ABSTRACT Incidence of Lyme disease (LD) has increased over the last few decades in the United States (US). We examined trends in LD incidence and case burden in high‐incidence jurisdictions in the US from 2000 to 2021 by urbanicity. County‐level counts of confirmed LD cases from 2000 to 2021 were obtained from national surveillance data. Incidence rates were calculated using census population projections. Urbanicity was categorized using Rural–Urban Continuum Codes (RUCC). Mixed effects models were used to analyze annual changes in LD incidence. Over 70% of LD cases each year were residents of metro counties. All RUCCs had an incidence greater than 10 LD cases per 100,000 per year from 2001 to 2021. LD incidence significantly increased across all RUCCs, with the largest estimated increases in counties in moderately urban areas. Urban populations have substantially contributed to the overall burden of LD in the US, whereas populations in more moderately urban areas had the largest estimated increases in LD incidence. These findings highlight the need for targeted educational interventions and public health measures across urbanicity levels to address the rising burden of LD in the US.
ABSTRACT Background Intra‐arterial chemotherapy (IAC) has shown promise in improving outcomes for patients with Retinoblastoma (RB) globally. Creating a safe, effective, and sustainable IAC center in Ghana, a country with a high RB burden, will provide access to much‐needed specialized treatment for patients with RB. Aim This study aims to outline key considerations, obstacles, and opportunities for setting up an IAC center in a low‐resource country. Methods This narrative implementation report describes the establishment of an IAC service through a KBTH–Euracare partnership. Service requirements, barriers, and costs were identified from routine planning meetings, site reviews, stakeholder consultations, supplier information, and early implementation experience, informed by international centers and adapted locally. The model combines Euracare's infrastructure with trained KBTH personnel, mentorship, and knowledge transfer. Lessons reflect a descriptive review of implementation decisions and challenges. Findings Cost analysis revealed that the most viable strategy would be a phased implementation, beginning with a public–private partnership anchored by a major tertiary hospital to ensure scalability and resource optimization. Potential enablers include training and skills transfer, existing radiology units, and collaboration from international partners to support capacity‐building initiatives. Key barriers to establishing an IAC center in Ghana include lack of trained specialists, high equipment costs, and financial constraints. Conclusion Establishing an IAC center in a low‐resource country requires careful planning, coordination, and resource allocation. Despite the challenges, there are opportunities for partnerships, technology transfer, task‐shifting, research, and innovation.
ABSTRACT Background/Introduction In Sierra Leone, persistent challenges in sexual and reproductive health (SRH), including high maternal mortality, poor maternal health outcomes, and gender inequality, underscore the critical importance of family planning. Despite progress, with contraceptive use among married women rising from 8% (2008) to 21% (2019), barriers related to knowledge and cultural norms remain. This study explored the family‐planning perceptions of mothers and fathers, using a short film as a discussion stimulus. Methods We conducted 11 focus group discussions following the screening of a health‐promotion short film. Participants included 35 mothers and 21 fathers from the Bombali District. Discussions were analyzed using thematic analysis to identify gender‐based perspectives. Results Mothers predominantly expressed positive views, emphasizing the benefits of family planning for self‐advocacy and control, child well‐being, and health. In contrast, fathers primarily focused on concerns about contraceptive side effects and the impact on partner relationships. A notable theme among fathers was criticism of providing family planning to adolescent girls, based on fears it would promote promiscuity. Conclusions The stark contrast in perspectives underscores the need for family‐planning programs that are tailored to address gender‐specific concerns and that promote constructive communication amongst couples. The film effectively elicited nuanced discussions, suggesting that narrative‐based media are valuable tools for qualitative research and health promotion. These findings provide key insights for refining SRH interventions in Sierra Leone and similar contexts.
ABSTRACT Background Helicobacter pylori ( H. pylori ) infection and betel quid (BQ) chewing are both highly prevalent in South Asia and are independently implicated in upper gastrointestinal mucosal injury, yet their joint contribution to endoscopic pathology in dyspeptic patients is poorly characterised. We aimed to describe the exposure profile of dyspeptic patients with and without endoscopic pathology, quantify the individual and joint associations of H. pylori and BQ use with pathology and explore trends with BQ exposure. Methods In this cross‐sectional analytical study, 211 consecutive dyspeptic patients attending a tertiary gastroenterology department were classified as having endoscopic pathology (Group A, n = 141) or a normal endoscopic examination (Group B, n = 70). H. pylori status, BQ exposure (including a cumulative ‘BQ‐Quid‐Years’ index), and body mass index (BMI) were recorded, and multivariable logistic regression, additive‐interaction analysis and dose–response modelling were performed. Results Group A patients were older (median 40 vs. 31 years, p = 0.009) and more often male (58.2% vs. 41.4%, p = 0.039) than Group B. Pathology prevalence rose stepwise from 52.2% in patients negative for both H. pylori and BQ use to 72.5% in patients positive for both (trend p = 0.076). The relative excess risk due to interaction (RERI) showed no clear evidence of departure from additivity (−0.16, 95% confidence interval [CI] −1.14 to 0.39), although the wide interval does not exclude synergistic or sub‐additive effects. After multivariable adjustment, male sex (adjusted odds ratio [aOR] 3.01, 95% CI 1.50–6.04, p = 0.002) and, more modestly, age (aOR 1.02, 95% CI 1.00–1.05, p = 0.039) were independently associated with pathology; H. pylori (aOR 1.38, p = 0.353) and BQ use (aOR 1.66, p = 0.219) showed positive but non‐significant associations. Conclusions Male sex was the most robust, independently associated correlate of endoscopic pathology in dyspeptic patients, and age showed a more modest, independent association.
ABSTRACT Background Climate‐driven bushfires increasingly shape community health needs and challenge medical workforce capacity in Australia. Although population mobility can influence practitioner availability, it is unclear whether bushfires indirectly affect medical practitioner workforce distribution by prompting internal migration. Understanding these dynamics is critical for informing climate‐resilient health‐workforce policies. Methods We analysed a longitudinal panel of regional and remote Australian Local Government Areas (LGAs) from 2013 to 2021 using generalised estimating equations (GEEs) causal mediation analysis. Bushfire exposure was assessed using three complementary measures: (i) binary (any occurrence), (ii) cumulative (repeated events) and (iii) severity‐based (intensity of exposure). Outcomes were full‐time equivalent (FTE) medical practitioner, adjusted for remoteness and socio‐economic conditions. Internal migration was included as a potential mediator. Results Across all exposure metrics, bushfire‐affected LGAs exhibited significantly higher medical practitioner FTE rates. Cumulative exposure showed a positive association (0.29, p = 0.02), with severity‐weighted exposure yielding a similar directional effect (1.32, p = 0.04). Although internal migration was positively associated with FTE rates, it did not significantly mediate the relationship between bushfire exposure and workforce supply. Conclusions Bushfire exposure is associated with higher medical practitioner FTE rates in affected LGAs. However, internal migration does not appear to meaningfully mediate this relationship for our study region. For extreme and consecutive bushfires, defined as bushfire occurrence in at least five of the past 10 years, the evidence for mediation through population movement is limited. These findings suggest that changes in the medical workforce following bushfires are more likely driven by direct health system policies rather than by broader internal migration patterns. Planning for future climate‐related disasters should consider mechanisms that support responsive allocation and retention of medical practitioners, particularly in regional and remote areas with historically lower workforce levels.
