George Institute for Global Health

Abstract Objective We aimed to prospectively validate and compare published prediction models and clinician-assigned triage categories for early trauma care. Design Prospective multicentre cohort study. Setting Three public hospitals in urban India: one secondary care hospital in Mumbai and one tertiary care teaching hospitals in Delhi and Kolkata each. Participants Adult patients aged over 18 years presenting to the emergency department with a history of trauma between 2016 and 2022. A total of 13,041 patients were included in the final analysis. Methods We externally validated five published trauma prediction models (GAP, Gerdin, KTS, MGAP, and RTS) and clinician-assigned triage categories based on initial assessment. The primary outcome was 30-day all-cause mortality. Models were recalibrated using a separate updating sample prior to evaluation, and model performance was assessed in terms of discrimination (AUC), calibration (calibration slope and plots), and decision curve analysis. Results All models and clinician gestalt-based triage demonstrated excellent discrimination (AUC range: 0.90-0.96) and good calibration after updating. The GAP model achieved the highest AUC (0.96, 95% 0.94-0.97), and RTS demonstrated the highest sensitivity (0.70). Conclusion Simple, physiology-based prediction models and clinician gestalt both demonstrated excellent performance in predicting 30-day mortality among adult trauma patients in Indian emergency departments. These findings provide a practical foundation for further development of trauma triage systems.

Climate science has long struggled to communicate urgency proportionate to the severity of the crisis it describes. Terms such as ‘climate change’ carry neutral or even positive connotations, while ‘climate crisis’ and ‘climate catastrophe,’ though more accurate, lack specificity needed to guide an appropriate response. We propose that climate communication could benefit from adopting a staging framework analogous to the TNM cancer staging system: a model that conveys not only severity but progression and the rationale for proportionate intervention. Drawing on the cognitive science of metaphor, we show that framing shapes perception and decision-making unconsciously. A climate staging system would be low-cost to adopt, faces no obvious organized political opposition, and could align public perception with what is an advancing, potentially irreversible, planetary disease. Based on current planetary boundary data, we suggest the planet may already be at the equivalent of Stage III.

• Compassion fatigue studies in low-and middle-income countries are scarce, hindering effective interventions. • A socio-ecological model classifies compassion fatigue factors across three levels viz. individual, interpersonal, and system-level factors. • The article explores the consequences of compassion fatigue, including its short term and long-term effects on health care workers. Compassion fatigue, also referred to as secondary traumatic stress or vicarious traumatisation, is characterised by a reduction in intrinsic empathy for others (patients), associated with mental and emotional exhaustion caused by ongoing exposure towards individuals suffering from emotional, physical, mental or spiritual trauma. This condition is often found in front-line healthcare workers such as nurses, doctors and allied health professionals, particularly those working under stressful conditions, with lower levels of support. This narrative review aimed to identify factors associated with compassion fatigue in low- and middle-income countries as defined by the World Bank. The database search in MEDLINE (via PubMed) and an additional search in Google Scholar resulted in 595 hits, of which 38 were included in the review. The key findings illustrated that CF was associated with individual factors like feelings of fear, resilience and coping strategies, and systems level factors such as intense workload and difficult role demands. This narrative review highlights the significant impact of compassion fatigue on frontline healthcare workers in low- and middle-income countries. The findings emphasize the need for comprehensive strategies to enhance individual resilience and organizational support, aiming to create a more sustainable and compassionate healthcare environment.

In the field of sexual and reproductive health and rights (SRHR), there is a growing consensus that participation is critical to ensuring that the voices of youth are heard and their agency is exercised in a way that enables them to practice active citizenship. This includes collective action to hold duty bearers and power holders to account for their rights. Youth are increasingly being seen as important constituents; however, despite the growth in practice, the evidence on what strategies are adopted, how these initiatives work and why is limited. To explore interventions implemented within the ambit of accountability for SRHR rights, and to understand how these interventions generate or strengthen collective action to ultimately lead to the improvement of sexual and reproductive health and rights. We conducted a scoping review following the 5-step methodology developed by Arksey and O’Malley. Systematic searches were conducted on PubMed and Web of Science databases, identifying articles from Jan 2008 to Dec 2022, about interventions with youth that involve collective action for accountability pertaining to SRH rights. Data were charted, synthesized and reported. A total of 25 articles describing 18 interventions were included and represent a range of interventions categorised as collective action. The interventions can be divided into three categories: first, articles analysing the impact of community-based interventions by NGOs or external agencies (15); second, articles describing the evolution and impact of advocacy networks and broader social movements (4); and articles examining (national or global) policy advocacy processes that seek to engage youth (6). The strategies are analysed across three broad categories/themes, identifying what factors influenced the success of each: (1) Building youth empowerment and solidarity – seeding youth collectives as critical mass, ensuring diversity in the collectives, and the extent of critical consciousness and analysis engaged in by them (2). Building pressure and allyship – casting a wide net of allies across different interest groups, allying with adults in a manner that fosters equitable collaboration, building strategically relevant evidence and framing issues in a manner that speaks to change-makers and people at large; and (3) Negotiation with power holders – going beyond the state and negotiating with other power holders, building on existing favourable legislation, utilizing invited spaces and leveraging of political opportunities. As the interest in youth leadership in SRH deepens, this review underscores that even in contexts where youth engagement is recognised, the readiness of the system to respond to and grant legitimacy to youth voices is necessary for effective implementation. The evidence suggests that collective action interventions must be multi-level, strategic, and consider local social hierarchies, histories of civic organising, and policymaking. Power holders, not just at the state but also at the community level, must be held accountable for the sexual and reproductive rights of youth and their leadership to be realised.

Adults aged 50 years and older are more likely to experience unmet health care needs for hypertension, particularly given the existence of socioeconomic disparities in its diagnosis, treatment, and control. This study aims to assess unmet health care needs for hypertension following a care cascade among adults aged 50 years and older from both high-income countries and low- and middle-income countries (LMICs). We used data from five national cohorts to estimate the extent of unmet health care needs for hypertension diagnosis, treatment, and control in the US, the UK, China, Mexico, and India, and to examine the socioeconomic equity and influencing factors. We included 98,510 participants recruited between 2013 and 2018. The overall level of unmet health care needs for hypertension reached 73.42%, with Mexico having the highest level at 79.48% and the US having the lowest at 45.43%. Among all types of unmet needs, diagnostic gaps were the largest (46.7%), followed by treatment (22.9%) and control (30.5%). Males (RRR = 1.59), rural residents (RRR = 1.68), those with less than lower secondary educational level (RRR = 1.51), low-income level (RRR = 1.31), no public health insurance (RRR = 1.33), engaged in paid work (RRR = 1.60), and live alone (RRR = 1.17) were more likely to suffer unmet diagnostic needs. Similar patterns were found regarding the unmet treatment and control needs. A substantial proportion of adults aged 50 years and older suffer from unmet needs in hypertension care, particularly those in LMICs. Populations with low socioeconomic status are faced with more serious unmet health care needs. These findings suggest that policymakers should consider targeted strategies to address the identified deficiencies in chronic disease management.

BackgroundChina, once a malaria-endemic country, has developed a comprehensive set of extensive strategies and accumulated practical experience over 70 years of malaria elimination efforts. On June 30, 2021, China was officially certified by the World Health Organization as malaria-free. Substantial research has already summarized China’s malaria control experience from a technical standpoint. This study aims to examine China’s malaria elimination practices from a new perspective of the health system and social development.MethodsSemi-structured interviews were conducted with key informants, including national malaria program managers, renowned scholars, and technical personnels from China, international organizations, and high-burden countries in Africa. Interviews were conducted from July 2023 to July 2025, and data were analyzed using the thematic framework method.ResultsA total of 42 participants responded to the interview, and 7 key components from social development was proposed. The thematic analysis identified key factors influencing the achievement of malaria elimination in China. Specifically, 57.14% of experts mentioned agricultural crop types, 66.67% highlighted health education, 64.29% noted the working environment, 52.38% referred to employment opportunities, 59.52% addressed water and sanitation, 71.43% emphasized the living environment, and all experts underscored the critical role of the health system.ConclusionsSocial development is closely intertwined with malaria elimination, as advancements in healthcare, infrastructure, and community engagement are essential for ensuring the long-term success of malaria control efforts. Future studies could further explore the impact of specific factors on malaria elimination, thereby contributing valuable insights to global malaria elimination efforts.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s40249-025-01406-5.

The prevalence of frailty and its effect on cardiovascular outcomes is increasing on a global scale. Pharmacotherapies for cardiovascular diseases in older people with frailty present unique challenges that require a comprehensive and individualized approach. In this Review, we provide a general overview of these challenges, followed by an in-depth discussion of the problems inherent in applying standard approaches to cardiovascular care in this population. Specifically, we consider blood pressure control, glucose lowering in patients with type 2 diabetes mellitus, lipid lowering, antiplatelet therapies, direct oral anticoagulants for stroke prevention in atrial fibrillation, and the treatment of heart failure. Although the reduction in cardiovascular events in older individuals with frailty is crucial, the potentially increased risk of adverse effects with the use of cardiovascular medications must be carefully considered. Treatment targets and the choice of drug for these patients should be based on their overall health status and personal goals of care.

Zusammenfassung Hintergrund und Zielsetzung Eine bakterielle Kolonisation, insbesondere durch Staphylococcus aureus (SA), ist auf der Haut von Patienten mit primärem kutanen T‐Zell‐Lymphom (CTCL) prävalent. Die vorliegende Studie hatte das Ziel, Risikofaktoren für kutane bakterielle und SA‐Besiedelungen sowie deren Einfluss auf die Prognose von Patienten mit CTCL zusammen mit der Einnahme systemischer Antibiotika zu untersuchen. Methoden Diese retrospektive Studie umfasste 113 Patienten mit CTCL, bei denen zwischen 2010 und 2024 am Peking University First Hospital ein Hautabstrich durchgeführt wurde. Ergebnisse Fünfundachtzig Patienten (75,2%) wurden positiv auf bakterielle Kolonisationen der Haut getestet (SA, 60,2%). Ulzerierte Läsionen erhöhten die Wahrscheinlichkeit positiver Ergebnisse bei bakteriellen/SA‐Hautkulturen signifikant (multivariate Analyse). Außerdem waren fortgeschrittene Stadien, Tumoren, Erythrodermie, Lymphopenie und Eosinophilie mit erhöhtem Risiko für positive Hautkulturen verbunden (univariate Analyse). Die Cox‐Regressionsanalyse zeigte, dass die bakterielle/SA‐Kolonisation der Haut und die antibiotische Intervention nicht mit dem Gesamtüberleben korrelierten ( p > 0,05). Schlussfolgerungen Diese retrospektive Studie berichtet Daten zur Prävalenz bakterieller Kolonisationen der Haut asiatischer Patienten mit CTCL. Ulzerierte Läsionen erwiesen sich als wichtigster Risikofaktor für kutane bakterielle/SA‐Besiedelungen. Bei den asiatischen Patienten mit CTCL war weder die bakterielle Besiedelung der Haut noch eine solche mit Staphylococcus aureus mit einer schlechteren Prognose assoziiert, noch verbesserte eine kurzzeitige systemische Antibiotikatherapie die Ergebnisse.