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Malaria-related mortality has a very high association with poverty rates, and the disease is most prevalent in low- and middle-income countries. To achieve the malaria-specific targets of the Sustainable Development Goals, malaria-endemic countries and development partners need to take concerted action to reduce malaria cases and deaths. Reaching all affected communities with malaria interventions requires strong political commitment and a significant expansion of international and domestic financial resources. World Malaria Day 2019 is an opportunity to review progress and challenges in this field.

In geotechnical engineering, it is of great importance to study the mechanical properties of the interface between geomaterials and structure. In order to understand the shear behavior of the interface between soil-rock mixture and structure, the discrete element method is used to simulate the interface shear test of soil-rock mixture and rough structural plane. Two confining pressures and three roughness are considered. In terms of mechanical properties, macro-mechanical behavior and micro-mechanical behavior are analyzed. In terms of deformation, in order to identify the local area that plays a critical role in the interface, three methods are used to quantitatively describe the shear band thickness, including localized deformation, new contact, and particle displacement. Particle displacement is a physical quantity that can be directly observed in laboratory tests, while localized deformation must be calculated and analyzed. And new contact is a quantity that can be captured by discrete element simulation. Different analysis methods of shear band thickness are suitable for analyzing different problems by different test methods. The results show that the thickness of shear band increases with the increase of structural plane roughness. The mechanism of this phenomenon is explained by the microscopic particle inlay and the active and passive earth pressure on both sides of the structural plane unit.

IntroductionDespite international efforts to address women’s long-term health and well-being, significant gaps in sexual and reproductive health (SRH) services and non-communicable diseases (NCDs) prevention remain, particularly in low-and-middle-income countries (LMICs).MethodsWe analysed data from 726 278 women aged 15–49 from six national surveys (2017–2021, Benin, Cameroon, Gabon, India, Madagascar and Mauritania) on unmet needs for NCD prevention (blood pressure, glucose, cervical cancer screening) and SRH services (contraception, antenatal, postnatal care). Unmet needs prevalence was calculated as the percentage of participants with specific unmet needs and estimated across demographics and socioeconomic groups using multivariable logistic regression models.ResultsUnmet needs were strikingly high for NCD prevention: 36.6% for blood pressure, 70.0% for blood glucose and 98.5% for cervical cancer screening. In contrast, unmet needs for contraception, antenatal care and postnatal care were relatively lower: 7.5%, 14.5% and 14.5%, respectively. Significant variations were observed across countries. India had the lowest unmet needs for SRH services: 6.7% for contraception, 13.1% for antenatal care and 13.1% for postnatal care. Gabon had lower unmet needs for prenatal (16.8%) and postnatal care (14.8%) compared with other African countries and the lowest unmet need for cervical screening at 84.7% (95% confidential interval 83.1% to 86.2%), over 10 percentage points lower than others. Furthermore, socioeconomic factors like higher education, better economic status, healthcare access, insurance and internet use significantly lowered unmet needs, especially for antenatal and postnatal care. Employed women had higher unmet needs for antenatal (35.7%) and postnatal (37.3%) care than unemployed women (28.1%, 27.8%) but lower for NCDs prevention (98.9%, 71.8%) under two definitions than unemployed women (99.3%, 79.2%).ConclusionThis study highlights the urgent need to address high unmet needs for NCD prevention among women in LMICs, particularly cervical cancer screening. Unmet SRH needs are also a major concern, given significant disparities across countries. Especially, governments should prioritise measures to focus on vulnerable groups.

Familial dysalbuminemic hyperthyroxinemia (FDH) is a form of euthyroid hyperthyroxinemia caused by ALB gene variants that is commonly misdiagnosed in clinical practice. When coexisting with papillary thyroid carcinoma (PTC), this condition may complicate postoperative management strategies. This study aims to enhance clinical recognition of the coexistence of FDH and PTC and explore evidence-based management approaches. We retrospectively analyzed the diagnostic and therapeutic course of a patient with concurrent FDH and PTC in our clinic and reviewed the current literature. The proband exhibited unsuppressed thyrotropin (TSH) by levothyroxine (L-T4) monotherapy after PTC surgery, with abnormal, persistently elevated total thyroxine (T4) and free T4 levels. Further review of the medical records revealed a similar pattern of thyroid function abnormalities preoperatively. Genetic testing confirmed FDH caused by an ALB gene c.725G>A mutation. Sanger verification confirmed that both the proband’s mother and daughter carried the same variant. The proband ultimately achieved adequate TSH suppression with the combination therapy of L-T4 and desiccated thyroid extract (DTE). This case highlights the importance of considering FDH when postoperative T4 and TSH levels show discordance in PTC patients. Increased albumin-T4 binding affinity in these patients may prevent adequate TSH suppression with L-T4 monotherapy, while DTE directly delivers triiodothyronine, without requiring peripheral conversion. Therefore, combination therapy with L-T4 and DTE may achieve effective TSH suppression in these patients.

In 2019, heads of state pledged to strengthen efforts to address noncommunicable diseases and mental health as part of universal health coverage. They committed to progressively cover 1 billion additional people within four years with essential health services, as well as quality, safe, effective and affordable essential medicines and other health products.1 The coronavirus disease 2019 (COVID-19) pandemic has slowed these efforts and highlighted the vulnerability of people living with noncommunicable diseases and mental, neurological and substance use disorders,2 referred to as mental health conditions. Once the COVID-19 emergency is over, governments will need to take a critical look at their policies with regard to noncommunicable diseases and mental health conditions. Governments need to learn lessons from this crisis and use them to catalyse, reconceptualize and rebuild the global response to noncommunicable diseases and mental health. The response needs to be comprehensive and based on implementing the World Health Organization's (WHO) core technical guidance in these areas, including the most cost-effective noncommunicable disease interventions,3 or best buys.