes, the joint display surfaced contradictory and paradoxical findings that would otherwise be hidden.

Aligning Likert-scale responses with thematic analysis of open-text reveals subtleties that may be obscured by scores alone. Understanding the narratives behind ratings is essential to evaluate health care programming, particularly when surveys are the primary mechanism for incorporating patient voices into service planning and delivery.

We conducted a cross-sectional cohort study to assess how continuity of primary care within community-based health centers (CHCs) might have changed during the years surrounding the COVID-19 pandemic and how continuity varied by patient and visit characteristics.

In a national sample of CHCs providing primary care, we assessed the usual provider of care (UPC) index-the fraction of patient visits to the patient's most frequently seen clinician within the CHC-for patients with at least 2 primary care encounters within a calendar year during 2019-2023. We used age-stratified multilevel logit analyses to assess patient, clinic, and visit characteristics associated with the perfect UPC index of 1 in 2023.

Among an annual average of 353,608 patients seen in an average of 186 CHCs, the median UPC index was 1 in each year, with the mean index varying from a low of 0.822 in 2020 to a high of 0.831 in 2021. In the 2023 sample, logit analyses adjusted for clustering of patients within clinics found that among adults, the likelihood of achieving a UPC index of 1 was higher for patients who were middle-aged or older and had an income greater than 138% of the federal poverty level or an unknown income, whereas it was lower for patients who were of Hispanic ethnicity, were of Black/African American race, had multimorbidity, had a telehealth visit, and received care at large clinics. Among children, the likelihood of achieving a UPC of 1 was lower for those who were of Hispanic ethnicity, had a telehealth visit, and received care at large clinics.

In a large national sample of patients seen at CHCs, continuity of primary care within CHCs remained high before, during, and after the COVID-19 pandemic, and was associated with practice and patient characteristics that provide targets for systemic intervention. Although health care systems explore different approaches to balance continuity with easy access, CHCs continue to value and deliver high-continuity care.

Over the past 15 years, a large health care organization has embraced Caring Science as a unifying framework. Nearly 200 Caritas Coaches have been trained, and more than 1100 nurses have advanced their academic degrees through Caring Science-aligned programs. The integration of Dr Jean Watson's Theory of Human Caring has helped shift the culture toward one grounded in love, compassion, and healing-from the bedside to the boardroom. This manuscript describes the organization's strategic investment in developing Caritas Coaches, embedding Caring Science into onboarding, leadership development, and unit-level practices. Amid the COVID-19 pandemic, Caring Science emerged as a powerful anchor for resilience, purpose, and staff retention. Exemplars illustrate how executive leaders operationalized Caritas Principles to transform care delivery, create psychologically safe environments, and foster belonging. The results demonstrate that when organizations prioritize care for the caregiver, measurable improvements in staff satisfaction, patient experience, and clinical quality follow. Caring Science offers a replicable model for health systems seeking to restore humanity in health care.

Hemothorax caused by intercostal artery rupture is a potentially life-threatening disease. A 66-year-old woman presented to our emergency department with left back pain. She had undergone surgery for left hemothorax 14 years ago. Contrast-enhanced chest computed tomography revealed active bleeding from the left dorsal ninth intercostal artery near the descending aorta. Subsequently, she developed hypovolemic shock. Based on her medical history, the patient was suspected of having adhesions in the left thoracic cavity. Surgery was considered a time-consuming approach to control the bleeding. Our first treatment choice was transcatheter arterial embolization, which could control the bleeding. Subsequently, we performed video-assisted thoracoscopic surgery for a left large-volume hemothorax. The patient had no severe postoperative complications. Upfront transcatheter arterial embolization followed by video-assisted thoracoscopic surgery for recurrent hemothorax may be an effective, minimally invasive treatment strategy, particularly when surgical hemostasis is expected to be time-consuming.

Malnutrition is a prevalent and serious concern in adult survivors of stroke, often worsening their clinical status and leading to a poor prognosis. However, the effectiveness of nutritional interventions in this population remains uncertain. Furthermore, the impact of nutritional support on functional recovery, especially in relation to rehabilitation outcomes, has not been sufficiently investigated.

This meta-analysis aims to synthesize evidence from existing randomized controlled trials (RCTs) to determine whether nutrient supplements confer measurable benefits in poststroke rehabilitation, with overall mortality as the primary outcome and multiple relevant indicators as secondary outcomes.

RCTs that compare nutrient supplements and a standard diet or placebo supplements in adult survivors of stroke will be included. Literature searches will be conducted in the PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang, and Cochrane Library databases. Two reviewers will independently perform the processes of literature retrieval, screening, data extraction, and assessment of risk of bias. Risk of bias in included studies will be evaluated using the revised Cochrane risk-of-bias tool for RCTs. Review Manager will be used for data pooling. Subgroup analysis, trial sequential analysis, and sensitivity analysis will be conducted.

This study was funded in 2023 (2023ZDFC0301) and registered in PROSPERO (CRD420251028426) prior to initiation. As of November 25, 2025, literature screening has not yet started. The planned timeline is as follows: complete literature screening by February 28, 2026; finalize full-text assessment and data extraction by May 30, 2026; conclude trial sequential analysis by June 30, 2026; and complete manuscript preparation for publication by July 30, 2026.

This systematic review and meta-analysis will provide evidence for the efficacy of nutritional interventions in adult poststroke rehabilitation, which may inform clinical guidelines and optimize rehabilitation strategies for this vulnerable population.

Objective: To understand incidence trend of myocardial infarction (MI) mortality in permanent residents in Hebei Province from 2014 to 2022, and provide references for the development of MI prevention strategies. Methods: The data of 531 200 MI deaths were collected from the mortality surveillance database of Hebei Provincial CDC during 2014-2022. Excel 2019 and Joinpoint 5.3.0 were used to calculate the crude mortality rate of MI. The data from the 7^th National Population Census were used as the standard, the age-standardized mortality rate of MI rates was calculated. The annual percent change and average annual percent change (AAPC) were used to describe the change trends. The age-period-cohort model was used to evaluate the age, period, and cohort effects on mortality changes. Results: From 2014 to 2022, the crude mortality rate of MI was 79.15/100 000, and the age-standardized mortality rate was 86.22/100 000 in permanent residents in Hebei. The crude mortality rates of MI in the total population, men, and women all showed upward trends (AAPC=13.28%, 13.19%, 13.61%, all P<0.001), and the age-standardized mortality rates of MI also showed upward trend (AAPC=7.37%, 11.32%, 13.41%, all P<0.05). In the permanent residents, the mortality rates of MI in age groups 0-14 and 15-64 years showed upward trends in Hebei from 2014 to 2022 (AAPC=35.56%, 9.75%, both P<0.05). During 2014-2017, the MI mortality rate in age group ≥65 years showed an upward trend (AAPC=26.41%, P=0.011). In terms of age effect, the age effect coefficients were 270.60, 119.14, and 226.40 times higher in age group 77-79 years than in age group 20-22 years in men, women and total population, respectively. In terms of period effect, the MI death risk were 1.78, 1.63, and 1.78 times higher during 2020-2022 than those during 2014-2016 in men, women and total population respectively. In terms of cohort effect, the MI death risk were 375.83, 183.30, and 298.38 times higher in those born during 1999-2001 than in those born during 1936-1938 in men, women and total population respectively. Conclusions: The MI mortality rate in permanent residents in Hebei showed an upward trend, indicating that the prevention and control of MI is still challenging. The mortality rate in men was generally higher than that in women. It is necessary to conduct early detection and treatment of MI, further improve the treatment level, take targeted measures to improve people's health.

Objective: To evaluate the association between triglyceride glucose (TyG) index and its novel composite metabolic indexes combined with obesity-related indexes and cardiovascular disease (CVD) risk in middle-aged and old adults in China. Methods: Based on data from the China Health and Retirement Longitudinal Study from 2011 to 2020, a study was conducted in 6 158 middle-aged and old adults without CVD at baseline survey. Cox proportional hazard regression model was used to assess the association of each indicator with the risk for CVD. Kaplan-Meier curve and restricted cubic spline (RCS) were also used to explore the dose-response relationship and nonlinear trends. Subgroup analyses were used to test the stability of the association in people with different demographic characteristics. Results: A total of 1 639 CVD events occurred during the 9-year follow-up period. After adjusting for confounding factors, high levels of TyG index and its combined obesity index were significantly associated with an increased risk for CVD. Compared with the Q₁ group, the HRs (95%CIs) of TyG, TyG-BMI, TyG-waist-to-height ratio (WHtR), and TyG-weight-adjusted-waist index (WWI) were 1.36 (95%CI: 1.19-1.57), 1.74 (95%CI: 1.51-2.01), 1.55 (95%CI: 1.34-1.79), and 1.38 (95%CI: 1.20-1.60) in the Q₄ group, respectively. RCS analysis showed that TyG and TyG-BMI had linear association with the risk for CVD, whereas TyG-WHtR and TyG-WWI had non-linear association with the risk for CVD. Subgroup analyses suggested that the associations were in good agreement in people in different age, sex, education level and hypertension status group (all P for interaction >0.05). Conclusions: The TyG index combined with obesity index is significantly associated with the risk for CVD in middle-aged and old adults in China. Paying attention to the TyG index and obesity index in the middle-aged and old adults can benefit the prevention and treatment of CVD and other chronic diseases in the elderly in China.