Global Policy Institute

Influenza A subclade K viruses caused high infection rates in the 2025/2026 Northern Hemisphere season, raising concerns about antigenic drift and reduced vaccine effectiveness. We measured antibody responses in matched human pre- and post-vaccination sera against a vaccine-like as well as subclade K isolates. Pre-existing immunity to subclade K variants was noted with seasonal influenza vaccination boosting titers two-fold against subclade K and three-fold against the vaccine-like strain, indicating little antigenic drift. These data contrast ferret-based predictions of marked antigenic drift.

Urgent action is required to close gaps in routine programme delivery and strengthen pandemic preparedness. Synthesising pandemic learning from the United Kingdom (UK) Covid-19 Inquiry demonstrates that the potential of vaccine innovation to save lives will be undermined without robust and adaptable routine delivery strategies.

This paper investigates the complementarity between business training and timely access to financial capital for small and medium enterprises (SMEs) in Kenya. All participants in the business support program we study are offered training. One-third of participants are offered loans immediately after training ( Concurrent Loan group), one-third are offered loans six weeks after training ( Delayed Loan group), and the remaining third are offered loans after another four weeks ( Control group). While a long time lag may reduce knowledge retention and application among SMEs, concurrent access to loans and associated business spending may divert the entrepreneurs’ attention away from improving business practices. We find evidence for the latter in both intention-to-treat and treatment-on-the-treated estimates. While SMEs in both Control and Delayed Loan groups improve their business practices, SMEs in the Concurrent Loan group who take loans do not improve their practices at all. Moreover, entrepreneurs who take loans spend less time on their businesses and experience declines in their business revenue. • Providing loans immediately after business training reduces improvements in business practices for small and medium enterprises. • A delayed access to loans after training helps entrepreneurs to focus on implementing training lessons. • Access to loans reduces the time treated entrepreneurs spend on their businesses and lowers business performance.

Although the prevalence of early childhood caries (ECC) has declined over the past few decades, it remains a significant public health concern in Japan. Socioeconomic disparities in ECC risk have been reported; however, the extent to which these disparities exist across different indicators of socioeconomic status (SES) and the degree to which early oral health practices help explain them remain unclear. This study evaluated the association between parental SES and ECC and examined the extent to which early oral health behaviors contributed to these associations. We analyzed the data from 68,312 children and their parents participating in the Japan Environment and Children's Study, a nationwide birth cohort recruited between 2011 and 2014. Parental SES, including household income equivalized using the OECD-modified equivalence scale and educational attainment, was assessed using self-reported questionnaires. Diagnoses of dental caries from birth to age 4 years were reported retrospectively by caregivers when the child was 4 years old. Multivariable logistic regression was used to examine associations between SES and ECC. Mediation analyses were conducted to evaluate whether oral health behaviors at age 2, including fluoride application, tooth brushing practices, continued bottle feeding, and frequency of between-meal snacks, mediated these associations. All models were adjusted for demographic and potential confounding factors. Overall, 23.0% of children had been diagnosed with caries by age 4 years. The higher prevalence was consistently observed among children from lower SES backgrounds starting at around age 2 years. Both lower household income and lower parental educational attainment were associated with higher odds of ECC. The highest odds were observed among children whose parents had secondary-level education (adjusted odds ratio: 1.52; 95% confidence interval: 1.44-1.59). Although oral health behaviors mediated these associations, each behavior accounted for less than 5% of the total effect. Lower household income and parental educational attainment were consistently associated with a higher risk of ECC from early childhood. Mediation analyses using oral health behaviors assessed at age 2 indicated that these behaviors explained a small proportion of the observed socioeconomic disparities, suggesting a small contribution of individual behaviors to early-life socioeconomic inequalities in ECC.

ObjectiveIndividuals choosing permanent female contraception (PFC) face barriers including age and parity. Prior literature has focused on regret, but rarely on understanding patient perspectives. Social media is increasingly used to obtain medical information; hence this study seeks to use popular platforms to evaluate motivations, barriers, and facilitators to obtaining PFC.MethodsThis study collected Twitter and Reddit posts from October 2020 to April 2023 and July 2017 to April 2023, respectively. Data was analyzed using Bidirectional Encoder Representations from Transformers (BERT), followed by manual deductive coding of relevant topic clusters to characterize user-generated PFC discussions. We collected 409,641 posts including 321,267 tweets and 88,374 Reddit posts and performed content analysis using a deductive coding schema using the socio-ecological model approach to determine which posts to include in the final analysis. Sentiment analysis was conducted to detect emotions and themes most correlated with post engagement.ResultsWe identified 2,356 posts, including 2,076 tweets (88.12%) and 280 subreddit posts (11.88%) from Reddit relevant to PFC discourse. Major themes included clinician (n = 246; 10.44%), patient (n = 1,388; 58.91%), interpersonal (n = 254; 10.78%), institutional (n = 311; 13.20%), and policy-level perspectives (n = 157; 6.66%) and derived 22 subthemes. The top subthemes included patients’ seeking/sharing PFC advice (20.80%), discussion of successful completion or commitment/intent to undergo PFC (27.04%), interactions with healthcare providers and beliefs surrounding PFC regret (10.77%), the cost associated with PFC (7.05%), and the Dobbs V. Jackson ruling (6.66%). Additionally, there was a significant increase in posts on PFC following the Dobbs decision. Sentiment analysis shows that posts containing emotional words (both positive and negative) and words related to themes such as home, friends, and family were more likely to receive engagement on Reddit while sentiments related to health, optimism, and communication were correlated with tweet engagement.ConclusionAs reproductive healthcare continues to face restrictions, online communities provide insight into the motivations and decision-making behaviors of people seeking PFC. Findings can help clinicians better understand patient perspectives, and improve our ability to provide person-centered contraception care for patients desiring PFC.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12978-025-02239-z.

Abstract Background This study aimed to investigate the occurrence, antimicrobial resistance profiles, and genetic characteristics of extended-spectrum beta-lactamase (ESBL)-producing E. coli in wastewater collected in Dakar, Senegal. Methods A total of 48 wastewater samples were collected during both the dry and wet seasons (May–December 2019) and analyzed for E. coli and ESBL-producing E. coli concentrations using TBX agar with and without cefotaxime supplementation. Antimicrobial susceptibility testing (AST) and ESBL confirmation were performed using the Kirby-Bauer disc diffusion method and the double-disk synergy test, and polymerase chain reaction (Endpoint PCR) assays were performed to identify ESBL genes and determine phylogenetic groups. Results All samples (n = 48) carried ESBL-producing strains. The concentrations of ESBL-producing E. coli ranged from 1.36 × 10⁴ to 3.30 × 10⁵ CFU/100 mL, whereas the ratio of ESBL-producing E. coli among the total E. coli population varied between 0.20% and 16.33%. All the 107 isolated ESBL-producing E. coli strains were multidrug resistant (MDR), with 100% resistance to beta-lactams (ampicillin, ticarcillin, cefalotin, cefotaxime, ceftazidime, cefepime, aztreonam) and high resistance rates to non-beta-lactam antibiotics, including ciprofloxacin (77.57%). Notably, no resistance was observed to imipenem. Molecular analysis identified CTX-M-type genes in all isolates, with bla CTX-M-1 group (89.71%) and bla CTX-M-8 group (88.78%) being the most prevalent. The bla CTX-M-15 variant, a subgroup of bla CTX-M-1, was detected in 96.88% of bla CTX-M-1 positive isolates. Additionally, bla TEM (31.77%) and bla OXA-1 (34.57%) were detected, while bla SHV and bla CTX-M-25 were absent. Phylogenetic analysis of 107 isolates revealed a diverse distribution across four phylogroups: A (37.38%), D (22.43%), B1 (14.02%), and B2 (5.67%). The predominance of phylogroup A, often associated with commensal strains, suggests fecal contamination as a primary source. However, the significant presence of phylogroup D, which is linked to extraintestinal infections, raises concerns about the dissemination of potentially pathogenic strains. Conclusion This study highlights the high prevalence of ESBL-producing E. coli in wastewater in Dakar. The detection of MDR strains, particularly those carrying CTX-M-15 and belonging to pathogenic phylogroups, underscores the urgent need for comprehensive surveillance, improved wastewater treatment, and public health interventions to mitigate the spread of antibiotic resistance in Senegal.

ABSTRACTAims/IntroductionWe examined the differences in diabetes care between public assistance recipients (PARs), exempt from medical costs and guaranteed a minimum income, and the National Health Insurance (NHI) beneficiaries, covering non‐employed and self‐employed individuals with some cost sharing in Japan.Materials and MethodsThis observational study used claims data from a Japanese municipality (April 2017–March 2022) to identify individuals aged 20–68 with type 2 diabetes on antidiabetic medications. We analyzed care processes annually and cross‐sectionally, focusing on tests, medications, and medical costs, and followed health outcomes (hypoglycemia and hospitalization) monthly and longitudinally. Multivariable Poisson regression models estimate the risk ratios for binary care processes, and a gamma regression model analyzes medical costs as continuous variables. Health outcome incidence rate ratios were assessed using multivariable Poisson regression, with the observation period as an offset.ResultsWe included cross‐sectional data from 11,385, 11,566, and 9,943 people (2018–2020) and longitudinal data from 18,655 individuals. In the analysis considering the whole periods, PARs were more likely to receive annual eye examinations (adjusted risk ratio 1.15, 95% confidence interval [CI] 1.08–1.22), use sodium‐glucose cotransporter‐2 inhibitors (1.22, 1.13–1.31), and use glucagon‐like peptide‐1 receptor agonists (1.63, 1.41–1.90). The total (1.16, 1.09–1.23) and outpatient medical costs (1.31, 1.24–1.38) were higher, whereas the inpatient costs (0.85, 0.77–0.94) were lower for PARs. Hypoglycemia incidence was also higher (adjusted incidence rate ratio 2.21, 95% CI 1.38–3.54).ConclusionsPublic assistance might improve the diabetes care process, but not fully health outcomes. These findings suggest additional supports for PARs and further research for NHI beneficiaries in poverty.