Background People in many regions of the world are often affected by blizzards, which are also showing an increasing trend in certain areas due to climate change. This literature review aimed to synthesize evidence on the health impacts of blizzards. Methods This literature review was informed by systematic review principles. PubMed and Web of Science were searched from January 1, 1935, to May 31, 2025. The risk of bias of the included studies was assessed using the Office of Health Assessment and Translation (OHAT) risk of bias rating tool, and findings were synthesized descriptively due to substantial heterogeneity across studies. Results A total of 28 studies were included. Available evidence indicated that blizzards were associated with adverse health outcomes affecting multiple systems and organs, including trauma, cardiovascular diseases, respiratory diseases, neurological diseases, and foodborne and waterborne diseases. However, evidence was geographically concentrated in a limited number of countries, diseases, categories, and subpopulations. Conclusions Blizzards may pose substantial risks to human health, yet important evidence gaps remain. Deepening the understanding and strengthening the prevention of the negative health impacts of blizzards is an integral part of addressing the health threats of climate change globally. This requires joint efforts from government-led policy support, individual coping, education of the population, and scientific research and technological innovation. Registration PROSPERO CRD42024586068.
Background Global value chains (GVCs) have connected food production, trade, resource use, and environmental pressures across countries. In the European Union, these links are closely related to progress on food security, clean energy, responsible consumption and production, and climate action. However, most existing studies focus on single sustainability outcomes, while less is known about how agricultural GVC participation relates to several SDG dimensions simultaneously. Methods This study uses a pooled country-year dataset for 27 EU member states from 2015 to 2024 to examine the associations between agricultural GVC participation and SDG-related outcomes. Multiple Factor Analysis was used to explore the structure of the SDG indicators and GVC participation variables. Latent Variable Partial Least Squares (LV-PLS) modelling was then applied to estimate associations between the GVC participation construct and five SDG-related constructs. Results The MFA results explained 43.46% of the variance across the SDG and GVC indicators and identified differentiated GVC participation patterns. In the LV-PLS model, the overall GVC participation construct was negatively associated with Zero Hunger (β=-0.253, p<0.001), positively associated with Clean Energy dependency (β = 0.415, p < 0.001), negatively associated with Responsible Consumption and Production (β = -0.512, p < 0.001), positively associated with Climate Action (Environment) (β = 0.377, p < 0.001), and negatively associated with Climate Action (Economy) (β = -0.201, p < 0.001). Conclusions The findings suggest that the sustainability implications of agricultural GVC participation differ across participation patterns. Forward-oriented countries should prioritize R&D investments with higher value-added green exports, while backward-oriented countries should pay greater attention to reducing dependence on imported inputs and energy. These results suggest that EU agricultural and trade policies should distinguish between participation types, with greater attention to reducing input dependence in backward-oriented countries and supporting green upgrading in forward-oriented ones.
Background: Work-related psychosocial factors can affect cardiovascular health; however, their impact on stroke prognosis among young employed workforce remains understudied. This longitudinal study investigated the relationship of work stress, measured by the Demand-Control-Support model, with changes in disability over a year among 103 Thai workers aged 20 to 59 who had a stroke. Methods: The study evaluated job strain (combination of high demand and low control) and social support before discharge at baseline. Disability status, using the Barthel index (BI) and modified Rankin Scale (mRS), was measured at baseline, 6 months, and 12 months after discharge. Generalized estimating equations were used to test the hypothesis that job strain and social support at baseline would have direct effects on disability throughout a year. Results: The results showed that job strain was not significantly associated with disability (both BI and mRS), while low social support was significantly associated with worse disability over a year, particularly mRS (Coefficient 0.10; 95% CI: 0.0063, 0.20). The interaction between job strain and social support was not significant. Conclusion: These findings suggest the potential importance of social support in the recovery process from stroke, particularly in the workplace. Given the rising global burden of stroke in working-age adults, these findings underscore the crucial role of worksite health promotion for stroke management. (c) 2026 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Background: Despite the health impacts of socioeconomic status, physical inactivity, and air pollution being well-documented, fewer studies have quantified their combined effects on mortality, life expectancy, and economic burden. Methods: This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011 - 2020). Cox proportional hazards regression estimated HRs and population attributable fractions (PAF) for eight modifiable risk factors. Flexible Cox models assessed life expectancy changes using a risk score. Economic burden was estimated using the value of a statistical life (VSL). Results: This study included 19,846 participants aged 45 and older from 28 provinces. The Combined PAF of mortality due to the eight modifiable risk factors was 71.64%, with major contributions by low socioeconomic status (37.01%), low physical activity (27.64%), and high PM2.5 exposure (13.87%). Life expectancy losses were 4.48 years for current smokers and 3.19 years for current drinkers; former smokers and drinkers lost 4.49 and 4.64 years, respectively. Each one-point increase in the risk score was associated with an average loss of approximately 2 years in life expectancy at age 45. Participants with a score of zero were expected to live 18.37 years longer than those scoring nine. The average economic loss attributable to these risk factors was 1833.95 million US dollars per 100,000 population. Subgroup analyses revealed greater impacts in rural and northern regions. Conclusions: Modifiable risk factors contribute substantially to mortality, reduced life expectancy, and economic losses among middle-aged and older adults, highlighting the need for targeted public health strategies. (c) 2026 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).
Background: Hot weather is likely to increase further due to climate change. Previous studies have found that hotter months corresponded to a higher risk of in-hospital bacterial infections. However, the short-term association between high temperatures and bacterial infections, as well as the related vulnerable populations, is unclear. Methods: The meteorological data were sourced from the National Meteorological Data Sharing Platform. All hospitalized patients who underwent bacterial testing at Henan Provincial People's Hospital between January 2017 and December 2019 were included in the analysis, encompassing 195,630 test results from 82,070 patients. No missing data were observed for basic information such as gender, age, and surgical status. We adopted a time-stratified case-crossover design and a distributed lag nonlinear model to assess the short-term associations between temperature and the specific bacterial positive detection rate. Relative humidity and PM2.5 concentration were incorporated as covariates into the model. We further conducted subgroup analyses by gender, age group, and surgical or invasive treatment status to identify relevant vulnerable populations. Results: There were six types of bacteria with high positive detection rates, namely Enterococcus spp, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter spp, with positive cases (positive detection rates) of 1928 (0.99 %), 2056 (1.05 %), 3279 (1.68 %), 6563 (3.35 %), 6979 (3.57 %), and 7115 (3.64 %). Summer was one of the seasons with a high bacterial positive detection rate; the risk of positive detections for Pseudomonas aeruginosa, Acinetobacter spp, and Klebsiella pneumoniae increased with increasing temperatures in the summer. At a lag of 0-3 days, compared with the 5th percentile of summer temperatures, high temperatures (the 95th percentile) were associate with the increase of positive detection rates of Pseudomonas aeruginosa, Pseudomonas spp., and Klebsiella pneumoniae, with relative risk values (95% CIs) of 1.799 (1.225, 2.640), 1.382 (1.052, 1.816), and 1.692 (1.274, 2.246), respectively. The harmful effects of high temperatures occurred mainly among the elderly and those who had undergone surgical or invasive procedures. Conclusion: High summer temperatures may increase the risk of detecting Pseudomonas aeruginosa, Acinetobacter spp, and Klebsiella pneumoniae, with the elderly population and patients undergoing surgery as relevant vulnerable populations. (c) 2026 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc
Background Ambient temperature and temperature variability (TV) may influence metabolic dysfunction-associated steatotic liver disease (MASLD), but large-scale evidence is lacking. We aimed to quantify nonlinear associations between long-term temperature/TV exposure and MASLD prevalence in China and evaluate their global relevance. Methods In this cross-sectional study of 33,236 adults from 33 Chinese provinces (2010–2020), MASLD was diagnosed via ultrasonography. Meteorological data were linked to residential addresses to calculate long-term temperature/TV. Generalized additive models were employed to delineate nonlinear exposure–response relationships. Global patterns were assessed using Global Burden of Disease (GBD) data in 2021 from 204 countries or territories. Results A reverse J-shaped relationship emerged between ambient temperature and MASLD prevalence (minimum risk at 21.4 °C), with extreme cold (1st percentile) increasing risk (OR = 1.42, 95% CI: 1.11–1.82). TV exhibited a U-shaped association (threshold: 12.2 °C), where extreme low (1st percentile: OR = 1.38, 1.09–1.73) and high TV (99th percentile: OR = 1.15, 1.02–1.34) elevated MASLD risk. Vulnerable subgroups included males, individuals ≥45 years, smokers, and obese individuals. Globally, non-optimal temperature exposure was strongly correlated with age-standardized MASLD prevalence (R = 0.43, p < 0.001), driven predominantly by high-temperature contributions (R = 0.55 vs. 0.18 for low temperature). Conclusion Chronic cold exposure and extreme temperature variability independently increase MASLD risk, with amplified effects in metabolically vulnerable populations. The global correlation between non-optimal temperature exposure and MASLD burden highlights climate change as a critical modifier of liver health. Integrating temperature mitigation into public health strategies may reduce MASLD incidence amid escalating climate challenges.
In its Sustainable Development Goal 2, the United Nations emphasizes the need to ensure sustainable agriculture in the quest to meet the zero-hunger goal. Particularly in developing economies that heavily rely on the agricultural sector, the knowledge and the digital economies are crucial for advancing agroenvironmental sustainability schemes and creating an eco-friendly system. This study aims to examine the roles that knowledge and digital economies play in shaping the outcomes of environmental regulatory measures in the agricultural sector. The study examines this relationship for a panel of 82 developing and emerging economies spanning the period 1994 to 2021. Employing the Two-Step System GMM and the IV-2SLS strategies, we uncover the following insights: First, environmental regulatory policies in developing countries do not contribute to reducing the levels of agricultural nitrous oxide and methane emissions. Second, the knowledge and digital economy contribute to reducing agricultural greenhouse gases when interacting with environmental regulatory policies. These results remain consistent after accounting for the income bracket. However, these countries require more developed knowledge economies and higher digital penetration rates to establish a sustainable agro-system. The findings recommend that governments strengthen environmental regulatory enforcement in developing countries while integrating a knowledge-based economy and promoting ICT diffusion to enhance agro-environmental sustainability. (c) 2026 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).
Objectives: The burden of urological cancers attributable to modifiable risk factors varies across sociodemographic contexts, yet a comprehensive assessment of the impact of development levels remains lacking. Methods: Using data from the Global Burden of Disease 2021 study, we assessed associations between the Sociodemographic Index (SDI) and age-standardized mortality rates (ASMRs) of urological cancers attributable to modifiable risk factors across 204 countries in 2021. Trends in ASMRs and disability-adjusted life year (DALY) rates from 1990 to 2021 were analyzed using estimated annual percentage change (EAPC). Mortality changes were decomposed into four components. Inequalities were quantified using the slope index of inequality (SII) and concentration index (CI). Results: SDI was positively correlated with ASMRs for all five attributable burdens. Countries with higher SDI exhibited the highest ASMR and DALY rates. Notably, in low-middle SDI countries, bladder cancer due to high FPG and kidney cancer due to high BMI showed the steepest increases. These countries also experienced slower declines or even upward trends in smoking-attributable mortality. Decomposition revealed varying contributions of risk-deleted rates and aging. Most SDI-related inequalities widened or remained stable. Conclusion: Sociodemographic development critically shapes the burden of urological cancers attributable to modifiable risks, highlighting the need for development-tailored preventive strategies.
Background: Residents' health behaviors are crucial factors in the prevention of diseases. A city's digitalization degree refers to the extent to which digital infrastructure and products can empower local industries and residents. Existing studies about the influence of digital technologies and products on health behaviors are mainly individual-level studies. Extant city-level studies primarily investigate the influence of cities' digitalization degrees on economic and environmental factors. There is a lack of city-level study examining the impact of cities' digitalization degrees on residents' health behaviors. Method: This study constructs a panel dataset comprising the data of 289 prefecture-level or above cities in China in the period from 2020 to 2023. Regression models are employed to examine the relationship between cities' digitalization degrees and residents’ health behaviors. Based on geographic locations, cities are sorted as “eastern or middle cities” and “western cities”. According to the concentration level of economic and social resources, cities are sorted into “central cities” and “non-central cities”. Based on these two categorizations, the heterogeneity of the main effect is also investigated. Furthermore, the average slopes and the dummy variable indicating whether a city is selected by the “Broadband China Strategy” are utilized as instrumental variables to address the endogeneity caused by omitted variables. Results: In the basic regression model, cities' digitalization degrees show significantly positive relationship with residents' health behaviors (β1 = 0.178, 95 % CI [0.042, 0.315], p = 0.011; β2 = 0.841, 95 % CI [0.458, 1.225], p < 0.001). The result is robust in the regression models using instrumental variables. Heterogeneity analysis indicates that for “eastern and middle cities”, there is a significantly positive relationship between cities' digitalization degrees and residents' health behaviors (β1 = 0.251, 95 % CI [0.105, 0.396], p = 0.001; β2 = 0.986, 95 % CI [0.512, 1.459], p < 0.001), while this relationship is not significant for “western cities” (β1 = 0.032, 95 % CI [-0.176, 0.242], p = 0.759; β2 = 0.500, 95 % CI [-0.138, 1.139], p = 0.123). For “non-central cities”, there is a significantly positive relationship between cities' digitalization degrees and residents’ health behaviors (β1 = 0.285, 95 % CI [0.107, 0.463], p = 0.002; β2 = 1.097, 95 % CI [0.670, 1.524], p < 0.001), while this relationship is not significant for “central cities” (β1 = 0.014, 95 % CI [-0.184, 0.213], p = 0.885; β2 = 0.146, 95 % CI [-0.593, 0.886], p = 0.690). Interpretation: Digitalization of cities can promote residents' health behaviors for three potential reasons. First, cities' digitalization degrees improve local residents' accessibility to health resources. Second, cities' digitalization degrees strengthen local residents' capacity regarding health behaviors. Third, cities' digitalization degrees enhance local residents’ purchasing power for health resources.
Women’s empowerment is increasingly recognized as a vital factor in achieving global development goals, particularly the eradication of hunger (SDG 2) and the advancement of gender equality (SDG 5). Despite this relevance, existing studies remain limited in scope, often relying on cross-sectional, country-specific, or child-focused analyses that do not capture the broader, population-level relationship between women’s empowerment and undernourishment across Africa. To address this gap, the present study offers a continent-wide assessment of how multiple dimensions of women’s empowerment, including civil liberties, civil society participation, political participation, and political empowerment, shape undernourishment in 50 African countries from 2002 to 2020. Using a panel framework that combines fixed effects estimation, Driscoll–Kraay standard errors, and the two-step system GMM estimator, the analysis identifies a consistent and significant negative relationship between women’s empowerment and the prevalence of undernourishment. All four empowerment dimensions contribute meaningfully to improved nutritional outcomes, and extensive robustness checks confirm the reliability of the findings. The study thus provides clear empirical evidence that strengthening women’s agency is a multidimensional pathway to reducing undernourishment, offering a foundation for more targeted and gender-responsive policy strategies to advance food security across Africa.
Rising ecological footprints in G-7 countries pose significant challenges to global sustainability, despite their economic and technological leadership. While prior research has examined individual drivers of environmental degradation in advanced economies, there remains a critical gap in understanding the integrated roles of artificial intelligence (AI), financial accessibility, and government effectiveness in mitigating ecological pressures, particularly through comprehensive panel data analysis in the G-7 context. This study addresses this gap by exploring how these factors influence environmental sustainability across G-7 nations, using the ecological footprint as a key indicator from 2010Q1 to 2022Q4. Employing the Panel Mean Group Autoregressive Distributed Lag model as the primary estimator, with Augmented Mean Group and Common Correlated Effects Mean Group estimators for robustness, the empirical results reveal that economic growth and urbanization significantly exacerbate ecological degradation in both the long and short run. Conversely, AI innovation, financial accessibility, and effective governance substantially reduce environmental impacts. These findings advance the discourse on Sustainable Development Goals (SDGs), especially SDG 9 (Industry, Innovation and Infrastructure), SDG 11 (Sustainable Cities and Communities), and SDG 13 (Climate Action). To foster a sustainable transition, policymakers should prioritize investments in AI-driven green technologies to optimize resource efficiency, expand inclusive financial mechanisms to fund eco-innovations and renewable projects, and implement governance reforms that enforce stringent environmental regulations in G-7 economies.
Food security, one of the fundamental challenges facing developing countries, is influenced by a range of factors, including climate change, economic instability, ineffective policies, and international sanctions. Using a grounded theory approach, this study comprehensively examined the challenges of food security in Iran’s agricultural sector by analyzing causal, contextual, and intervening factors, as well as identifying strategies and consequences. Data were collected through in-depth interviews with 38 agricultural experts and specialists and analyzed using open, axial, and selective coding. The results indicate that the primary obstacles to achieving sustainable food security in Iran include climate change, water scarcity, dependence on imports, weak infrastructure, economic fluctuations, contradictory policies, and international pressures. The study also proposes strategies such as improving water and soil resource management, developing new agricultural technologies, reducing food waste, strengthening farmer support policies, and increasing resilience to climate change. These insights provide a comprehensive framework for policymakers and practitioners to design evidence-based programs that strengthen national food security and promote sustainable agricultural development.
Healthcare systems have an ethical duty to ensure equal access to high-quality healthcare as a matter of social justice. In their pursuit of that duty, they generate substantial environmental harms. For that reason, healthcare systems also have an ethical duty to minimise their environmental impacts as a matter of environmental justice and ecological justice. Many countries are already transitioning to less environmentally harmful healthcare. This study investigates whether the two duties come into tension when designing new green hospitals and how such tensions (if found to eventuate) are navigated in practice. We conducted case study research in collaboration with an Australian hospital network, with one of the network’s new public hospital builds comprising our case of focus. We undertook semi-structured interviews between March and June 2023 with those responsible for making design decisions in relation to the new public hospital being built. We analysed interview data thematically and report three main themes: separating the clinical and the environmental; tensions; and addressing tensions. We conclude by providing analysis of what is at stake in identified tensions using theories of justice, offering lessons that can help other hospitals mitigate against such tensions arising, and considering whether and when the moral reasoning employed in the case-under-study should be used to navigate the tensions. This study provides those responsible for green hospital design with a better understanding of what tensions they are likely to encounter between health, social, and environmental goods and how to reduce those tensions’ occurrence. That understanding will help them to identify and avoid such tensions in their practice, but further work is needed to develop ethical guidance on how they should navigate the tensions when they occur.
Digitalization has become ubiquitous; however, stakeholders have varying degrees of integration globally. Within the context of this study, a digitalization strategy has the potential for economic growth, enhanced health services, and ensuring national stability, thereby improving social well-being and facilitating a country's emergence as a developing nation. This study seeks to examine Senegal's digital landscape, with a particular focus on its impact on health and well-being, which are pivotal in the nation's progression towards becoming an emerging country. This study identifies key themes and factors contributing to Senegal's digital transformation and its potential to enhance overall quality of life. A systematic literature review (SLR) revealed a paucity of relevant research specific to the Senegalese context. Through thematic analysis, we identified research gaps (themes) that could assist Senegal in achieving its digitalization objectives: incremental transitioning facilitated by broadband improvements; digitalization of the economic, political, and human resources sectors; influence of trust and perceived risk on the adoption of emerging technologies; and integration of emerging technologies across all facets of life. Moreover, we conducted a pilot survey based on the Unified Theory of Acceptance and Use of Technology to obtain additional insights into digital healthcare adoption. (c) 2025 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).
Background: The misalignment between cancer burden and drug innovation poses significant challenges for global health. However, the global scope, temporal trends, and underlying factors contributing to this mismatch remain underexplored. We aim to evaluate the extent, trends, and driving forces behind the disparity between early drug development and cancer burden. Methods: This retrospective cohort study encompasses a total of 9473 early phase cancer drug trials from 1990 to 2023. Concentration curves and concentration indices (CIs) were employed to measure and track the mismatch over time. Residual analysis derived from a regression model identified cancers that may be either overlooked or overly focused upon. Decomposition of CIs was applied to ascertain the contributors to this mismatch and its evolution. Results: The CI between early drug development and cancer burden exhibited an upward trend over time, rising from 0.105 (95 % CI: 0.015 to 0.225) in the 1990s to 0.208 (95 % CI: 0.092 to 0.326) in the 2020s. Early drug development activities had disproportionately favored high-burden cancers. Demandside factors, such as disease burden (average contribution: 53.35 %) and market size (average contribution: 25.16 %), were the primary drivers of both the mismatch and its growth. Conclusions: The primary drivers of early drug development are medical and market demands, which lead to disproportionate focus on more prevalent or commercially attractive cancers. To address these disparities, targeted initiatives and policy reforms are necessary to ensure that drug development aligns more closely with global health needs, especially for cancers that receive insufficient attention. (c) 2025 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Background: The rising global incidence of diabetes poses a major health challenge, with growing evidence linking diabetes mellitus (DM) and ambient temperature. Due to compromised heat stress responses, people with diabetes are more vulnerable to extreme weather, common comorbidities, insulin resistance, and chronic inflammation. This study examines the impact of ambient temperature on healthcare utilization among diabetes patients in Jakarta, Indonesia, using data from the National Health Insurance program. Method: The study used 2015-2023 sample data from Indonesia's Healthcare and Social Security Agency (BPJS Health), comprising 2,407,300 participants diagnosed with DM. Claims data were stratified by residence, DM type, and healthcare facility type (primary vs. referral care). These were linked with daily, weekly, and monthly temperature records obtained from the Indonesian Agency for Meteorology, Climatology, and Geophysics (BMKG). Negative binomial regression model were applied to assess associations between temperature and DM-related healthcare visits, as the data indicated overdispersion in the count outcomes. Results: Higher daily average temperatures were associated with increased healthcare visits, particularly in primary care. A 1 degrees C increase in the 7-day average temperature was associated with a 3 % rise in patient visits, while a 14-day average increase was linked to a 4 % rise. Lag structures reduced daily variability, highlighting consistent associations. Utilization patterns also showed peaks on Mondays and declines on weekends and public holidays. Conclusions: Diabetic patients are vulnerable to elevated temperatures, potentially due to impaired thermoregulation and medication effects. As climate change exacerbates extreme temperatures, Jakarta's healthcare system may face increased demand. Interventions such as access to cool public spaces, enhanced patient monitoring, and resilient healthcare infrastructure are recommended. (c) 2025 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Introduction: Vietnam is undergoing a rapid demographic transition, with an increasingly aging population, posing new challenges for the healthcare system. Sarcopenia, an important contributor to frailty, functional decline, and disability in older adults, remains underdiagnosed due to the inconvenience of standardized assessment tools and the lack of validated anthropometric thresholds for specific populations. Methods: We conducted a cross-sectional study involving 416 community-dwelling individuals aged >= 60 years in Can Tho, Vietnam. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cutoff values for body mass index (BMI), calf circumference (CC), arm circumference (AC), and waist circumference (WC), with the Youden index applied to determine the most accurate thresholds. Results: The identified Vietnam-specific anthropometric thresholds for sarcopenia were: BMI <= 22.6 kg/m(2) for men and <= 21.2 kg/m(2) for women; CC <= 34.5 cm and <= 32.0 cm; AC <= 26.0 cm and <= 24.0 cm; WC <= 85.0 cm and <= 78.0 cm, respectively. These localized thresholds improved diagnostic accuracy, with BMI showing the strongest performance. CC and AC were less reliable among women, while WC offered high specificity but lower sensitivity. Conclusion: Our results endorse Vietnam-specific anthropometric cutoffs, particularly BMI, as a practical, cost-effective sarcopenia screening tool for under-resourced primary care. Integrating these thresholds into national guidelines can accelerate universal health coverage and sustainable aging by enabling early detection and community-based interventions to avert functional decline in Vietnam's aging population.
Background Domain-specific large language models (LLMs) may aid primary care, but reliability and safety are uncertain, and general-practice evaluations remain limited. Methods Observational, exam-based comparison (Feb–May 2025) using standardized items from the Chinese General Practitioner Licensing Examination. A general-practice LLM (AIGP) was evaluated against 389 physicians on the same items under deterministic decoding. Each item was run 50 technical replicates. Outcomes: accuracy; stability (coefficient of variation, ICC(2,k)); and expert-rated potential clinical harm for incorrect outputs. Results AIGP achieved 88.41% ± 1.87 accuracy vs physicians 72.12% ± 4.97 (mean difference 16.29, 95% CI 15.56–17.01; P < .001). Stability favored AIGP (CV 2.12 vs 6.89; agreement across replicates ICC(2,k)=0.993, 95% CI 0.991–0.995). Although overall errors were fewer, AIGP’s mistakes were systematic and carried higher average harm ratings, clustering in red-flag contexts (pregnancy, pediatrics, anticoagulation, acute chest pain). Conclusions In a controlled test setting, AIGP outperformed physicians and showed excellent stability. Findings are exploratory and context-limited (exam-based, text-only) and reveal systematic higher-harm failure modes. AIGP is a starting point for decision support, not a deployable clinical tool without prospective real-world validation and safety guardrails (human-in-the-loop review, contraindication/dose checks, uncertainty-aware refusal).
Since the term ''ultra-processed food'' was introduced in the fields of nutrition and public health, numerous studies have demonstrated its detrimental effects on health. Despite resistance from food companies and researchers with potential conflicts of interest, the concept has gained broad acceptance in both academic and non-academic circles. This article extends the discussion beyond nutrition by examining the wider concept of ''ultra-processed,'' its implications, and its application to other domains, including the metaphorical notions of ''ultra-processed people'' and an ''ultra-processed world.'' In doing so, we aim to raise awareness of the phenomenon of ''ultra-processing,'' highlighting its pervasive influence across food, society, and digital environments, and encouraging reflection on its consequences for everyday life. This expansive approach aligns with notable philosophical and sociological perspectives, yet our exploration of these trends offers an innovative angle.
