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Introduction: Effective diabetes management relies mainly on an individual's ability to perform self-care tasks. However, this process is influenced by a complex interplay of factors. This study explores the multifaceted influences on Diabetes Self-Management (DSM), examining both factors influencing and affecting DSM. Understanding these influences is crucial for developing targeted Digital Health Interventions that empower individuals with diabetes to achieve successful self-management., Objectives: To identify problems faced by Type 2 Diabetes Mellitus (T2DM) individuals in self-managing diabetes and leveraging mHealth technology, with need-based solutions to Empower Self-Management in T2DM., Methodology: In-depth semi-structured interviews were conducted among ten patients with T2DM visiting the outpatient department of a tertiary care hospital in coastal Karnataka. Additionally, six healthcare professionals (HCPs) working closely with T2DM patients were interviewed to understand their perspectives on using mHealth to manage T2DM effectively. The themes for the solutions described were analyzed using ATLAS-TI software., Results: Our research examined certain factors that might have influenced effective diabetes self-management and investigated patient perspectives on using digital health solutions in diabetes self-management. This study found that technology skills, duration of diabetes, knowledge, and personal beliefs were all significant factors affecting self-management in participants with T2DM. Additionally, socioeconomic factors were also seen to influence effective diabetes self-management. The Google search engine was used by 50% of the participants interviewed to learn about T2DM. Diet management through Google searches was used by a minority (30%) of the patients. None of the participants had previously used any mobile health applications (mHealth apps) to manage T2DM. 20% of the participants expressed limited knowledge about using smartphones or wearables to track health parameters. The study also identified potential non-technological barriers to mHealth adoption. To address these concerns, researchers used an empathy map to develop solutions that promote mHealth use., Conclusion: Several challenges and need-based mHealth solutions were identified to empower diabetes self-management education among T2DM patients. Implementing need-based mHealth solutions such as data tracking, personalized feedback, and access to educational resources can lead to better disease control and a higher quality of life for those with T2DM. Further research and development in mHealth interventions, and collaborative efforts among healthcare providers, patients, and technology developers, hold a promising future for the healthcare sector in providing efficient, effective, and accessible care., (© 2024. The Author(s).)

High-throughput omics technologies have become valuable tools for systems science research and clinical management of sepsis. This article analyzes sepsis research using omics technologies in the European Union (EU) and the United Kingdom from 1990 to May 2023 using bibliometric data from the Web of Science database. Using VOSviewer for network analysis, we examined the distribution patterns, funding characteristics, and collaborations among the states, noting trends of convergence and divergence. The analysis included 2078 articles, revealing an increasing rate of publications on sepsis research using omics approaches. The United Kingdom's research output is notably high, contributing 28.3% of the total research from the EU and United Kingdom combined. Germany, France, the Netherlands, and Italy together account for 56.9% of the publications from the EU member states. The United States is the leading international collaborator, particularly with the United Kingdom, followed by Germany and France. The EU-15 countries have significantly more publication outputs in this domain with growing but limited inclusion of the newer members of the EU. We suggest that the role of EU member states and the United Kingdom in sepsis research using omics technologies can be advanced by facilitating high-value, technology-driven health research, fostering collaboration, convergence, and equity in global health and biomedical research.

Introduction: Cardiovascular diseases are a major public health issue and the leading cause of mortality globally. The global economic burden of out-of-pocket expenditure (OOPE) for cardiovascular surgeries and procedures is substantial, with average costs being significantly higher than other treatments. This imposes a heavy economic burden. Government insurance schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aim to enhance affordability and access to cardiac care., Methodology: This retrospective study analyzed OOPE incurred for top cardiac surgeries under AB-PMJAY, private insurance, and uninsured patients at a tertiary care teaching hospital in Karnataka. Data of 1021 patients undergoing common cardiac procedures from January to July 2023 were analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for normality. The study aims to evaluate financial risk protection offered by AB-PMJAY compared to private plans and inform effective policy-making in reducing the OOPE burden for surgeries in India., Results: The study analyzed OOPE across 1021 patients undergoing any of four surgeries at a tertiary care teaching hospital in Karnataka. AB-PMJAY patients incurred zero OOPE across all surgeries. Uninsured patients faced the highest median OOPE, ranging from ₹1,15,292 (1390.57 USD) to ₹1,72,490 (2080.45 USD) depending on surgery type. Despite the presence of private insurance, the median out-of-pocket expenditure ranged from ₹1,689 (20.38 USD) to ₹68,788 (829.67 USD). Significant variations in OOPE were observed within different payment groups. Private insurance in comparison with AB-PMJAY had limitations like co-payments, deductibles, and limited coverage resulting in higher OOPE for patients., Discussion: The results illustrate the efficacy of AB-PMJAY in reducing the financial burden and improving the affordability of cardiac procedures compared to private insurance. This emphasizes the significance of programmmes funded by the government in reducing the OOPE burden and ensuring equitable healthcare access. The comprehensive and particular estimates of OOPE for different surgical procedures, categorized by payment methods provide valuable information to guide the development of policies that aim to reduce OOPE and progress toward universal health coverage in India., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee – 2 issued approval IEC2:564/2023, dated November 20, 2023. The Institutional Review Board of Prasanna School of Public Health (PSPH) is the Kasturba Medical College (KMC) and Kasturba Hospital Institutional Ethics Committee – 2. Both PSPH and KMC are constituent units of the Manipal Academy of Higher Education (MAHE), Karnataka, India. In line with regulatory norms, MAHE has mandated all hospital-based studies in MAHE to apply to the KMC and Kasturba Hospital Institutional Ethics Committee. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kamath et al.)

Objective: Our aim was to assess the level and socio-demographic correlates of the ability to maintain health among children in Albania, a post-communist country in the Western Balkans., Methods: A cross-sectional study was conducted in Albania in September 2022. The study population consisted of a nationwide representative sample of 7,831 schoolchildren (≈54% girls) aged 12-15 years. A structured self-administered and anonymous questionnaire inquired about the children's attitudes toward health promotion (ability to maintain and improve health) and a range of key dimensions on knowledge and practices regarding healthcare services. Socio-demographic data were also collected. Binary logistic regression was used to assess the socio-demographic correlates of children's ability to maintain health., Results: Overall, about 71% of schoolchildren exhibited the best attitudes toward health promotion (ability to maintain and improve health). In the multivariable adjusted logistic regression models, poorer attitudes toward health promotion (ability to maintain and improve health) were significantly related to older age (OR=1.2, 95% CI=1.0-1.3), middle/low maternal education (OR=1.2, 95%CI=1.1-1.3), poor/very poor economic situation (OR=1.5, 95%CI=1.2-1.8), lack of appropriate knowledge about rights to healthcare (OR=1.3, 95% CI=1.1-1.5), lack of knowledge about obtaining healthcare services (OR=1.7, 95%CI=1.4-2.2), and lack of consultations/visits with health professionals excluding vaccinations (OR=1.2, 95%CI=1.1-1.4)., Conclusions: Almost 1/3 rd of Albanian schoolchildren included in this study did not exhibit the best attitudes toward health promotion (ability to maintain and improve health). The best attitudes were related to a higher socioeconomic level and adequate knowledge and practices regarding healthcare services. There is thus a need to increase health literacy levels among children in order to ultimately induce sustainable healthy behavioural/lifestyle practices., (© 2024 Herion Muja et al., published by Sciendo.)

We derive the macroscopic dynamic equations for ferromagnetic smectic-A liquid crystals for which the spontaneous magnetization is parallel to the layer normal of the layering. As additional macroscopic variables when compared to simple fluids, we have the layer displacement u, familiar from smectic liquid crystals, and the magnetization density M. We find a number of reversible and dissipative cross-coupling terms to the additional macroscopic variables and discuss possible experiments to detect them. Among other effects, we point out that the velocity of first sound becomes anisotropic due to the influence of the modulus of the magnetization, while the magnitude of the velocity of second sound is modified. As for the static behavior, we find cross-coupling terms between the magnitude of the magnetization, on the one hand, and layer compression as well as osmotic pressure, on the other hand. In addition, we point out that as a dissipative effect, temperature gradients can induce gradients in the magnetization parallel to the layer normal, mediated by layer compressions.

Introduction: Tobacco usage is an epidemic as statistics point towards smoking as the second leading cause of death. Populations experiencing humanitarian emergencies may experience a higher propensity for tobacco, alcohol, and other substance abuse disorders. This review aimed to map tobacco prevention and control interventions in humanitarian settings., Methods: The search for this scoping review was conducted in six databases and supplemented with a gray literature search. Articles were screened at title-abstract and full-text by two pairs of authors, and data was abstracted by three individuals independently. An adapted diffusion of governance framework is used to discuss the findings., Results: A total of 26 articles were included from the searches conducted in the databases and grey literature. The interventions targeted all age groups. The documents retrieved from the grey literature search were classified as population-based interventions, as they were not restricted to a particular group of individuals. Interventions were delivered at various locations, using different methods and engaging multiple stakeholders. Interventions assessed were grouped into packaging, labeling, and other policy interventions (pricing and taxes)., Conclusion: There are few tobacco prevention and control interventions in the humanitarian context. The diffusion of governance perspective in implementing these interventions in humanitarian settings provides a cue for inter-sectoral cooperation among different stakeholders and disciplines beyond the health sector. Our review recommends exploring complementarity between the demand and supply side interventions for tobacco control., Implications: The scoping review has highlighted various tobacco prevention and control efforts in humanitarian settings. The interventions were delivered using various modes, and yet the burden of smoking is higher among the humanitarian population. Further research may use impact evaluation techniques to assess the impact of these interventions to facilitate the re-design of the implementation approach and policy priorities., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

The COVID-19 pandemic has highlighted the importance of local evidence ecosystems in which academia and practice in the Public Health Service (PHS) are interconnected. However, appropriate organizational structures and well-trained staff are lacking and evidence use in local public health decision-making has to be integrated into training programs in Germany. To address this issue, we developed a framework incorporating a toolbox to conceptualize training programs designed to qualify public health professionals for working at the interface between academia and practice. We conducted a scoping review of training programs, key-informant interviews with public health experts, and a multi-professional stakeholder workshop and triangulated their output. The resulting toolbox consists of four core elements, encompassing 15 parameters: (1) content-related aspects, (2) context-related aspects, (3) aspects relevant for determining the training format, and (4) aspects relevant for consolidation and further development. Guiding questions with examples supports the application of the toolbox. Additionally, we introduced a how-to-use guidance to streamline the creation of new training programs, fostering knowledge transfer at the academia-practice interface, equipping public health researchers and practitioners with relevant skills for needs-based PHS research. By promoting collaborative training development across institutions, our approach encourages cross-institutional cooperation, enhances evidence utilization, and enables efficient resource allocation. This collaborative effort in developing training programs within local evidence ecosystems not only strengthens the scientific and practical impact but also lays a foundation for implementing complex public health measures effectively at the local level., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Arnold et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Health security as a domain has gained tremendous importance in the recent past. Emerging and re-emerging diseases globally, coupled with the derailment of the determinants of health mainly the socio-political environment, has made health security a cross-cutting entity in diverse fields including International Relations (IR). With the ongoing global polycrisis, the health-related issues which were previously sidelined as a concept of less strategic importance in the IR field, are now contributing to the shift of the world order. This has instilled an increased participation of IR scholars in the discussions and debates on health security concerns. The field of IR contains numerous theoretical lenses through which scholars analyze such situations, policies, and systems of the world., Methods: In this paper, we use a scoping review method to inspect how IR theories have been applied in analyzing health security concerns., Results: We observed that various diverging IR theories have been used to deliberate on states' actions in tackling the recent pandemic and have also been prescriptive about the changing notions of multilateralism and international governing organizations. Realism, liberalism, and securitization were among the most frequently applied IR theories in the context of health security discussions., Conclusions: This work provides an impetus to enhance the interaction among interdisciplinary teams leading to evolving solutions that can address issues of global importance in the contemporary world., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Pattanshetty S et al.)

Malaria is a major public health problem in developing countries. The burden of malaria in fragile and conflict-affected states (FCAS) is increasing year by year. Moreover, the population living in FCAS is often the most vulnerable and at high risk of malaria due to factors, such as deteriorating healthcare system, mass relocations, and reduced resilience to shocks. Therefore, this scoping review aims to map the interventions that are conducted at the FCAS on malaria prevention among the general population. In addition, this review can help policy-makers and international health bodies, providing a comprehensive overview that can lead to more targeted, effective, and context-specific interventions. Databases, such as PubMed, EBSCO-CINAHL, Web of Science, ProQuest, and Cochrane Central Register of Controlled Trials, were searched using specified search terms. A total of 3601 studies were retrieved from the search. After screening, 62 studies were included in the synthesis that met the eligibility criteria. Narrative analysis of the findings was done. The results revealed that in fragile countries, interventions for children below 5 years of age included IPTi, TDA, and ACT. In conflicted countries, interventions for children below 5 years of age included TDA, LLINs, SMC, drug trials, and vaccination. Similar interventions were reported for other age groups and populations. Despite ongoing conflicts, malaria interventions have been maintained in these countries, but a persistent high burden of malaria remains. To achieve the goals of malaria elimination, the results of the review highlight the need for continued research and evaluation of malaria control interventions to assess their effectiveness and impact. Strengthening health systems, building partnerships, utilizing digital health technologies, and conducting context-specific research are recommended to improve healthcare access and reduce the burden of malaria in FCAS., (© 2024. The Author(s).)

We present the macroscopic dynamics of ferroelectric smectic A, smectic [Formula: see text], liquid crystals reported recently experimentally by three groups. In this fluid and orthogonal smectic phase, the macroscopic polarization, [Formula: see text], is parallel to the layer normal thus giving rise to [Formula: see text] overall symmetry for this phase in the spatially homogeneous limit. A combination of linear irreversible thermodynamics and symmetry arguments is used to derive the resulting dynamic equations applicable at sufficiently low frequencies and sufficiently long wavelengths. Compared to non-polar smectic A phases, we find a static cross-coupling between compression of the layering and bending of the layers, which does not lead to elastic forces, but to elastic stresses. In addition, it turns out that a reversible cross-coupling between flow and the magnitude of the polarization modifies the velocities of both, first and second sound. At the same time, the relaxation of the polarization gives rise to dissipative effects for second sound at the same order of the wavevector as for the sound velocity. We also analyze reversible cross-coupling terms between elongational flow and electric fields as well as temperature and concentration gradients, which lend themselves to experimental detection. Apparently this type of terms has never been considered before for smectic phases. The question how the linear [Formula: see text] coupling in the energy alters the macroscopic response behavior when compared to usual non-polar smectic A phases is also addressed., (© 2024. The Author(s).)

Introduction: The HPV vaccine is characterized by its significant effectiveness in preventing the occurrence of cervical cancer. However, the South Asian countries face multiple challenges in implementing the human papillomavirus vaccine (HPV) at scale. Implementation of human papillomavirus vaccination for eliminating cervical cancer necessitates investigating the factors that impact the health system of these nations. Hence, this review will map the evidence on factors influencing the scaling up of human papillomavirus vaccination in South Asia., Methods: The proposed scoping review will follow the steps given by Arksey and O'Malley and Levac et al. The search approach will follow McGowan et al. (14) evidence-based manual for Peer Analysis of Electronic Search Strategies (PRESS 2015) for systematic searches. Using a comprehensive search, the literature from 2006 onward will be identified from PubMed, CINAHL, EMBASE, Web of Science, and Scopus. The search strategy will include terms relating to the HPV vaccine and implementation. A predefined criterion for the inclusion and exclusion of studies will be adopted by three review authors independently to determine the eligible studies. The results will be narratively synthesized and examined in addition to being quantitatively presented to provide an outline. The review will be presented per the "Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR)" guidelines., Conclusions/discussion: The evaluation is anticipated to map the barriers and enablers influencing the rollout of the human papillomavirus vaccine. Lessons learned from the South Asian countries, where the vaccine has been implemented, may contribute to aiding the implementation of the vaccine in countries with similar health systems in an effective manner., Systematic Review Registration: The protocol was prospectively registered on the "open science framework". The registration DOI is https://doi.org/10.17605/OSF.IO/T5SW9 ., (© 2023. The Author(s).)

The implementation of Human Papillomavirus (HPV) vaccination is crucial for eliminating cervical cancer in India. The infodemic, characterised by misleading information, could hinder the successful implementation of the initiative. Misinformation related to the HPV vaccine, such as rumours, has been reported and circulated, contributing to an alarming pattern of vaccine hesitancy observed on social media. This study aimed to identify the public sentiment towards HPV vaccination based on the 'Behavioral and Social Drivers (BeSD)' framework through geospatial, content and sentiment analysis. A total of 1,487 tweets were extracted. After preprocessing, 1010 tweets were identified for sentiment and content analysis. The sentiments expressed towards the HPV vaccine are mixed, with a generally positive outlook on the vaccines. Within the population, there is a pervasive proliferation of misinformation, primarily focusing on vaccine safety and efficacy, contentious subjects, ethical considerations, and a prevalent sense of uncertainty in selecting the appropriate vaccine. These observations are crucial for developing targeted strategies to address public concerns and enhance vaccination rates. The insights gained from these results will guide policymakers, healthcare practitioners, and public health organisations to implement evidence-based interventions, thereby countering vaccine hesitancy and improving public health outcomes.

Background: The stigma associated with monkeypox (mpox) may prevent people from following recommended guidelines. Using a "model of stigma communication," this study maps and determines the mpox stigma on Twitter among LGBTQ+ (Lesbian, gay, bisexual, transgender, queer and more) community., Methods: The tweets that contained the terms '#monkeypox', '#MPVS', '#stigma', and '#LGBTQ+' and were published between May 01, 2022 and Sept 07, 2022 were extracted. For sentiment analysis, the VADER, Text Blob, and Flair analysers were implemented. This study evaluated the dynamics of stigma communication based on the "model of stigma communication". A total of 70,832 tweets were extracted, from which 66,387 tweets were passed to the sentiment analyser and 3100 tweets were randomly selected for manual coding. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria was adopted to report this study ., Findings: This research provided insight on the cause, communication, and patterns of mpox stigma in the LGBTQ+ community. In the community, stigmatisation was influenced by the group's labelling as the source of monkeypox. Some users believed that mpox resembled previously observed diseases such as HIV/AIDS, and COVID-19. Despite officials and media outlets disseminating information about preventing mpox and stigmatisation, a number of individuals failed to comply. The LGBTQ+ community faced peril in the form of violence due to escalating stigma. Misinformation and misinterpretation spread further stigmatisation., Interpretation: This study indicates that authorities must address misinformation, stigmatization of the LGBTQ+ community, and the absence of a comprehensive risk-communication plan to improve the system. The effects of stigmatization on the vulnerable population must be handled in conjunction with a well-developed risk communication plan, without jeopardizing their wellbeing., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Competing Interests: There are no conflicts of interest.

Background: Hepatitis C is a disease with a strong social component, as its main transmission route is via blood, making it associated with lifestyle. Therefore, it is suitable to be worked on from the perspective of public health policy, which still has a lot of room to explore and improve, contrary to diagnoses and treatments, which are already very refined and effective., Objective: An interactive gamified policy tool, designated as Let's End HepC (LEHC), was created to understand the impact of policies related to hepatitis C on the disease's epidemiology on a yearly basis until 2030., Methods: To this end, an innovative epidemiological model was developed, integrating Markov chains to model the natural history of the disease and adaptive conjoint analysis to reflect the degree of application of each of the 24 public health policies included in the model. This double imputation model makes it possible to assess a set of indicators such as liver transplant, incidence, and deaths year by year until 2030 in different risk groups. Populations at a higher risk were integrated into the model to understand the specific epidemiological dynamics within the total population of each country and within segments that comprise people who have received blood products, prisoners, people who inject drugs, people infected through vertical transmission, and the remaining population., Results: The model has already been applied to a group of countries, and studies in 5 of these countries have already been concluded, showing results very close to those obtained through other forms of evaluation., Conclusions: The LEHC model allows the simulation of different degrees of implementation of each policy and thus the verification of its epidemiological impact on each studied population. The gamification feature allows assessing the adequate fulfillment of the World Health Organization goals for the elimination of hepatitis C by 2030. LEHC supports health decision makers and people who practice patient advocacy in making decisions based on science, and because LEHC is democratically shared, it ends up contributing to the increase of citizenship in health., International Registered Report Identifier (irrid): RR1-10.2196/38521., (©Ricardo Baptista-Leite, Henrique Lopes, Björn Vandewalle, Jorge Félix, Diogo Franco, Timo Clemens, Helmut Brand. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 25.09.2023.)

Digital health records can provide advantages to healthcare practice, policy, and research. Several countries have established population-based digitalised data collection, integrated through data linkage techniques. In Lombardy (Italy), a regional population-based registry was established in the 2000s. It collects data from the social and health sector, anonymised immediately after their acquisition and restructured in a single repository. Data can be used for public health interest, planning, monitoring, services evaluation, and research. Indeed, data can also be provided to universities and other scientific institutes. The availability of such data enables to explore the epidemiology of infectious, chronic, and rare diseases. Thus, epidemiological research can support policymakers to tackle public health threats. However, analysis of electronic health records comes along with several challenges, including data inaccuracy, incompleteness, and biases. Researchers should take into consideration limits and barriers related to quality of data. Moreover, health data use must adhere to the national and European privacy legislation, at times limiting the potential of data integration. Therefore, even if big data drives innovation and scientific knowledge, ethical issues regarding privacy should be considered in public debate.

We present a model for the dynamics observed recently by Sano et al. [Nat. Commun. 12, 6771 (2021)] in a coherently layered system made up of sheetlike colloidal particles (nanosheets) subjected to an external concentration gradient. Adding a new macroscopic variable characteristic for the nonequilibrium situation encountered in the experiments to the hydrodynamics of smectic A liquid crystals, we show that all salient dynamic features observed in the experiments can be accounted for. For this nonequilibrium phenomenon, we identify the symmetry of the underlying ground state as undulating smectic A-like layering and the applied concentration gradient applied in the layer planes as the nonequilibrium driving force. As a result of our analysis, we find a coherent motion of undulating layers generated by a Helfrich-Hurault type instability propagating at a fixed velocity in accordance with the observations. If the coherence of the layering is lost, there is no longer any coherent propagation to be expected-as is also observed., (© 2023 Author(s). Published under an exclusive license by AIP Publishing.)

We investigate the properties of time-dependent dissipative solitons for a cubic complex Ginzburg-Landau equation stabilized by nonlinear gradient terms. The separation of initially nearby trajectories in the asymptotic limit is predominantly used to distinguish qualitatively between time-periodic behavior and chaotic localized states. These results are further corroborated by Fourier transforms and time series. Quasiperiodic behavior is obtained as well, but typically over a fairly narrow range of parameter values. For illustration, two examples of nonlinear gradient terms are examined: the Raman term and combinations of the Raman term with dispersion of the nonlinear gain. For small quintic perturbations, it turns out that the chaotic localized states are showing a transition to periodic states, stationary states, or collapse already for a small magnitude of the quintic perturbations. This result indicates that the basin of attraction for chaotic localized states is rather shallow., (© 2023 Author(s). Published under an exclusive license by AIP Publishing.)

Background: Health diplomacy is one of the emerging avenues for academics where foreign policy dynamics and global health meet. Its relevance has augmented especially after the COVID-19 pandemic that brought the world to a halt. International organization and national entities that are responsible for health governance as well as its socio-economic determinants have been increasingly involved in the negotiations for a collective action towards a better health infrastructure and preparedness. However, the approach to health diplomacy seems to vary with whether health is looked through diplomacy lens or vice versa. Thus, inculcating adequate and appropriate competencies of both fields to conduct negotiations for health while keeping national interests and international commitments intact is imperative. Methods: This study investigates 50 programmes/courses that have been currently offered around the globe to understand the competencies that have been identified as essential for a health diplomat. We examined four aspects: i) geographical distribution of programme/course (ii) the type of global health diplomacy programme being offered and their duration (iii) mode of teaching and (iv) cross-cutting themes that the programme offers. Results: We found that the courses/programmes have been mostly provided by the countries of the Global North who play a key part in international negotiations. Although there were diverse types of certifications identified, they can be classified into two groups - core health diplomacy and inclusive health diplomacy programmes. The health diplomacy training is preferred to be provided in-person due to the nature of the work. Conclusions: While competencies for health governance and international relation have been dominant among the current programmes, other cross-cutting themes such as economics, politics, law, public policy, crisis management, environment and public health have been considered essential. The article concludes with a proposal of a framework to streamline the sectors and the competencies that is required in health diplomats., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Pattanshetty S et al.)

The present study explores district-level data associated with health insurance coverage (%) and the prevalence of hypertension (mildly, moderately, and severely elevated) observed across men and women as per NFHS 5. Coastal districts in the peninsular region of India and districts in parts of northeastern India have the highest prevalence of elevated blood pressure. Jammu and Kashmir, parts of Gujarat and parts of Rajasthan have a lower prevalence of elevated blood pressure. Intrastate heterogeneity in spatial patterns of elevated blood pressure is mainly seen in central India. The highest burden of elevated blood pressure is in the state of Kerala. Rajasthan is among the states with higher health insurance coverage and a lower prevalence of elevated blood pressure. There is a relatively low positive relationship between health insurance coverage and the prevalence of elevated blood pressure. Health insurance in India generally covers the cost of inpatient care to the exclusion of outpatient care. This might mean that health insurance has limited impact in improving the diagnosis of hypertension. Access to public health centers raises the probability of adults with hypertension receiving treatment with antihypertensives. Access to public health centers has been seen to be especially significant at the poorer end of the economic spectrum. The health and wellness center initiative under Ayushman Bharat will play a crucial role in hypertension control in India.

Background: Following the mpox 2022 outbreak, several high-income countries have developed plans with inclusion criteria for vaccination against the mpox disease. This study was carried out to map the factors influencing mpox vaccination uptake to help address the challenges and increase vaccination confidence., Methods: This was a study based on Tweet analysis. The VADER, Text Blob, and Flair analyzers were adopted for sentiment analysis. The "Levesque conceptual framework for healthcare access" was adopted to evaluate the factors impacting access and the decision to get mpox vaccination. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria were adopted., Findings: A total of 149,133 tweets were extracted between 01/05/2022 and 23/09/2022. Around 1% of the random tweets were used for qualitative analysis. Of the 149,113, tweets were classified as positive, negative and neutral, respectively, by (a) VADER: (55,040) 37.05%, (44,395) 29.89%, and (49,106) 33.06%, (b) TextBlob: (70,900) 47.73%, (22,729) 15.30%, and (54,921) 36.97%, and (c) Flair: (31,389) 21.13%, (117,152) 78.87%, and 0.00%. Sentiment trajectories revealed that communication, stigmatization, accessibility to and availability of vaccines, and concerns about vaccine safety as factors influencing decision-making in the content and flow of tweets., Interpretation: Twitter is a key surveillance tool for understanding factors influencing decisions and access to mpox vaccination. To address vaccine mistrust and disinformation, a social media-based risk communication plan must be devised. Adopting measures to remove logistical vaccination hurdles is needed. Obtaining fact-based information from credible sources is key to improving public confidence., (© 2023. The Author(s).)

Background: Launched in September 2018, the ABPMJAY is the world's largest publicly funded health insurance (PFHI) program with population coverage of 500 million. A systematic review was conducted., Methods: A comprehensive literature search was conducted in four databases: PubMed, Web of Science, Scopus, and Google Scholar. The literature search was conducted with the search terms: "Ayushman Bharat OR ABPMJAY OR modicare AND RSBY." The search was set to title and abstract. Gray literature and government websites were also searched for relevant documents. A total of 881 documents were identified (PubMed: 53, Web of Science: 46, Scopus: 97, Google Scholar: 681, government websites: two, and gray literature: two). Fifty-two duplicates were identified. After the elimination of the duplicates, 829 unique documents were identified. These 829 unique citations were then subjected to a review of title and abstract independently by 2 reviewers. Six-hundred and ninety-two articles were rejected after review of title and abstract. One-hundred and thirty-seven articles were screened for full text independently by two reviewers. Sixty-six articles were rejected after review of the full text. Disagreements were resolved by discussion. Seventy-one unique articles were included in the final review. To attain the objective of the study, which is to critically analyze and provide an overview of Ayushman Bharat, a narrative synthesis was performed., Results: Seven themes were identified from the review: (1) health and wellness centers (HWCs); (2) out-of-pocket health expenditure (OOPHE); (3) fraud; (4) upcoding and provision of unnecessary medical care; (5) moving focus away from primary care; (6) coverage; and (7) lop-sided access, exclusion at the periphery, and brain drain. There is very little impact evidence of the ABPMJAY available., Conclusions: The government could plan impact evaluation studies in every state that the ABPMJAY is functional in. Any high-quality feedback generated might enable the National Health Authority, the government body leading and coordinating the ABPMJAY, to take necessary steps operationally and advice the government on strategy. Another concern is that the ABPMJAY PFHI might negatively impact the ongoing process of continuous strengthening and development of the government health-care system at all levels-primary, secondary, and tertiary. Continual recalibration and course corrections on the basis of high-quality feedback might enable ABPMJAY reduce catastrophic OOPHE for 500 million Indians. This is more than 6% of humanity: the largest block of people served by a single PFHI in history., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 International Journal of Preventive Medicine.)

The mortality gap between former East and West Germany decreased rapidly in the decade following the reunification of the country in 1990. However, because no previous study has estimated life expectancy (e0) over time for all German districts, the extent of mortality convergence across districts and its determinants are largely unknown. We used a novel relational Bayesian model to estimate district e0 in Germany during 1997-2016, examined mortality convergence using a novel convergence groups approach, and explored the role of selected district characteristics in the process. Differences in e0 between German districts decreased for both sexes during 1997-2016, mainly driven by rapid mortality improvements in eastern German districts. However, considerable heterogeneity in district-level e0 trajectories within federal states was evident. For example, district clusters in northwestern Germany showed increasing e0 disadvantage, which led to a north-south divergence in mortality. A multinomial regression analysis showed a robust association between the e0 trajectory and the district-level tax base and long-term unemployment but not with hospital density. Thus, an equitable "leveling up" of health seems possible with policies investing in places and the people who inhabit them., (Copyright © 2023 The Authors.)

Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al. ' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination.

Competing Interests: We declare no competing interests.

We study the time-dependent behavior of dissipative solitons (DSs) stabilized by nonlinear gradient terms. Two cases are investigated: first, the case of the presence of a Raman term, and second, the simultaneous presence of two nonlinear gradient terms, the Raman term and the dispersion of nonlinear gain. As possible types of time-dependence, we find a number of different possibilities including periodic behavior, quasi-periodic behavior, and also chaos. These different types of time-dependence are found to form quite frequently from a window structure of alternating behavior, for example, of periodic and quasi-periodic behaviors. To analyze the time dependence, we exploit extensively time series and Fourier transforms. We discuss in detail quantitatively the question whether all the DSs found for the cubic complex Ginzburg-Landau equation with nonlinear gradient terms are generic, meaning whether they are stable against structural perturbations, for example, to the additions of a small quintic perturbation as it arises naturally in an envelope equation framework. Finally, we examine to what extent it is possible to have different types of DSs for fixed parameter values in the equation by just varying the initial conditions, for example, by using narrow and high vs broad and low amplitudes. These results indicate an overlapping multi-basin structure in parameter space.

Introduction: A variety of mobile health (mHealth) applications are available to monitor an individual's health or lifestyle to make it convenient to access healthcare facilities at home. The usability of mHealth applications in controlling HbA1c (estimated average blood glucose) levels is unclear despite their increasing use. The burden of type 2 diabetes mellitus (T2DM) is high in low and middle-income countries (LMICs), with the highest burden in the Indian population. Our objective is to identify the effectiveness of mHealth applications in managing blood glucose levels of individuals with T2DM and to assess the impact of using mHealth applications in managing T2DM concerning health-promoting behaviour among the LMICs in the context of India., Methods and Analysis: The electronic databases included for search are PubMed, Ovid Medline, EBSCO, CINAHL, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials; additional sources of the search will be grey literature available on diabetes management websites and reference lists of included studies. Studies published in the English language in indexed and peer-reviewed sources will be considered. Studies reporting the effectiveness of mobile applications in the management of T2D in LMICs will be eligible for inclusion. The Population-Intervention-Comparison-Outcomes framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2021 will be used for reporting. Data analysis will be carried out using narrative synthesis, and a meta-analysis may be conducted if we come across homogenous data for the outcome., Ethics and Dissemination: As this study is a systematic review, we will not be recruiting any participants for the study and hence will not require ethical approval. The study summary will be disseminated at a conference., Prospero Registration Number: CRD42021245517., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Europeanization is assumed to influence health policy in the Western Balkans, but little is known about the actual impact of this process in these countries which constitute a complex geopolitical region of Europe. In this context, we used time trends to explore the Western Balkans health policies during the Europeanization through a cross-country comparative analysis of six countries. We conducted a health policy analysis by adapting the framework for globalization and population health coined by Huynen et al. in 2005. We analyzed 90 progress reports of Albania, Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia and Serbia from 2005 to 2020. In particular, we considered chapter 28 on "Consumer and health protection" and other chapters that contained the words "health" or "population health". Evidence indicates that Europeanization influences Western Balkans' policies at different levels. Western Balkan countries revise national legislation in accordance with new European Union acquis as addressed in the progress reports and build cooperation with international institutions. They build national health reforms and reorganize relevant institutions to better address regulations in accordance to Europeanization. However, it is necessary to monitor law implementation so that the current legislation is enforced and further positive impact can be measured on population health., (Copyright © 2022. Published by Elsevier B.V.)

We investigate properties of oscillatory dissipative solitons (DSs) in a cubic complex Ginzburg-Landau equation stabilized by nonlinear gradient terms. As a main result we find a transition to dissipative solitons with spatiotemporal disorder as a function of the diffusion coefficient. This transition proceeds via quasiperiodicity and shows incommensurate satellites next to the fundamental frequency and its harmonics indicating a possible route to localized spatiotemporal chaos. The transition back to oscillatory DSs follows a similar scenario.

We present the macroscopic dynamics of polar nematic liquid crystals in a two-fluid context. We investigate the case of a nonchiral as well as of a chiral solvent. In addition, we analyze how the incorporation of a strain field for polar nematic gels and elastomers in a solvent modifies the macroscopic dynamics. It turns out that the relative velocity between the polar subsystem and the solvent gives rise to a number of cross-coupling terms, reversible as well as irreversible, unknown from the other two-fluid systems considered so far. Possible experiments to study those novel dynamic cross-coupling terms are suggested. As examples we just mention that gradients of the relative velocity lead, in polar nematics to heat currents and in polar cholesterics to temporal changes of the polarization. In polar cholesterics, shear flows give rise to a temporal variation in the velocity difference perpendicular to the shear plane, and in polar nematic gels uniaxial stresses or strains generate temporal variations of the velocity difference., (© 2022. The Author(s).)

Background: Antimicrobial resistance may result from inappropriate use of antibiotics in health care. Turkey is one of the countries with the highest antibiotic consumption in the world. Considering the role of transnational ties between Turkish migrants and their social contacts in Turkey, the attitudes and behaviors relating to rational antibiotic use in Turkey can also affect the use of antibiotics by Turkish migrants residing abroad. This study explores physicians' and pharmacists' experiences and perspectives on rational antibiotic use among Turkish adults in Turkey and among Turkish migrants in Germany, Sweden, and the Netherlands, three European countries with large populations of Turkish migrants., Methods: Following a qualitative study design using convenience and snowball sampling, in-depth interviews with 21 family physicians and 24 pharmacists were conducted in the aforementioned countries. We transcribed all interviews verbatim and performed content analysis separately in the countries, followed by translation, pooling and joint interpretation of the findings., Results: Physicians and pharmacists encountered irrational use of antibiotics among their patients in Turkey. Physicians interviewed in the three European countries explained that Turkish migrants differ from non-migrants with respect to their attitudes towards antibiotics, for example by more often expecting to be prescribed antibiotics. All physicians and pharmacists in the selected countries reported to inform their patients on how to use antibiotics upon prescription; however, Turkish migrants' poor language proficiency was considered as a substantial communication barrier by the physicians and pharmacists interviewed in the European countries., Conclusions: The study illustrated some aspects of irrational antibiotic use among the population in Turkey and Turkish migrants in selected European countries. It emphasized the need for closer community participation, adequate information campaigns, as well as in-service training of health care providers in Turkey. The strategies and interventions on rational antibiotic use should also be supported and encouraged by health care providers, who need to reach out to people with various cultural backgrounds., (© 2022. The Author(s).)

•Civic literacy refers to the ability to engage meaningfully with one's community.•Digital, health, and civic literacy are key predictors for digital health literacy.•The extent to which these three affect digital health literacy remains unclear.•Building digital health literacy is vital to limit inequalities from expanding., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

We present the macroscopic dynamic description of a ferromagnetic nematic, where the nematic part and the magnetic part can move relative to each other. The relative velocity that describes such movements can be a slowly relaxing variable. Its couplings to the nematic and the magnetic degrees of freedom are particularly interesting since the symmetry properties (behavior under spatial inversion and time reversal) of the three vectorial quantities involved are all different. As a consequence, a number of new crosscouplings involving the relative velocity exist. Some of them are discussed in more detail. First, we demonstrate that transverse temperature gradients generate transverse relative velocities and, vice versa, that transverse relative velocities give rise to temperature gradients. Second, we show that a simple shear flow in the relative velocity with the preferred direction in the shear plane can lead in a stationary situation to a tilt of the magnetization.

The COVID-19 pandemic brought visibility and intensified the discussions on the European Union's (EU) health mandate. The proposals of the European Commission (EC) to move towards a European Health Union (EHU) can be seen as a starting point towards more integration in health. However, the definition of what the EHU will look like is not clear. This paper searches to find a common definition, and/or features for this EHU through a systematic literature review performed in May 2021. "European Union's concern about health for all" is suggested as a definition. The main drivers identified to develop an EHU are: surveillance and monitoring, crisis preparedness, funding, political will, vision of public health expenditures, population's awareness and interest, and global health. Based on these findings, five scenarios were developed: making a full move towards supranational action; improving efficiency in the actual framework; more coordination but no real change; in a full intergovernmentalism direction; and fragmentation of the EU. The scenarios show that the development of a EHU is possible inside the current legal framework. However, it will rely on increased coordination and has a focus on cross-border health threats. Any development will be strongly linked to political choices from Member States.

Although European integration can be expected to result in mortality convergence (reduced mortality differences), a life expectancy divide persists in the European Union (EU) between the old Member States (OMS) in the west and the new Member States (NMS) in the east. Studies investigating the impact of European integration on mortality convergence are rare and did not consider regional differences. We examine the short-term effects of the 2004 enlargement on mortality convergence at the supranational, national, and subnational levels. Using sex-specific life expectancies for 23 Member States (1990-2017) and the NUTS 2 regions in Czechia, Hungary, and Poland for 1992-2016, we examined the trend in sigma and beta mortality convergence measures at the country and regional levels using joinpoint regression. We found no compelling evidence that EU accession influenced the process of mortality convergence between OMS and NMS, or within the three NMS, over the short term. While there was overall beta and sigma convergence at the national level during 1990-2017, no regional convergence showed, and the trends in convergence did not significantly change at the time of EU accession or soon after (2004-2007). The accession in 2004 did not visibly impact the overall process of mortality convergence over the short term, likely because of the greater influence of country and region-specific policies and characteristics. The interaction of Member State and regional contexts with the mechanisms of European integration requires further study. Future enlargement procedures should emphasise tailored support to ensure more equitable gains from European integration., Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-021-09596-y., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s) 2021.)

We investigate the macroscopic dynamics of a two-fluid system with tetrahedral order. As all normal-fluid two-fluid systems one has-compared to a simple fluid-the velocity difference between the two subsystems and the concentration of one component as additional macroscopic variables. Depending on the type of system, the concentration can either be a conserved quantity or relax on a long, but finite timescale. Due to the existence of the tetrahedral order such a system breaks parity symmetry. Here we discuss physical systems without preferred direction in real space, meaning that our description applies to optically isotropic materials. We find a number of reversible as well as dissipative dynamic cross-coupling terms due to the additional octupolar order, when compared to a fluid mixture. As the most interesting cross-coupling term from an experimental point of view, we identify a dissipative cross-coupling between the relative velocity and the usual velocity gradients. Applying a shear flow in a plane, this dissipative cross-coupling leads to a velocity difference perpendicular to the shear plane. As a result one can obtain a spatially homogeneous oscillation of the relative velocity. In addition, this induced relative velocity can couple as a function of time and space to the concentration, which gives rise to an overdamped propagating soundlike mode, where the overdamping arises from the fact that velocity difference is a macroscopic variable and not strictly conserved. We also show that electric field gradients are connected with an analogous reversible cross-coupling and can lead in a planar shear geometry to an overdamped propagating mode as well.

Background: Evidence about the magnitude and determinants of medication intake adherence among patients and the general population in Southeastern Europe is scant., Aims: To assess the prevalence and sociodemographic correlates of medication intake adherence among adult primary health-care (PHC) users in Albania., Methods: A cross-sectional study was conducted in 2018-2019 in a representative sample of 1553 adult PHC users (response: 94%) selected probabilistically from 5 major regions of Albania. There were 849 (55%) women and 704 (45%) men, with a mean age 54.6 (16.4) years. A structured interviewer-administered questionnaire inquired about medication intake adherence prescribed by family physicians, and sociodemographic characteristics. Binary logistic regression was used to assess the sociodemographic correlates of medication intake adherence., Results: Three hundred (19.8%) participants did not take the prescribed medication. In multivariable-adjusted logistic model, significant correlates of nonintake of medication included rural residence, low educational level, unemployment and low economic level. Among these 300 participants, 273 (91%) considered the high cost of the drugs as a reason for not taking the medication., Conclusion: We found a high prevalence of nonintake of medication prescribed by family physicians. Decision-makers and policy-makers in Albania and elsewhere should consider the provision of essential drugs free of charge or at low cost to low socioeconomic groups and other vulnerable and marginalized population categories, because the costs of noncompliance will eventually be higher., (Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

We investigate the influence of spatially homogeneous multiplicative noise on propagating dissipative solitons (DSs) of the cubic complex Ginzburg-Landau equation stabilized by nonlinear gradient terms. Here we focus on the nonlinear gradient terms, in particular on the influence of the Raman term and the delayed nonlinear gain. We show that a fairly small amount of multiplicative noise can lead to a change in the mean velocity for such systems. This effect is exclusively due to the presence of the stabilizing nonlinear gradient terms. For a range of parameters we find a velocity change proportional to the noise intensity for the Raman term and for delayed nonlinear gain. We note that the dissipative soliton decreases the modulus of its velocity when only one type of nonlinear gradient is present. We present a straightforward mean field analysis to capture this simple scaling law. At sufficiently high noise strength the nonlinear gradient stabilized DSs collapse.

Background: The relationship of health literacy (HL) with objective measures including anthropometric measurements remains an under-researched topic to date., Objective: To assess the association between body mass index (BMI) and HL among Albanian adults., Methods: A cross-sectional study was conducted in Tirana, Albania, in 2012-2014 including a population-based sample of 1154 individuals aged ≥18 years. HL was assessed by the use of HLS-EU-Q instrument. Anthropometrics included measurement of weight and height based on which BMI was calculated. Information on socio-demographic characteristics was also collected. Logistic regression was employed to assess the independent association of BMI and HL controlling all socio-demographic factors., Results: One-fifth of the participants reported an inadequate HL level, whereas almost one-third (31%) reported an excellent HL level. About 41% of study participants were overweight and further 22% were obese. In multivariate analysis, there was evidence of a strong and significant association between BMI and HL: the odds of overweight/obesity were two times higher (OR = 2.0, 95% CI = 1.3-3.1) among inadequate HL individuals compared with excellent HL participants., Conclusion: Our findings, pertinent to a transitional country in the South East Europe, point to a strong, consistent and highly significant association between BMI and HL, irrespective of a wide array of socio-demographic characteristics., (© The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We study the interaction of stable dissipative solitons of the cubic complex Ginzburg-Landau equation which are stabilized only by nonlinear gradient terms. In this paper we focus for the interactions in particular on the influence of the nonlinear gradient term associated with the Raman effect. Depending on its magnitude, we find up to seven possible outcomes of theses collisions: Stationary bound states, oscillatory bound states, meandering oscillatory bound states, bound states with large-amplitude oscillations, partial annihilation, complete annihilation, and interpenetration. Detailed results and their analysis are presented for one value of the corresponding nonlinear gradient term, while the results for two other values are just mentioned briefly. We compare our results with those obtained for coupled cubic-quintic complex Ginzburg-Landau equations and with the cubic-quintic complex Swift-Hohenberg equation. It turns out that both meandering oscillatory bound states as well as bound states with large-amplitude oscillations appear to be specific for coupled cubic complex Ginzburg-Landau equations with a stabilizing cubic nonlinear gradient term. Remarkably, we find for the large-amplitude oscillations a linear relationship between oscillation amplitude and period.

We present a macroscopic two-fluid model to explain the breakdown of flow alignment in nematic liquid crystals under shear flow due to smectic clusters. We find that the velocity difference of the two fluids plays a key role to mediate the time-dependent behavior as soon as a large enough amount of smectic order is induced by flow. For the minimal model it is sufficient to keep the nematic degrees of freedom, the mass density of the smectic clusters and the degree of smectic order, the density, and two velocities as macroscopic variables. While frequently a smectic A or C phase arises at lower temperatures, this is not required for the applicability of the present model. Indeed, as pointed out before by Gähwiller, there are compounds showing a breakdown of flow alignment over a large temperature range and no smectic phase, but a solid phase at lower temperatures. We also demonstrate that, using a one velocity model, there is no coupling under shear flow between induced smectic order and the director orientation in stationary situations thus rendering such a model to be unsuitable to describe the breakdown of flow alignment. In a two-fluid description, flow alignment breaks down and becomes unstable with regard to a space- and time-dependent state due to an induced finite velocity difference. In an Appendix we outline a mesoscopic model to account for the sign change in the anisotropy of the electric conductivity observed in nematics with smectic clusters.

Background: The high mortality rates in the European Union (EU) Member States that acceded in 2004 sparked political interest in mortality convergence. Whether mortality is converging in the EU remains unclear. We reviewed the literature on mortality convergence in the post-2004 EU territory as a whole. We also explored whether the study designs influenced the results and whether any determinants of mortality convergence had been empirically examined., Methods: A systematic literature review was performed. Our search included scientific databases and the websites of international governmental institutions and European demographic research institutes., Results: We uncovered 94 unique records and included seven studies that reported on 36 analyses. There was marked methodological heterogeneity, including in the convergence measures (beta and sigma convergence). All of the beta convergence analyses found narrowing mortality differentials, whereas most of the sigma convergence analyses found widening mortality differentials. The results are robust to the units of analysis and mortality and dispersion measures. Our results also suggest that there is a lack of evidence on the determinants of mortality convergence in the EU., Conclusions: There is general agreement that the EU regions and the Member States with high initial mortality rates improved the fastest, but this trend did not lead to overall mortality convergence in the EU. The harmonization of mortality convergence measures and research into determinants of mortality convergence are needed to support future EU cohesion policy. Policy-makers should consider supporting areas that have moderate but stagnant mortality rates, in addition to those with high mortality rates., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.)

Aim: Our aim was to assess the independent association between blood glucose level and health literacy (HL) adjusting for many socio-demographic characteristics and body mass index (BMI) in an adult population in Albania, a transitional country in the South Eastern Europe. Methods: A cross-sectional study was carried out in Tirana in 2012-2014 including a population-based sample of 1,154 individuals aged ≥18 years (57% women; mean age: 45.5 ± 16.4 years; response rate: 88.6%). HL was assessed by use of HLS-EU-Q instrument. Blood glucose level was measured in a fasting state by use of rapid finger stick method. Information on socio-demographic characteristics was collected, and BMI was calculated based on measurement of height and weight in all participants. General Linear Model (GLM) and binary logistic regression were used to assess the independent association of blood glucose level and HL adjusting for all socio-demographic factors and BMI. Results: One-third of participants had pre-diabetes (100-125.9 mg/dl) and further 11% had diabetes (≥126 mg/dl) based on the measured blood glucose level. In fully-adjusted GLM, mean blood glucose level was significantly lower among individuals with excellent HL compared with their counterparts with inadequate HL (99.3 vs. 106.0, respectively). Furthermore, the odds for the presence of diabetes in the group of study participants whose HL was "inadequate" were 2.6 times higher (95% CI = 1.3-5.4) compared to those whose HL was "excellent." Conclusion: We obtained evidence of a strong and significant inverse relationship between measured blood glucose level and HL, independent of many socio-demographic characteristics and measured BMI in a population-based study in a country of the Western Balkans., (Copyright © 2020 Dika, Duli, Burazeri, Toci, Brand and Toci.)

Aim: We aimed to assess adult primary health care (PHC) users' understanding of their medication information in a transitional South Eastern European population across seven domains. Methods: A cross-sectional study, carried out in Albania in 2018-19, included a representative sample of 1,553 PHC users aged ≥18 years (55% women; overall mean age: 54.6 ± 16.4 years; overall response rate: 94%). Participants were asked about their understanding of information they received from their respective family physicians about prescribed medicines in terms of factors like cost, dosage, and side-effects. Socio-demographic data were also gathered. Binary logistic regression was employed to assess the socio-demographic predictors of information about medication use and administration. Results: Across different aspects of use and administration, 21-60% of participants did not understand their medications. Less understanding of medication use was particularly high among the poor and those with low education and among urban residents, irrespective of socioeconomic status. Conclusion: This study provides important evidence about the level and socio-demographic determinants on understanding of information about medication use and administration among adult PHC users in a transitional former communist country in South Eastern Europe. Policymakers should be aware of the joint role and interplay between health literacy (demand side) and information provision (supply side), which both significantly influence the understanding of medication use by the general population., (Copyright © 2020 Roshi, Burazeri, Schröder-Bäck, Toçi, Italia, Ylli and Brand.)

This article provides a high-level picture of the developments in organ transplantation in the European Union (EU) between 2009 and 2015. This was the period during which the European Commission and EU 28 member states developed an EU Action Plan on organ donation and transplantation. This plan was adopted by the European Commission in 2008, following calls for policy action to increase transplant numbers. It set out priority actions for member states and European Commission to address. This article describes the three main approaches used by the European Commission and National Competent Authorities to develop this action plan. We also present a quantitative comparison of 2015 and 2008 transplant data, based on the Newsletter Transplant by the Council of Europe (CoE) and the Spanish National Transplant Agency (ONT). This comparison shows contributions of different EU Member States, as well as of different donation and transplant programs to the overall increase of 4597 transplants per year (+16.4%). While another evaluation study of the action plan reported a strong positive impact of the action plan, it is beyond the remit of this publication to demonstrate a causal relationship between the EU Action Plan and the increase in number of organ transplants., (© 2020 Steunstichting ESOT. Published by John Wiley & Sons Ltd.)