Pre-eclampsia is a multisystem disorder that arises in at least 2-4% of pregnancies and is characterised by hypertension and new-onset organ dysfunction. The pathophysiology of pre-eclampsia is diverse but mostly involves a mismatch between fetoplacental demands and uteroplacental supply, combined with a maternal predisposition to cardiometabolic disease. While our understanding of the mechanisms underlying pre-eclampsia has advanced in recent years, maternal and perinatal mortality remains high in low-income and middle-income countries (LMICs), where preeclampsia incidence is higher. Risk factors include maternal chronic hypertension, diabetes, obesity, and previous pre-eclampsia. Preventive strategies include structured behavioural changes focused on diet quality and moderateintensity physical activity for women with metabolic risk factors, low-dose aspirin for women at high risk, and riskstratified timed birth at term. To date, the only recourse for pre-eclampsia is delivery of the placenta, and many discrepancies in care remain between high-income countries and LMICs. Current efforts primarily focus on the prediction, accurate diagnosis, and prevention of pre-eclampsia.
Psoriasis is a common, chronic, immune-mediated skin disease affecting more than 40 million individuals worldwide. Psoriasis, along with psoriatic arthritis, are part of a broader psoriatic disease spectrum, and present with inflammatory skin and musculoskeletal manifestations driven by shared genetic, environmental, and immunological mechanisms. Skin psoriasis presents with diverse clinical phenotypes, including chronic plaque psoriasis, guttate, palmoplantar, erythrodermic, and pustular forms. Beyond cutaneous manifestations, psoriasis is associated with a substantial psychosocial burden and a wide range of comorbidities, including mental health disorders and cardio-metabolic diseases. Key psoriasis risk factors include genetic polymorphisms (most notably HLA-C*06:02), obesity, and environmental factors such as trauma, infections, and specific medications. Advances in understanding the key role of the IL-23-IL-17 inflammatory axis and related immunogenetic pathways have redefined psoriasis as a complex immune disorder, leading to the development of highly effective targeted biologic and small-molecule therapies that modulate cytokine signalling and intracellular pathways, offering improved disease control across cutaneous and musculoskeletal domains.
Violence against sex workers can be substantial, with severe physical and mental health consequences. In this Series paper, we review the global evidence on violence prevention and support interventions by and for sex workers, and focus on violence reduction, mental health, and access to services. We found that peer-reviewed evidence focused on client-perpetrated violence, whereas non-peer-reviewed evidence focused on broader human rights abuses and police violence. The central involvement of sex workers in intervention design and delivery resulted in improved engagement and effectiveness in terms of reducing violence. Interventions that reduced violence from clients did not affect intimate partner violence, and vice versa. Peer networks strengthen agency through collective safety planning, information sharing, and emotional support, yet access is limited for migrant and street-based sex workers. Broader stakeholder engagement-including from police, policy makers, health and social services, and third parties such as managers and security-is essential for addressing structural determinants of violence, although reliance upon these same stakeholders can reinforce systems that perpetuate violence. Addressing violence requires interventions that recognise the diverse forms and perpetrators of violence, alongside broad structural reforms to tackle its root causes.
Sex workers face compounding social and health inequities driven by multiple stigmas-social processes of devaluation that reduce access to power, resources, and opportunities. In this Series paper, we review the evidence and report that structural, interpersonal, and internalised stigma profoundly shape sex workers' health by undermining access to health and human rights, with well documented impacts on sexual health, mental wellbeing, safety, and access to justice. Furthermore, stigma within communities and health, social, workplace, and legal systems often intersect to drive health inequities, social exclusion, and legal harms experienced by diverse sex workers globally. Despite these challenges, sex workers actively negotiate and resist the effects of stigma through peer support, advocacy, and community building, highlighting their agency and resilience. Decriminalisation, community mobilisation and empowerment, and rights-affirming health care are evidence-based strategies to reduce stigma and promote the health, safety, and rights that are urgently needed to optimise health and wellbeing for sex workers across the globe.
