Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide

OBJECTIVE

To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries.

METHODS

A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care.

RESULTS

The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement.

CONCLUSION

Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.

Pomegranate Rhizosphere Microbial Diversity Revealed by Metagenomics: Toward Organic Farming, Plant Growth Promotion and Biocontrol?

Food production must undergo systems change to meet the sustainable development goals (SDGs). For example, organic farming can be empowered by soil microorganisms with plant growth promotion (PGP) and biocontrol features. In this context, there have been limited studies on pomegranate. We investigated microbial diversity in rhizosphere of the pomegranate "Bhagwa" variety and its potential role in PGP and biocontrol. Both bulk and rhizosphere soil samples were analyzed for their physicochemical properties. Whole metagenome sequencing was conducted using the Illumina NovaSeq6000 platform. Surprisingly, we found that bulk and rhizosphere soil samples had comparable microbial diversity. Metagenome sequencing revealed the abundance of Streptomyces indicus, Bradyrhizobium kalamazoonesis, and Pseudomonas cellulosum in the rhizosphere that are reported here for the first time in agricultural literature. Pathway prediction analysis using KEGG (Kyoto Encyclopedia for Genes and Genomes) and COG (clusters of orthologous genes) databases identified metabolic pathways associated with biocontrol properties against pathogens. We confirmed the metagenome data in vitro, which demonstrated their PGP potential and antimicrobial properties. For instance, S. indicus produced high concentration of indole-3-acetic acid, a PGP phytohormone, that can stimulate plant growth. In addition, an antimicrobial susceptibility assay suggested that bacterial extracts displayed activity against Xanthomonas, a primary pathogen causing the pomegranate wilt disease. In conclusion, this study suggests that S. indicus, B. kalamazoonesis, and P. cellulosum can potentially be PGP and biocontrol agents that may contribute to increased crop productivity in pomegranate cultivation. These agents and their combinations warrant future research with an eye on SDGs and so as to enable and innovate organic farming and pomegranate agricultural practices.

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Fostering the discussion of planetary health in occupational therapy and physiotherapy

INTRODUCTION

Occupational therapists and physiotherapists aim to promote health, prevent various diseases and help people in their rehabilitation processes. So far, there is a paucity of understanding of the big picture of how the new paradigm of planetary health (PH) is connected to the education and practice of these professionals.

METHODS

This research aimed to address this gap by investigating and deploying a bibliometric analysis to elucidate the pivotal role of occupational therapists and physiotherapists in addressing PH challenges. The ultimate goal is to construct a comprehensive framework crosschecking the bibliometric analysis and the collection of 10 case studies selected by experts to outline how best practices in occupational therapy and physiotherapy, related to the three pillars of sustainability and the UN's Sustainable Development Goals (SDGs), can contribute to increasing PH.

RESULTS

The bibliometric analysis revealed four major research strands: 1) enhancing patient care and quality of life; 2) integrating sustainability in health care and rehabilitation; 3) professional development and clinical competence; and 4) evidence-based practice and quality improvement. Moreover, further temporal analysis revealed how the topic evolved, from advancing evidence-based practice and clinical effectiveness, exploring the strengthening of health care and person-centred practices, to connecting the topic to aspects also predicted by the SDGs, such as integrating environmental and climate concerns in therapy and addressing psychological and self-care impacts on health. The case studies confirmed this trend, and a framework of PH in occupational therapy and physiotherapy through the lens of the SDGs was developed to support future research and practitioners in advancing this research field.

CONCLUSIONS

Occupational therapists and physiotherapists are essential players in public health and can integrate sustainability at every level of practice, from using resources during therapy sessions to advocating for more sustainable lifestyles.

Healthcare sustainability in cardiothoracic surgery

BACKGROUND

Climate change is the greatest threat to human health. Cardiothoracic patients suffer direct consequences from poor environmental health and we have a vested interest to address this in our practice. As leaders of complex high-end surgery, we are uniquely positioned to effect practical and immediate changes to significantly pare down emissions within the operating theatre, outside the operating theatre and beyond the confines of the hospital.

METHODS

We aim to spotlight this pressing issue, take stock of our current efforts, and encourage fellow specialists to drive this agenda.

RESULTS

Sustainability in healthcare needs to be formalized as part of the core curriculum in surgical training and awareness generated via carbon audits and life cycle analyses. Practical actions such as reducing unnecessary equipment usage, choosing reusable equipment over single use disposables, judicious use of investigations rooted in clinical reasoning and sharing of resources across services and health systems help reduce the carbon output of our specialty.

CONCLUSION

The 'Triple Bottom Line' serves as a good template to calibrate efforts that balance quality against environmental costs. More can be done to advocate for and find solutions for sustainable healthcare with cardiothoracic surgery.

Prevalence of visual impairment and estimation of refractive errors among school children in Kakamega, Kenya

AIM

To investigate the prevalence of visual impairment (VI) and provide an estimation of uncorrected refractive errors in school-aged children, conducted by optometry students as a community service.

METHODS

The study was cross-sectional. Totally 3343 participants were included in the study. The initial examination involved assessing the uncorrected distance visual acuity (UDVA) and visual acuity (VA) while using a +2.00 D lens. The inclusion criteria for a subsequent comprehensive cycloplegic eye examination, performed by an optometrist, were as follows: a UDVA<0.6 decimal (0.20 logMAR) and/or a VA with +2.00 D ≥0.8 decimal (0.96 logMAR).

RESULTS

The sample had a mean age of 10.92±2.13y (range 4 to 17y), and 51.3% of the children were female (n=1715). The majority of the children (89.7%) fell within the age range of 8 to 14y. Among the ethnic groups, the highest representation was from the Luhya group (60.6%) followed by Luo (20.4%). Mean logMAR UDVA choosing the best eye for each student was 0.29±0.17 (range 1.70 to 0.22). Out of the total, 246 participants (7.4%) had a full eye examination. The estimated prevalence of myopia (defined as spherical equivalent ≤-0.5 D) was found to be 1.45% of the total sample. While around 0.18% of the total sample had hyperopia value exceeding +1.75 D. Refractive astigmatism (cil<-0.75 D) was found in 0.21% (7/3343) of the children. The VI prevalence was 1.26% of the total sample. Among our cases of VI, 76.2% could be attributed to uncorrected refractive error. Amblyopia was detected in 0.66% (22/3343) of the screened children. There was no statistically significant correlation observed between age or gender and refractive values.

CONCLUSION

The primary cause of VI is determined to be uncorrected refractive errors, with myopia being the most prevalent refractive error observed. These findings underscore the significance of early identification and correction of refractive errors in school-aged children as a means to alleviate the impact of VI.

Mother, child and adolescent health outcomes in two long-term refugee camp settings at the Thai-Myanmar border 2000-2018: a retrospective analysis

AIM

The study assessed mothers, children and adolescents' health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border.

BACKGROUND

Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project.

METHODS

This retrospective study looked at the trends of MCAH indicators of mortality and morbidity and compared them to the sustainable development goals (SDGs) indicators. A review of programme documents explored and triangulated the evolution and changing context of the PHC services, and associated project costs were analysed. To verify changes over time, interviews with 12 key informants were conducted.

FINDINGS

While maternal mortality (SDG3.1) remained high at 126.5/100,000 live births, child mortality (SDG 3.2) and infectious diseases in children under 5 (SDG 3.3) fell by 69% and by up to 92%, respectively. Maternal anaemia decreased by 30%; and more than 90% of pregnant women attended four or more antenatal care visits, whereas 80% delivered by a skilled birth attendant; caesarean section rates rose but remained low at an average of 3.7%; the adolescent (15-19 years) birth rate peaked at 188 per 1000 in 2015 but declined to 89/1000 in 2018 (SDG 3.7).

CONCLUSION

Comprehensive PHC delivery, with improved health provider competence in MCAH care, together with secured funding is an appropriate strategy to bring MCAH indicators to acceptable levels. However, inequities due to confinement in camps, fragmentation of specific health services, prevent fulfilment of the 2030 SDG Agenda to 'Leave no one behind'. Costs per birth was 115 EURO in 2018; however, MCAH expenditure requires further exploration over a longer period.

Nutritional and Organoleptic Characteristics of Sausage Based on an Autochthonous Ecuatorian Fish, Old Blue (Andinoacara rivulatus)

The consumption of fisheries and aquaculture products has been increasing in recent decades, and it is necessary to strike a balance between production and sustainability in aquaculture; this is essential homework to support the demand for human food. This study aimed to investigate the sensory and nutritional characteristics of a sausage made from the fillet of the native fish Old Blue (Andinoacara rivulatus) to stimulate the local economy. A multifactorial A*B*C design was used, with Factor A being rearing systems (wild and farmed), Factor B being types of protein (quinoa meal and soybean meal), and Factor C being lipids of animal (pork fat) and vegetable (sunflower oil) origin. Highly significant differences were observed in all formulas, according to Tukey (p < 0.05). The highest protein percentage was with soybean flour at 11.24%, while quinoa flour had 10.80% of the product. In sensory characteristics, the best attributes were for texture in the mouth with a hedonic scale from 0 to 5, with 4.2 firmness being mostly acceptable, odor at 4.5, the aromatic attribute with the highest and best value, and color was the clearest at 4.3 acceptability. The flavor was 4.3, mostly more pleasant according to the tasters. The yield of farmed fillets was 23.16% compared to wild 13.89%, and the balance of sausage yield was 393 g with a yield of 76.33% of the total weight. Microbiological analysis of the sausage with the native species showed the absence of pathogenic microorganisms. A commercial shelf life of 30 days was also established for the sausage, demonstrating an added value through this processing, allowing its exploitation in areas further away from the fishing sites and, thus, a greater possibility of social development in the area.

Multi-functional xylanase from Aspergillus sydowii: biosynthesis of nanoconjugates, optimization by Taguchi approach and biodeinking potential

The search for effective production of xylanase which is an important industrial enzyme led to the present study that explored xylanase production by Aspergillus sydowii SF through Taguchi optimization that incorporated nanoconjugates in submerged fermentation. Calcium and zinc oxide nanoconjugates biosynthesized by xylanase were characterized via UV-Vis spectroscopy, Fourier transform infrared spectroscopy, and Transmission electron microscopy (TEM). The xylanase-mediated calcium oxide and zinc oxide nanoconjugates with λmax of 374 and 316 nm, respectively, and were 5.32-17.69 nm in size. Xylanase production was improved by 2.90-10.58 folds (64.24-234.15 U/mL) through Taguchi optimization cum nanoconjugates, and ANOVA showed that nanoconjugates contributed 13.62-65.97% to improved production. The xylanase had up to 88.38% deinking activity, with 49.60-84.64% removal of blue color. The remarkable xylanase production, its use to biosynthesize nanoconjugates and biodeinking potentials contribute to the development of versatile biocatalysts with applications in biotechnology, nanotechnology, and sustainable paper production. To the best of our knowledge, this represents the first report of xylanase for biosynthesis of calcium oxide and zinc oxide nanoparticles, as well as nanosupplementation to induce xylanase production, which can open new vista in bioprocess optimization.

Emerging challenges in antimicrobial resistance: implications for pathogenic microorganisms, novel antibiotics, and their impact on sustainability

Overuse of antibiotics is accelerating the antimicrobial resistance among pathogenic microbes which is a growing public health challenge at the global level. Higher resistance causes severe infections, high complications, longer stays at hospitals and even increased mortality rates. Antimicrobial resistance (AMR) has a significant impact on national economies and their health systems, as it affects the productivity of patients or caregivers due to prolonged hospital stays with high economic costs. The main factor of AMR includes improper and excessive use of antimicrobials; lack of access to clean water, sanitation, and hygiene for humans and animals; poor infection prevention and control measures in hospitals; poor access to medicines and vaccines; lack of awareness and knowledge; and irregularities with legislation. AMR represents a global public health problem, for which epidemiological surveillance systems have been established, aiming to promote collaborations directed at the well-being of human and animal health and the balance of the ecosystem. MDR bacteria such as E. coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., Acinetobacter spp., and Klebsiella pneumonia can even cause death. These microorganisms use a variety of antibiotic resistance mechanisms, such as the development of drug-deactivating targets, alterations in antibiotic targets, or a decrease in intracellular antibiotic concentration, to render themselves resistant to numerous antibiotics. In context, the United Nations issued the Sustainable Development Goals (SDGs) in 2015 to serve as a worldwide blueprint for a better, more equal, and more sustainable existence on our planet. The SDGs place antimicrobial resistance (AMR) in the context of global public health and socioeconomic issues; also, the continued growth of AMR may hinder the achievement of numerous SDGs. In this review, we discuss the role of environmental pollution in the rise of AMR, different mechanisms underlying the antibiotic resistance, the threats posed by pathogenic microbes, novel antibiotics, strategies such as One Health to combat AMR, and the impact of resistance on sustainability and sustainable development goals.

Global trends and spatial drivers of diabetes mellitus mortality, 1990-2019: a systematic geographical analysis

Objective

Diabetes mellitus is the leading cause of death worldwide, and multiple risk factors associated with diabetes mortality.

Methods

Employing spatial statistics, we characterized the spatial distribution and patterns of diabetes mortality, and revealed the spatial relationship between diabetes mortality and 11 socioeconomic and environmental risk factors at the country level, from 1990 to 2019.

Results

Globally, significantly high rates of diabetes mortality were primarily clustered in countries with limited land areas or located on islands, such as Fiji, Kiribati, Eswatini, and Trinidad and Tobago. Countries with weaker economic independence are more likely to have higher diabetes mortality rates. In addition, the impact of socioeconomic and environmental factors was significant at the country level, involving health expenditure, number of physicians, household and ambient air pollution, smoking, and alcohol consumption. Notably, the spatial relationship between diabetes mortality and ambient air pollution, as well as alcohol consumption, showed negative correlations. Countries with high diabetes mortality rates generally had lower levels of ambient air pollution and alcohol consumption.

Conclusion

The study highlights the spatial clustering of diabetes mortality and its substantial variation. While many risk factors can influence diabetes mortality, it's also essential to consider the level of these factors at the country level. Tailoring appropriate interventions based on specific national circumstances holds the potential to more effectively mitigate the burden of diabetes mortality.

Chlorine Water Taste Threshold and Acceptability among Indigenous and Non-Indigenous Populations in Rural Panama

Although gains in access to water services over the past two decades have been large, more than two billion people still lack access to safely managed drinking water. This study examines and compares free chlorine taste and acceptability thresholds of rural Indigenous Ngäbe and rural Latino Panamanians to study if taste aversion may be a limiting factor in chlorination of community systems in Panama using the three-alternative forced choice test methodology. This study is the first to establish a best-estimate taste threshold for a rural Indigenous group and the only study in Latin America to report best-estimate taste thresholds using those methods. Median taste thresholds were 0.87 mg/L Cl2 for Indigenous Ngäbe participants (n = 82) and 1.64 mg/L Cl2 for Latino participants (n = 64), higher than both the minimum concentration for biologically safe water (0.2 mg/L) and the recommended concentration range in Panama (0.3-0.8 mg/L). Median acceptability thresholds were established much higher than taste thresholds at 3.45 mg/L Cl2. The results show that the ability to accurately taste chlorine may not be the limiting factor for adoption of safe water initiatives in remote and Indigenous communities.

Promoting Sustainable Development Goals by Optimizing City-Level Solar Photovoltaic Deployment in China

Solar photovoltaic (PV) installations, which enable carbon neutrality, are expected to surge in the coming decades. This growth will support sustainable development goals (SDGs) via reductions in power-generation-related environmental emissions and water consumption while generating new jobs. However, where and to what extent PVs should be utilized to support SDGs must be thoroughly addressed. Here, we use multiple PV deployment scenarios to compare the benefits of PVs and related SDGs progress in 366 prefectural-level cities in China. We developed an assessment framework that integrates a PV allocation model, an electricity system optimization model, and a benefit assessment approach. We identify vast differences in PV distribution and electricity transmission and elucidate trade-offs and synergies among the SDGs under various PV implementation scenarios. The water conservation-oriented scenario yields substantial carbon reduction, air pollutant mitigation, and water saving cobenefits, leading to the greatest SDGs improvements. Prioritizing employment creation enhances job-relevant SDGs but inhibits environmental resource benefits. SDGs in less developed cities present greater progress across all scenarios. This study highlights the need to consider spatial heterogeneity and the potential trade-offs between different SDGs and regions when designing energy transition strategies.

Advances in Biological Wastewater Treatment Processes: Focus on Low-Carbon Energy and Resource Recovery in Biorefinery Context

Advancements in biological wastewater treatment with sustainable and circularity approaches have a wide scope of application. Biological wastewater treatment is widely used to remove/recover organic pollutants and nutrients from a diverse wastewater spectrum. However, conventional biological processes face challenges, such as low efficiency, high energy consumption, and the generation of excess sludge. To overcome these limitations, integrated strategies that combine biological treatment with other physical, chemical, or biological methods have been developed and applied in recent years. This review emphasizes the recent advances in integrated strategies for biological wastewater treatment, focusing on their mechanisms, benefits, challenges, and prospects. The review also discusses the potential applications of integrated strategies for diverse wastewater treatment towards green energy and resource recovery, along with low-carbon fuel production. Biological treatment methods, viz., bioremediation, electro-coagulation, electro-flocculation, electro-Fenton, advanced oxidation, electro-oxidation, bioelectrochemical systems, and photo-remediation, are summarized with respect to non-genetically modified metabolic reactions. Different conducting materials (CMs) play a significant role in mass/charge transfer metabolic processes and aid in enhancing fermentation rates. Carbon, metal, and nano-based CMs hybridization in different processes provide favorable conditions to the fermentative biocatalyst and trigger their activity towards overcoming the limitations of the conventional process. The emerging field of nanotechnology provides novel additional opportunities to surmount the constraints of conventional process for enhanced waste remediation and resource valorization. Holistically, integrated strategies are promising alternatives for improving the efficiency and effectiveness of biological wastewater treatment while also contributing to the circular economy and environmental protection.

Barriers to Adopting a Plant-Based Diet in High-Income Countries: A Systematic Review

Adopting a plant-based diet (PBD) has been shown to reduce the risk of developing certain diseases and is linked to environmental benefits. This review synthesises the evidence on the barriers adults aged 18 to 65 living in high-income countries (HIC) may experience when adopting a PBD. A systematic literature review was conducted using four search databases: Medline, Embase, Global Health, and Web of Science. Barriers were mapped to behaviour change strategies using the COM-B model. Ten studies were included in the final review, including 1740 participants. Five were qualitative, four were cross-sectional, and one was a pre- and-post-intervention study. In total, 40 barriers were identified and synthesised into 11 themes: financial, lack of knowledge, emotional, health, convenience, social, enjoyment of meat, environmental, accessibility, personal ability, and media. Of the 40 barriers, nutritional intake/requirements (categorised into the "health" theme) had the most evidence. This barrier encompassed concerns around being able to meet nutritional needs if an individual were to adopt a PBD. Habits (in the "personal ability" theme), which included established eating habits and habitual behaviours relating to animal-source foods, had the second most evidence alongside the barrier of not knowing what to eat as part of a PBD (in the "lack of knowledge" theme). Education interventions and communication/marketing policies were the behaviour change mechanisms mapped onto these barriers. Future interventions should focus on informing individuals about what to consume as part of a nutritionally balanced PBD and facilitating habitual dietary change.

Increased Stigma, and Physical and Sexual Violence Against Men Who Have Sex with Men and Transgender Women in Sub-Saharan Africa: A Qualitative Evidence Synthesis Analyzing Social and Structural Barriers to HIV Testing and Coping Behaviors

In sub-Saharan Africa, accessing HIV testing services is a significant challenge for men who have sex with men (MSM) and transgender women (TGW). In this qualitative evidence synthesis, our aim is to understand social and structural barriers and how they hinder MSM's and TGW's access to HIV testing services in sub-Saharan African countries. We searched four selective databases (PubMed, Web of Science and CINAHL complemented with Google Scholar) for qualitative studies, published in English between January 2005 and December 2023, generated 1507 articles, of which 22 were included. Thematic synthesis was conducted for data synthesis. This led to five barriers that hinder HIV test uptake among MSM and TGW, which included: non-availability of tailored HIV testing services, stigma, lack of trust among service providers, sexual and physical violence, and criminalization of same sex relationship. To navigate these social and structural barriers and cope with fears of discrimination and criminalization, MSM and TGW engaged into riskier behaviors, including avoiding HIV testing, non-disclosure, or relying on informal or alternative sources of HIV testing. Decriminalization of same-sex relationship and peer-led HIV testing services were noted to address structural barriers, including stigma and poor access, and subsequently increase the participation in HIV testing services.

Urban heat mitigation by green and blue infrastructure: Drivers, effectiveness, and future needs

The combination of urbanization and global warming leads to urban overheating and compounds the frequency and intensity of extreme heat events due to climate change. Yet, the risk of urban overheating can be mitigated by urban green-blue-grey infrastructure (GBGI), such as parks, wetlands, and engineered greening, which have the potential to effectively reduce summer air temperatures. Despite many reviews, the evidence bases on quantified GBGI cooling benefits remains partial and the practical recommendations for implementation are unclear. This systematic literature review synthesizes the evidence base for heat mitigation and related co-benefits, identifies knowledge gaps, and proposes recommendations for their implementation to maximize their benefits. After screening 27,486 papers, 202 were reviewed, based on 51 GBGI types categorized under 10 main divisions. Certain GBGI (green walls, parks, street trees) have been well researched for their urban cooling capabilities. However, several other GBGI have received negligible (zoological garden, golf course, estuary) or minimal (private garden, allotment) attention. The most efficient air cooling was observed in botanical gardens (5.0 ± 3.5°C), wetlands (4.9 ± 3.2°C), green walls (4.1 ± 4.2°C), street trees (3.8 ± 3.1°C), and vegetated balconies (3.8 ± 2.7°C). Under changing climate conditions (2070-2100) with consideration of RCP8.5, there is a shift in climate subtypes, either within the same climate zone (e.g., Dfa to Dfb and Cfb to Cfa) or across other climate zones (e.g., Dfb [continental warm-summer humid] to BSk [dry, cold semi-arid] and Cwa [temperate] to Am [tropical]). These shifts may result in lower efficiency for the current GBGI in the future. Given the importance of multiple services, it is crucial to balance their functionality, cooling performance, and other related co-benefits when planning for the future GBGI. This global GBGI heat mitigation inventory can assist policymakers and urban planners in prioritizing effective interventions to reduce the risk of urban overheating, filling research gaps, and promoting community resilience.

Decoding the synergistic potential of MAZ-51 and zingerone as therapy for melanoma treatment in alignment with sustainable development goals

Melanoma, an invasive class of skin cancer, originates from mutations in melanocytes, the pigment-producing cells. Globally, approximately 132,000 new cases are reported each year, and in South Africa, the incidence stands at 2.7 per 100,000 people, signifying a worrisome surge in melanoma rates. Therefore, there is a need to explore treatment modalities that will target melanoma's signalling pathways. Melanoma metastasis is aided by ligand activity of transforming growth factor-beta 1 (TGF-β1), vascular endothelial growth factor-C (VEGF-C) and C-X-C chemokine ligand 12 (CXCL12) which bind to their receptors and promote tumour cell survival, lymphangiogenesis and chemotaxis. (3-(4-dimethylaminonaphthelen-1-ylmethylene)-1,3-dihydroindol-2-one) MAZ-51 is an indolinone-based molecule that inhibits VEGF-C induced phosphorylation of vascular endothelial growth factor receptor 3 (VEGFR-3). Despite the successful use of conventional cancer therapies, patients endure adverse side effects and cancer drug resistance. Moreover, conventional therapies are toxic to the environment and caregivers. The use of medicinal plants and their phytochemical constituents in cancer treatment strategies has become more widespread because of the rise in drug resistance and the development of unfavourable side effects. Zingerone, a phytochemical derived from ginger exhibits various pharmacological properties positioning it as a promising candidate for cancer treatment. This review provides an overview of melanoma biology and the intracellular signalling pathways promoting cell survival, proliferation and adhesion. There is a need to align health and environmental objectives within sustainable development goals 3 (good health and well-being), 13 (climate action) and 15 (life on land) to promote early detection of skin cancer, enhance sun-safe practices, mitigation of environmental factors and advancing the preservation of biodiversity, including medicinal plants. Thus, this review discusses the impact of cytostatic cancer drugs on patients and the environment and examines the potential use of phytochemicals as adjuvant therapy.

The role of primary health care in improving health status, financial protection and health equity in the context of China's health system reform

BACKGROUND

Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity.

METHODS

We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations.

RESULTS

From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density.

CONCLUSIONS

In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.

On the Commemorative Ceremony and Symposium for the 20th Anniversary of Food Safety Commission, Cabinet Office, Government of Japan

Food Safety Commission, Cabinet Office, Government of Japan (FSCJ) was established in 2003 and marked its 20th anniversary in 2023. FSCJ held a commemorative ceremony and symposium to celebrate its 20th anniversary at Mita conference hall (Mita, Minato-ku, Tokyo) on September 1st, 2023, which attracted a total of 164 on-site attendees including six media companies, as well as 460 online viewers. FSCJ Chairperson Dr. YAMAMOTO gave a summary of each session; Session 1 outlined the various future challenges against which risk assessment organizations must prepare. In Session 2, panelists shared information on the development of new evaluation methodologies and international collaborations in order to meet various global demands and issues. In Session 3, the FSCJ introduced its future initiatives and called for international collaboration in sharing information and expertise to address data gaps and emerging issues, to which all panelists expressed their support. The importance of personnel development to tackle these challenges was also raised. In concluding the seminar, Dr. YAMAMOTO expressed that the common understanding gained from this occasion was the most fruitful achievement, owing to the international colleagues who shared their thought-provoking presentations and insights.