Cardiovascular disease accounted for almost 20% of registered deaths in South Africa in 2024, with men and women facing sharply different risks as they age.
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Amazon wins global rights to stream Emmys in six-year dealMake social science an operational pillar of the Bundibugyo outbreak responseThe route decision in early and surgical menopause rests on other evidenceGo-Ahead won Tampines bus contract on quality despite higher bid; most services now improved: Jeffrey SiowSingapore studying stronger safeguards for high-risk AI uses as systems grow more autonomous: Josephine TeoSara Duterte: Ex-Velasco aide out to destroy herAmazon wins global rights to stream Emmys in six-year dealMake social science an operational pillar of the Bundibugyo outbreak responseThe route decision in early and surgical menopause rests on other evidenceGo-Ahead won Tampines bus contract on quality despite higher bid; most services now improved: Jeffrey SiowSingapore studying stronger safeguards for high-risk AI uses as systems grow more autonomous: Josephine TeoSara Duterte: Ex-Velasco aide out to destroy her
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Health2h ago
Make social science an operational pillar of the Bundibugyo outbreak response
Agreement: I Agree Body: Dear Editor The ongoing Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo (DRC) is intensifying, with sustained transmission and continued increases in reported cases and deaths.[1] Community engagement remains a major challenge, reflected in profound community mistrust, anger, fears, and social disruption in affected communities, including attacks on healthcare facilities and burning of treatment centers in eastern DRC.[2-4] Such events reflect a major interplay of insecurity, misinformation, and deficits in trust between communities, health systems, and outbreak response teams, underscoring the need to understand and fully integrate the socio-cultural and behavioural factors into outbreak responses.[3] At a time when no specific medical countermeasures are available for BVD, social science should complement the traditional core pillars of epidemic preparedness and response by generating evidence on community perception, behaviour, expectations, experiences, and barriers to care. Such evidence can inform community engagement, social and behavioral change, risk communication, social mobilization, and psychosocial support to the affected community.[4,5] Thus, five complementary actions could strengthen Bundibugyo outbreak preparedness and response. First, fully integrate social science as a core component of Bundibugyo outbreak operations, resource allocation, and preparedness planning alongside epidemiological and virological approaches. Second, incorporate socio-cultural and behavioural data into routine outbreak intelligence alongside epidemiological and virological data, enabling decision-makers to develop context-adapted outbreak responses. Third, collect and analyse socio-cultural and behavioural evidence from the onset of an outbreak to identify evolving perceptions, expectations, misinformation, and barriers to care, enabling timely adaptation of response strategies. Fourth, actively involve local leaders and community representatives in generating and interpreting social science evidence to ensure that findings reflect local socio-cultural contexts, perceptions, and behaviors. Fifth, ground the social science approach in shared responsibility and accountability with affected communities, enabling social scientists and community representatives to jointly generate evidence, while ensuring that the community can articulate their concerns, priorities, expectations, and experiences. Social science should therefore be fully recognized and operationalized as a core component of Bundibugyo outbreak response. Its evidence should be integrated with the epidemiological and virological intelligence to support a more responsive, accessible, trusted, context-adapted response, both during the current outbreak and in future preparedness planning. Bibliography 1. World Health Organization, Ebola disease caused by Bundibugyo virus - Democratic Republic of the Congo, August 1, 2026, https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON614?u... , Accessed August 24, 2026. 2. BBC News, Angry crowd sets Ebola hospital tents on fire in DR Congo, May 22, 2026, https://www.bbc.com/news/articles/cp8p2g8yp8do , Accessed August 24, 2026. 3. Alimuddin Z, Jean B, Francince N, et al., Rebuilding community trust after attacks on Ebola treatment facilities in DRC: lessons from previous epidemics, International Journal of Infectious Disease, 2026;170, 108837. 4. Kevin L, Daniel H, Sharon A, et al., Integrating the social sciences in epidemic preparedness and response: A strategic framework to strengthen capacities and improve Global Health security, Globalization and Health, 2020;16:120. 5. World Health Organization, Strengthening the Bundibugyo virus disease response through community evidence, August 11, 2026, https://www.who.int/news/item/11-08-2026-strengthening-the-bundibugyo-vi... , Accessed August 25, 2026. No competing Interests: Yes The following competing Interests: Electronic Publication Date: Tuesday, October 6, 2026 - 15:11 AI use: Yes I have used AI AI use details: AI was used to improve spelling and grammar Highwire Comment Subject: How a legacy of mistrust in DRC has led to 17 Ebola outbreaks in 50 years Workflow State: Released Full Title: Make social science an operational pillar of the Bundibugyo outbreak response Highwire Comment Response to: How a legacy of mistrust in DRC has led to 17 Ebola outbreaks in 50 years Check this box if you would like your letter to appear anonymously:: Last Name: Adripio First name and middle initial: Benjamin Mungufeni Email: fenybencard.5@gmail.com Address: Bunia Occupation: Post-graduate student Affiliation: 1. University of Bunia, Bunia, Congo, The Democratic Republic of Congo, Department of Internal Medicine, Faculty of Medicine; 2. University of Nairobi, Nairobi, Kenya, Department of Medical Microbiology and Immunology, Faculty of Health Science; BMJ: Additional Article Info: Rapid response
BBmj
Health2h ago
The route decision in early and surgical menopause rests on other evidence
Agreement: I Agree Body: Dear Editor, Berggreen and colleagues provide contemporary estimates of thrombotic risk, and conclude that the method of use matters, without saying for whom the choice should change.¹ For the women who will take therapy longest, their cohort provides no direct evidence. Entry was restricted to women aged 50 to 69, a floor based on the average age of menopause. A history of oophorectomy, infertility treatment, endometriosis or polycystic ovary syndrome excluded women. Surgical menopause is therefore absent from the cohort, and age at menopause was never recorded, so early menopause cannot be separated within it. These are the women in whom systemic therapy matters most, and who start it earliest and continue it longest. The international premature ovarian insufficiency guideline states that hormone therapy can mitigate some of the consequences for bone, cardiovascular and cognitive health.² Joint FIGO and IMS guidance adds that early menopause should no longer be managed as a variant of menopause at the usual age.³ Guidance already favors transdermal over oral therapy for women at increased venous risk.⁴ Transdermal therapy was not associated with increased thrombotic rates in this cohort, and no separate estimate exists for either group. The reassurance therefore does not extend to early or surgical menopause. The same boundary shapes a second result, since the greatest arterial risk estimates appeared in women starting oral therapy before 50. Early menopause would be expected to cluster there, and surgical menopause was excluded. The authors note that menopausal history may partly explain the finding before 50, but not that these estimates cannot be applied to early or surgical menopause. Until that is examined, the route decision for these women rests on other evidence. Where the finding is quoted, its entry criteria should be quoted with it. References: 1. Berggreen J, Pourhadi N, Wood-Kurland H, et al. Contemporary menopausal hormone therapy and thrombotic disease: nationwide nested case-control study. BMJ 2026;394:e100688. 2. ESHRE, ASRM, CREWHIRL and IMS Guideline Group on POI, et al. Evidence-based guideline: Premature Ovarian Insufficiency. Fertil Steril 2025;123(2):221-36. 3. Benedetto C, Khadilkar SS, Nappi RE, et al. Hormone therapy (HT) in women with premature ovarian insufficiency or early menopause: time to think of a new paradigm for healthy aging. A joint FIGO and IMS position paper. Int J Gynaecol Obstet 2026;175(1):26-47. 4. National Institute for Health and Care Excellence. Menopause: identification and management. NICE guideline NG23. London: NICE, 2015 (updated November 2024). No competing Interests: Yes The following competing Interests: Electronic Publication Date: Tuesday, October 6, 2026 - 10:01 AI use: No, I have not used AI Highwire Comment Subject: Contemporary menopausal hormone therapy and thrombotic disease: nationwide nested case-control study Workflow State: Released Full Title: The route decision in early and surgical menopause rests on other evidence Highwire Comment Response to: Contemporary menopausal hormone therapy and thrombotic disease: nationwide nested case-control study Check this box if you would like your letter to appear anonymously:: Last Name: Zhang First name and middle initial: Jiawen Email: zhangjiawen@tongji.edu.cn Address: No. 301 Yan Chang Zhong Road, Shanghai, P.R.C. Occupation: Doctor Affiliation: Shanghai Tenth People's Hospital BMJ: Additional Article Info: Rapid response
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Health8h ago
What is the XFG Covid variant? Cases on rise as hospitalisations up more than 400% in a month
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Diabetic eye disease: Why regular eye tests matter even when you can see clearly
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