The Journal of Medicine, Law & Public Health
The Journal of Medicine, Law & Public Health (JMLPH) is an interdisciplinary, peer-reviewed publication dedicated to exploring the critical intersection of medical practice, legal frameworks, and public health policy. Published by ARETION Publishing Group, JMLPH serves as a vital platform for professionals and academics across various fields to discuss and disseminate research findings, legal analyses, and policy discussions that significantly influence health outcomes and healthcare delivery. The journal publishes a diverse array of content, including original research articles, comprehensive reviews, insightful case studies, and thought-provoking commentaries, all subject to a rigorous peer-review process to uphold the highest standards of quality and relevance. JMLPH is designed for a broad readership, encompassing healthcare providers, legal experts, public health practitioners, researchers, and policymakers. Through its publications, JMLPH aims to inform and shape practice and policy, foster multidisciplinary collaboration, and promote the integration of health, law, and public health principles in addressing contemporary health challenges. With its recent acquisition by ARETION Publishing Group and ongoing commitment to maintaining strong academic standards and independence, JMLPH continues to play a pivotal role in contributing valuable insights and knowledge to the academic community. Publication Fees JMLPH charges no submission fee, no peer-review fee and no article processing charge (APC). A publication fee of £70 per accepted article is set out in the journal's fee schedule, but that fee is currently met in full by ARETION (Arkan AlRay Co) under its corporate social responsibility programme. Authors pay nothing to submit to or publish in JMLPH. Should this change, the new fee and its effective date will be published at least 90 days in advance, and manuscripts already under review will be assessed under the schedule in force at the time of submission.
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The Impossibility of 100% Specificity in Rapid Diagnostic Test Reporting
Background: In commercial materials for rapid diagnostic tests, it is still common to find claims of “100% specificity”. From a statistical and epistemological point of view, this kind of statement is deeply problematic. Aims: This paper examines how justified those claims really are and what they mean in concrete clinical and public health settings. Methods: We analyze the statistical foundations of specificity estimation, apply the Mayo-Spanos severity framework, and review three commercial rapid antigen test listings to illustrate reporting practices. Results: Claims of 100% specificity are either logically falsified by observed false positives or unsupported by finite validation samples. The rule of three shows that zero false positives in n negatives only rule out a false-positive rate above 3/n. Severity analysis reveals that even with 210 negative samples, the claim that specificity >99.5% is supported with only 65% severity. In low-prevalence settings, assuming 100% specificity inflates positive predictive value (PPV) from 66% to 100%. Conclusion: Reporting 100% specificity is scientifically untenable. Regulatory and editorial standards could realistically require confidence intervals and, at the very least, discourage unqualified point estimates.
Copyright (c) 2026 José A. Martínez https://creativecommons.org/licenses/by/4.0
The Unit Commensurability Problem in the Nutri-Score Algorithm: a Construct Validity Analysis
Background: The Nutri-Score labelling system, based on the Food Standards Agency modified Nutrient Profiling System (FSAm-NPS) algorithm, assigns penalty points to four food components — energy, total sugars, saturated fatty acids (SFAs), and sodium — calculated per 100 g. Prospective cohort studies have validated the FSAm-NPS dietary index as a mortality predictor. Aims: To examine whether the per-100-g reference unit of the FSAm-NPS algorithm is commensurable with the epidemiologically relevant exposure unit in dose-response nutrition research, and to evaluate implications for construct validity. Methods: Analytical review of the FSAm-NPS scoring architecture, Messick’s construct validity framework, and the exposure units reported in dose-response meta-analyses for the four penalised components. Results: Dose-response evidence for all four FSAm-NPS components is expressed in daily intake units (mg/day or g/day), not per 100 g of food. Converting these estimates to per-100-g units requires the assumption of a fixed portion size, rendering component weights arbitrary from the perspective of individual health risk. Prospective cohort validations do not resolve this problem: they validate a composite dietary quality index, not individual component weights. Conclusion: The FSAm-NPS algorithm contains an unresolved construct validity gap arising from unit incommensurability. Future iterations should either derive component weights from portion-corrected dose-response functions or explicitly declare these weights as normative conventions subject to periodic revision.
Enhancing Cross-Level Coordination in Healthcare Incident Command Through Virtual Incident Command System (VICS) Integration
Background: Multi-level healthcare incident command relies on timely, verified situational information; however, voice-based updates constrain situational visibility for leaders coordinating remotely. This study examined how a virtual incident command system (VICS) can be integrated as an augmentation layer within facility-level (Level 1) and healthcare cluster-level (Level 2) incident command in the Saudi Ministry of Health healthcare cluster system. Methods: A qualitative, design-oriented case study used semi-structured interviews, complemented by a documentary review of non-identifying incident and exercise materials (e.g., incident/exercise reports, debrief notes, meeting minutes, and after-action reviews), with purposively selected incident command and coordination personnel (N=34) across three strata: cluster incident command leadership, operational first responders and support units, and cluster emergency operations centre and disaster specialists. VICS functions were piloted during tabletop exercises and functional drills (i.e., simulated scenarios rather than live emergency incidents) to assess feasibility and governance alignment. Data were analysed using the Framework Method informed by Ritchie and Spencer, supported by role-by-theme matrices and triangulation across data sources. Results: Three themes described exercise-based participant perceptions of integration: (1) enhanced situational awareness via real-time visual access and information verification; (2) strengthened leadership presence and accountability across levels; and (3) improved adaptive escalation readiness through informed oversight without automatic command transfer. Conclusion: A virtual incident command system can augment existing incident command by improving cross-level situational visibility and coordination while preserving authority structures and decision rights. Our findings support the formalisation of early visual activation and governance-aligned virtual visibility within multi-level healthcare emergency management.
Copyright (c) 2026 Salem S. Alammi, Abdullah Alshareef, Ahmed Alyami, Ali Alammi, Abdullatif Bin Khunayn https://creativecommons.org/licenses/by/4.0
A Comparison of Patterns, Predictors, and Help-Seeking Behaviours Related to Intimate Partner Violence Among Women in Rural and Urban Communities of Osun State
Background: Intimate partner violence (IPV) is a major public health problem with serious physical, psychological, sexual, and socioeconomic consequences for women. This study compared patterns, predictors, and help-seeking behaviours related to IPV among women in rural and urban communities in Osun State, Nigeria. Methods: A comparative cross-sectional mixed-methods study was conducted between May and July 2023 among 500 ever-partnered women (250 rural and 250 urban) selected through multistage sampling. Quantitative data were collected using a pretested, interviewer-administered questionnaire adapted from the World Health Organization’s Multi-Country Study on Women's Health and Domestic Violence, while qualitative data were obtained through four focus group discussions. Data were analysed using descriptive statistics, multivariable logistic regression, and thematic analysis. Results: Physical violence was more common among rural women, whereas controlling behaviour and psychological violence predominated in urban communities. Significant predictors of IPV included partner alcohol consumption, childhood exposure to abuse, dysfunctional partner family background, and older partner age. Fewer than half of the respondents disclosed IPV, and among those who sought help, religious leaders and women's organisations were the most frequently consulted sources of support. Fear, shame, stigma, and economic dependence were the major barriers to help-seeking. Conclusion: Rural–urban differences exist in the patterns, predictors, and help-seeking behaviours associated with IPV. Strengthening referral pathways, survivor-centred support services, community education, and women's economic empowerment may improve IPV prevention and response.
Copyright (c) 2026 Ojediran Joke Oluwatoyin, Onayade Adedeji, Olarewaju Sunday, Akinwale John Faniyi https://creativecommons.org/licenses/by/4.0
Sociodemographic Factors and Health Literacy Among Hypertensive Patients in a Health Centre in West Africa: A Cross-Sectional Study
Background: Health literacy refers to the skills that enable individuals to make informed decisions to maintain their health. Aim: This study aimed to determine the association between sociodemographic factors and health literacy in hypertensive patients. Method: This was a cross-sectional survey conducted in the Cardiology Unit of Abidjan’s National Institute of Public Health, from June to September 2024. Health literacy was assessed using the Health Literacy Questionnaire covering nine dimensions, the first five on a 4-point scale and the last four on a 5-point scale. Mean scores were calculated for each dimension, and the patients’ sociodemographic characteristics were studied. Results: A total of 431 participants were included, with a mean age of 55.83 ± 11 years. The lowest scores were for ‘Social support for health’ and ‘Navigating the healthcare system’. In contrast, ‘Appraisal of health information’ and ‘Understanding health information’ scored highest. Among the first five dimensions of health literacy, an association was found between dimension 1 and gender, while among the last four dimensions, marital status was associated with dimension 7. Moreover, educational level was associated with all nine dimensions. Conclusion: Strengthening social support and health system navigation skills could improve the health literacy of hypertensive patients, while educational level is the sociodemographic factor that most strongly influences health literacyamong this cohort.
Copyright (c) 2026 Kouamé Rodolphe Dje, Koussoh Simone Malik, Guanga David Meless, Marie Laure Tiade, Desquith Angèle Aka, Julie Ghislaine Sackou-kouakou https://creativecommons.org/licenses/by/4.0
Malaria in Pregnancy: Knowledge, Attitudes, Perceptions, and Preventive Practices Among Pregnant Women in Okitipupa, Ondo State, Nigeria
Background: Malaria in pregnancy (MiP) remains a major public health concern in sub-Saharan Africa, contributing substantially to maternal and neonatal morbidity and mortality. Understanding and enhancing pregnant women's knowledge, attitudes, perceptions, and preventive practices in this regard is essential for improving malaria prevention and control. Objectives: This study assessed the knowledge, attitudes, and perceptions (KAP), as well as preventive practices regarding MiP among pregnant women attending antenatal clinics in Okitipupa, Ondo State, Nigeria. Methods: A descriptive cross-sectional study was conducted among 165 pregnant women attending antenatal clinics at two health facilities in Okitipupa, using a multistage sampling technique. Descriptive statistics summarised respondents' characteristics and KAP responses. Results: The respondents’ mean age was 28.6 ± 5.1 years, with most (66.1%) aged 26–35 years. Nearly all respondents (95.2%) had heard of malaria in pregnancy, while 92.7% correctly identified mosquito bites as the primary mode of transmission. Most participants recognised the seriousness of MiP and the protective roles of insecticide-treated nets (91.5%) and intermittent preventive treatment with sulfadoxine-pyrimethamine (83.0%). Nevertheless, misconceptions persisted regarding malaria transmission, self-medication, and the use of herbal remedies. Preventive attitudes were generally positive, although reported practices were not always consistent with respondents' knowledge. Conclusion: Pregnant women attending antenatal clinics in Okitipupa demonstrated generally good knowledge and positive attitudes towards malaria in pregnancy. However, persistent misconceptions and inappropriate preventive and treatment practices indicate the need for strengthened antenatal health education, culturally appropriate behaviour change communication, and sustained community engagement to improve maternal and neonatal health outcomes.
Copyright (c) 2026 Adeyemi Ogedengbe Omoge, Olabode Oluyinka Kayode https://creativecommons.org/licenses/by/4.0
Awareness of the Effect of Environmental Factors on Skin Among Students at Jouf University, Saudi Arabia
Background: Skin health is fundamental to all age groups, particularly the youth. Aim: To investigate the level of awareness of university students about the effects of environmental factors on the skin and to examine their skin care practices. Methods: An online questionnaire was distributed to all students attending Jouf University. Results: 506 students agreed to participate in the study. There was high participation from the health sector colleges (56.7%), and 82.4% and 80.4% of participants, respectively, agreed that pesticides and detergents could harm the skin. Only 50.4% believed that stress affects skin sensitivity. For skin protection, 85.57% identified sunscreen use as a protective measure (knowledge), whereas only 70.4% reported actually using sunscreen (practice). Furthermore, more than 50% of participants have positive attitudes towards the importance of skin care and follow good practices, while 72.3% achieved high-level knowledge (mean score: 3.25 out of 4.00) 72.3% have satisfactory knowledge (3.25 out of 4). The mean practice score was 27.67/44, and only 40.5% reached a high level of practice (≥70% of maximum score). There was a significant association between female gender and the use of sunscreen (p < 0.001). Nonetheless, nearly 40% of participants do not care for their skin regularly. Conclusion: There is a good level of awareness among university students regarding the effect of environmental factors on skin; however, this level remains unsatisfactory considering the importance of this issue. Educational campaigns are required to improve skin care practices among the youth.
Copyright (c) 2026 Ziad Mansour Alshaalan, Amany Ghazy, Sara Abdulaziz Alenizi, Maha Mohammed Alsahli, Rawan Zaidan Alrasheedi, Lojain Abdulsalam Alkhaldi, Misk Talal Alderaan, Renad Muhawish Alanazi, Salma Ahmed Fathy Shatara, Youssef Ahmed Shatara https://creativecommons.org/licenses/by/4.0
Button Battery Code: A Case Series of Button Battery Ingestions in Children at a Tertiary Referral Center and Proposed Management Protocol
Background: Button battery ingestion is a paediatric emergency associated with significant morbidity and mortality. Rapid recognition and removal are critical to prevent severe oesophageal and mediastinal complications. Methods: We report a case series of five patients with a mean age of 22.6 months (SD= 11.4 months) with confirmed button battery ingestion who were managed at a tertiary referral center. Results: Patients ranged from 13 to 41 months of age. Presentations varied from asymptomatic delayed presentation to acute respiratory distress. Endoscopic removal was required in all cases, with findings ranging from superficial mucosal erythema to severe grade 3 caustic necrosis. One child demonstrated features suggestive of an impending aortoesophageal fistula. Supportive care included parenteral nutrition, antibiotics, and proton pump inhibitors. Despite successful retrieval in most of the cases, long-term complications remain a concern. Conclusion: Button battery ingestion in children is unpredictable both in presentation and in outcome. Delays in recognition and failed initial removal attempts are associated with higher grades of oesophagal injury. Based on these findings, we propose the establishment of a “Button Battery Code” to standardise rapid response, expedite referral, and coordinate multidisciplinary management, similar to STEMI and stroke codes.
Copyright (c) 2026 Dhafer Ghurman Alshehri, Abdulrahman Mohammed Alwahbi , Sharafaldeen Bin Nafisah https://creativecommons.org/licenses/by/4.0
Knowledge, Attitudes and Practices Regarding Pregnancy Screening for Group B Streptococcus Among Women of Reproductive Age in Asir, southwestern Saudi Arabia: A Cross-Sectional Study
Background: Group B Streptococcus (GBS) is a leading cause of early-onset neonatal sepsis, and antenatal screening with intrapartum antibiotic prophylaxis substantially reduces disease burden. Maternal awareness of, and participation in, GBS screening in Saudi Arabia remain poorly characterised. Aim: To assess knowledge, attitudes, and practices (KAP) of women in the Asir Region, southwestern Saudi Arabia, regarding pregnancy screening for GBS, and to identify factors associated with higher knowledge, better practices, and more positive attitudes. Methods: A cross-sectional study was conducted between June and November 2024 among women aged 18–45 years in the Asir Region. Data were collected using a validated, self-administered questionnaire assessing sociodemographic characteristics, pregnancy history, and GBS-related KAP. Composite scores were standardised to a 0–100 scale and dichotomised using the median. Multivariable logistic regression identified independent predictors. Results: A total of 371 women participated (mean age 32.6 ± 9.3 years); 74.7% had heard of GBS. High knowledge, good practice, and positive attitude scores were observed in 49.1%, 35.8%, and 41.2% of participants, respectively. Previous pregnancy, prior history of GBS, and specialist obstetric care were independently associated with better practices and attitudes. Conclusion: Despite relatively high awareness, GBS screening practices remain suboptimal, underscoring the need for standardised antenatal screening protocols and targeted education.
Copyright (c) 2026 Yahya Shabi, Juman Hamzah Asiri, Asrar Gharsan Alqahtani, Raghad Yasser Azzawi, Shadan Ali Al Atif, Ghala Mohammed Asiri, Mada Hussain Al Jibril, Leen Omar Al Gelban, Saja Moraya Al Saleh, Albanadri Jamal Al Jathnan, Raghad Ibrahim Alzidani, Seham Saad Al Shahrani, Abdulaziz H. Alhazmi https://creativecommons.org/licenses/by/4.0
Male Breast Adenoid Cystic Carcinoma – A Narrative Review of a Rare Disorder
Background: Adenoid cystic carcinoma (ACC) is primarily a disease of the salivary glands and is exceptionally rare. Due to its rarity, there is no established consensus or recognised guidelines for management. This review aims to synthesise existing literature to improve clinical awareness and knowledge of male breast ACC (MB-ACC). Methods: A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, and Google Scholar for cases of MB-ACC published between 1969 and 2025. Inclusion criteria focused on peer-reviewed case reports providing clinical, histopathological, and immunohistochemical data. Approximately 20 cases were identified and analysed. Results: MB-ACC often presents as a slow-growing, subareolar mass, with a median age of onset (41.5 years) younger than typical male breast cancer. Diagnosis is confirmed via histopathology showing cribriform, tubular, or solid patterns with a double-layered cell structure. Most tumours are triple-negative (ER-/PR-/HER2-), though they paradoxically exhibit an indolent clinical course and favourable long-term prognosis compared with other triple-negative cancers. Management is primarily surgical, with modified radical mastectomy being the most frequently reported procedure. Conclusion: Although MB-ACC shares histological features with aggressive basal-like carcinomas, it carries a favourable prognosis. Early diagnosis through awareness is essential to avoid advanced presentation. Given the potential for late recurrence, long-term follow-up is recommended.
Copyright (c) 2026 Sajad Ahmad Salati https://creativecommons.org/licenses/by/4.0
Safety and Effectiveness of Intravenous Ferric Carboxymaltose for Moderate Anaemia in Pregnancy
Background: Anaemia in pregnancy is a major global health concern linked to adverse maternal and foetal outcomes. Intravenous ferric carboxymaltose (FCM) is a relatively new therapy that enables rapid correction of iron deficiency with minimal adverse effects. Aim: To evaluate the safety and effectiveness of intravenous FCM in pregnant women with moderate anaemia during the second and third trimesters. Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology of the Government Medical College in Srinagar, India, over 18 months. One hundred pregnant women with moderate anaemia (Hb 7–9.9 g/dL) received a single intravenous infusion of FCM (maximum 1000 mg). Haemoglobin and serum ferritin levels were measured before and four weeks after infusion. Adverse events and fetal outcomes were monitored. Results: Mean baseline haemoglobin was 7.81 ± 0.43 g/dL, which increased to 9.47 ± 0.48 g/dL (p < 0.001). Mean serum ferritin rose from 16.70 ± 6.97 ng/mL to 122.20 ± 15.98 ng/mL (p < 0.001). Only 2% of participants experienced minor allergic reactions; no serious maternal or fetal adverse events occurred. Conclusion: FCM is a safe and effective option for treating moderate anaemia in pregnancy, offering rapid correction with minimal side effects.
Copyright (c) 2026 Fiza Amin, Angraz Singh, Peerzada Ajaz Ahmad Shah, Shakir Rasool Khan, Tavseef Ahmad Tali https://creativecommons.org/licenses/by/4.0
Evolving Jurisprudence on Organ Transplantation in India: An Analytical Study of the Transplantation of Human Organs and Tissues Act
Background: Organ transplantation is a great advancement in modern medicine; it functions within a sensitive legal and ethical framework that seeks to balance the protection of fundamental human rights with medical needs. In India, this regulatory system is essentially founded upon the landmark legislation known as the Transplantation of Human Organs and Tissues Act (THOTA), 1994. Aim: The aim is to critically analyze the legal development, basic provisions, and practical challenges of THOTA and its amendments, with a core focus on ethical, procedural, and regulatory perspectives. Methods: We conducted a detailed descriptive and analytical review, scrutinizing primary sources such as THOTA, its amendments, and related rules, along with secondary literature from various legal, medical, and bioethical journals. The study examines, in depth, the structure, procedures, and practice of the law. Results: THOTA established key milestones, such as the recognition of brain-stem death and a national allocation system. However, major gaps persist: inadequate infrastructure, low deceased-donor rates, and vulnerabilities to organ trafficking. Conclusion: Although THOTA provides a robust legal framework, systemic limitations seriously impede its practical application. Requirements to optimize ethical and effective organ transplantation in India include better infrastructure, digital integration, public awareness, and standardization of procedures.
Copyright (c) 2026 Ruby Dubey https://creativecommons.org/licenses/by/4.0
Exploring Nurses Perception of iAudit: A Qualitative Study
Background: iAudit is widely used and recommended in the field of nursing to improve care quality. However, despite its use in clinical practice, the literature is lacking regarding its effectiveness from the perspective of front-line healthcare professionals. Aim: This research explores nurses’ perceptions of iAudit in a tertiary healthcare setting. Method: This is a qualitative study using individual, semi-structured interviews with nine registered nurses in an acute care tertiary hospital. Results: Three major themes emerged from the data analysis: (1) Efficiency of the auditing task, (2) Job efficacy and effectiveness, and (3) Delivery of quality healthcare services. Each theme reflects how iAudit influences nurses’ workflow, performance, and overall quality of patient care. Conclusion: According to nurses, iAudit is an efficient tool that enhances their efficiency and improves the quality of healthcare services.
Copyright (c) 2026 Cyrian Lumuma, Diosa Cueto, Zainab Jafary, Cellanie Janson, Eddylyn O'santos, Diana Lalithabai https://creativecommons.org/licenses/by/4.0
Quest for Legislative Intervention in Stem Cell Research and Therapy in Nigeria: Lessons from United Kingdom and South Africa
Introduction: Stem cell research, which examines the therapeutic applications of human stem cells for disease treatment, is actively conducted worldwide. In response to this, many jurisdictions have developed regulatory frameworks that define permissible stem cell applications and establish mechanisms for compliance. Nigeria is yet to enact such laws, though reports indicate that a small number of stem cell research centres do operate in the country. In the absence of regulation, unethical practices may thrive. This study examined regulatory approaches to stem cell research in the United Kingdom (UK) and South Africa and assessed stakeholder perspectives on stem cell research in Nigeria. Materials & Methods: The study adopted a qualitative approach and a multi-stage recruitment strategy to identify and document the opinions of 30 stakeholders from Lagos, Oyo, and the Federal Capital Territory (FCT), using in-depth and key informant interview guides. Results: The study found that a permissive legal framework, strictly implemented, has enhanced stem cell research in the UK, while South Africa has a more liberal framework that is not strictly implemented. The latter has encouraged unethical practices leading to increased stem cell tourism in South Africa. Findings from stakeholders in Nigeria showed apathy towards stem cell research among some, although the majority supported its practice in Nigeria subject to necessary regulation. Conclusion: Based on the study’s findings, a permissive legal regime is preferable to a restrictive one for stem cell research in Nigeria, provided it is supported by clear enforcement and effective regulatory oversight.
Copyright (c) 2026 Folakemi Ajagunna, Omolade Olomola https://creativecommons.org/licenses/by/4.0
The Newfoundland and Labrador Population Health Index (NLPHI): A Computerized Framework for Population-Level Longitudinal Health Outcome Monitoring
Background: Routine monitoring in public health and primary care settings benefits from a compact, population-level metric that summarizes multi-domain burdens in an interpretable way. Aims: To introduce the Newfoundland and Labrador Population Health Index (NLPHI) and a reference computerized implementation designed to be interpretable, auditable, and computationally transparent. Methods: NLPHI aggregates domain-specific intensity and mortality terms into domain-specific affect values (DSAV) and returns a scalar Population Health Index (PHI) by averaging DSAV scores across domains within defined reporting periods. The formulation connects to life-table and burden-of-disease thinking by combining a time-loss component with a remaining-life-expectancy-weighted mortality component, while remaining intentionally lightweight relative to formal disability-adjusted life years (DALY) calculation. A reference computerized application was implemented for feasibility evaluation using publicly available validated datasets. Results: The approach yields per-domain DSAV scores and an overall PHI suitable for routine monitoring, communication, and longitudinal review. The computerized application demonstrates reproducible computation, auditability, and trend visualization without reliance on proprietary databases. Conclusion: NLPHI provides a pragmatic, transparent framework for population-level health assessment and tracking. Strengths and limitations are outlined, and avenues for calibration and further validation studies are identified to support broader deployment.
Copyright (c) 2026 Mirza Niaz Zaman Elin https://creativecommons.org/licenses/by/4.0
The Newfoundland and Labrador Geriatric Health Index (NLGHI): Design, Implementation, and Clinical Workflow-Oriented Features for Community Geriatrics
Background: Primary care and community-based settings often face time limitations that make detailed, repeatable geriatric assessment difficult. There is a need for a practical, clinic-oriented tool that supports longitudinal tracking while remaining easy to interpret, transparent, and straightforward to use in routine workflows. Aims: This paper introduces NLGHI, a desktop-based application designed to support structured multi-domain data entry, automated composite scoring, longitudinal visualization, rapid report generation, and basic administrative functions within a single system. Methods: The application was developed in Python using a Qt-based interface, with established libraries such as NumPy and Matplotlib supporting computation and visualization. It records impairment levels across 27 predefined clinical and social domains and calculates a normalized composite score for each visit based on fixed weightings. Data are stored locally in JSON format to allow portability and direct inspection without dependence on external systems. Additional components include a symptom-lexicon module for advisory input and a patient workspace that supports notes, attachments, follow-ups, and timeline exports. Results: Implementation produces consistent scoring outputs and clear visual summaries, including trend graphs, across visits. Reports can be generated quickly, and patient records remain auditable within a single workstation. Basic validation checks help identify inconsistencies during data entry, while dashboards allow clinicians to review longitudinal changes without requiring server infrastructure. Conclusion: NLGHI offers a transparent and adaptable approach to geriatric data capture in small-scale clinical environments. It is intended to complement, rather than replace, established tools such as the Clinical Frailty Scale, Charlson and Elixhauser indices, and the Katz ADL, providing a practical option for ongoing monitoring in primary care and community settings.
Intellectual Property Rights and Public Health: A Critical Examination of the AfCFTA Framework
Background: The African Continental Free Trade Area Intellectual Property Rights Protocol (AfCFTA IP Protocol) incorporates several public health-related provisions designed to enhance health across the free trade area. This paper evaluates these provisions and assesses their potential to advance health outcomes within the region. Methods: The paper employs a black letter methodology, analyzing the substance of the provisions within the AfCFTA IP Protocol. Additionally, it makes comparative assessments with similar treaties to highlight strengths and weaknesses in the context of public health. Results: While the Protocol includes important provisions on public health, it lacks substantive obligations and effective enforcement mechanisms. Furthermore, the Protocol does not address significant recent developments in the international regime that could have been utilized to strengthen public health initiatives across the region. Conclusions: This paper shows that the AfCFTA IP Protocol upholds existing international regulations concerning IP and public health, while lacking proactive substantive elements. While this allows AfCFTA members to use IP for health-related issues, the absence of detailed provisions limits the potential to effectively address public health challenges across the continent. This shortfall represents a missed opportunity to leverage IP for improved health outcomes in the region.
Copyright (c) 2025 Chimdessa Tsega https://creativecommons.org/licenses/by/4.0
Clinical Practice Guidelines as Part of Evidence-Based Medicine and Related Legal Implications: An Analysis
‘Evidence-based medicine (EBM)’ describes the application of the best available scientific evidence in the treatment of patients. It is defined by the integration of best available research evidence with clinical expertise and patient values. A product of EBM is ‘clinical practice guidelines (CPG).’ Such guidelines include statements, informed by a systematic review of evidence, that outline recommendations to optimise patient care. The main focus of the present research is the use of clinical guidelines as a ‘standard of care’ in the context of medical malpractice litigation. Major challenges associated with the use of such guidelines include the multiplicity of guidelines for a given condition, and multimorbidity in patients (whereas guidelines typically address a single condition). Rigid adherence to CPG may also contribute to the erosion of professional autonomy and the development of ‘cookbook medicine’. Furthermore, concerning liability, the developers of such guidelines may be held indirectly liable, alongside professional caregivers, for harm incurred by patients. This paper adopts a qualitative methodology, including descriptive and critical analysis of the literature and case laws. Its findings recognise the potential of clinical guidelines to promote uniformity provided that ‘competent medical practice’, based on relevance, reliability, and authenticity, can overcome the issue of multiplicity. However, strict adherence to such guidelines is associated with the erosion of professional autonomy and professional judgement.
Copyright (c) 2025 Ayodhya Prabhashini Rathnayake https://creativecommons.org/licenses/by/4.0
Assessment of Water Quality in Public Hospitals in Hail City, Saudi Arabia 2021-2024
Background: Groundwater is the main water source for public hospitals in Hail City, making its quality essential for providing safe health services, preventing infections, and ensuring patient safety. Objective: This study aimed to assess the quality of groundwater used in public hospitals in Hail City using the water quality index (WQI) methodology. Methods: A retrospective descriptive cross-sectional study was conducted using water quality data collected between 2021 and 2024. Physical and chemical parameters were analysed to evaluate the suitability of groundwater for human use in healthcare settings. A total of 28 water quality reports from five major public hospitals were included in the analysis. Results: The results revealed spatial and temporal variations in groundwater quality across the studied hospitals. Higher levels of total dissolved solids (TDS), electrical conductivity (EC), and total hardness were observed during the summer season, likely due to evaporation and increased ion concentration. Lower values were recorded in winter and autumn, reflecting the influence of climatic conditions. Most water samples were classified as “excellent” according to WQI values. However, Hospital 4 and 5 showed elevated levels of TDS, EC, and hardness, suggesting possible issues related to water treatment or storage systems. Conclusion: The findings highlight the importance of continuous and season-specific monitoring of groundwater quality in public hospitals. The study also supports the effectiveness of the Water Quality Index (WQI) as a practical tool for ensuring consistent water safety in healthcare facilities.
Copyright (c) 2026 Eman Suliman Aljeloud, Abdullah Salem Al-Rasheed https://creativecommons.org/licenses/by/4.0
Digital Health Strategies for GDM Postpartum Care and Type 2 Diabetes Prevention Among Saudi Women – A New Proposed Digital Health Initiative
Women with a history of gestational diabetes mellitus (GDM) face a significantly increased risk of developing type 2 diabetes mellitus (T2DM), yet postpartum follow-up in Saudi Arabia remains to be improved. Timely screening and education are crucial to prevent disease progression and reduce national health burdens. This paper proposes an integrated care pathway to optimize postpartum management of GDM and reduce progression to T2DM. We recommend embedding NISAA+ within the Sehhaty application to automatically identify women with GDM, enabling home and clinic-based glucose monitoring with automated reminders for rescreening at 1–3 year intervals. We propose the establishment of a coordinated multidisciplinary model linking primary care and diabetes clinics with health educators, dietitians, and psychologists, with continuity supported within NISAA+. We also advocate for structured breastfeeding support, through lactation counseling, workplace advocacy, and digital tracking, as a cost-effective preventive strategy against type 2 diabetes progression. Lastly, we recommend synchronizing maternal postpartum diabetes screening with infant wellness visits at 6 weeks, 1 year, and 3 years to improve screening adherence and enable early detection of dysglycemia. This integrated approach would combine digital health infrastructure, multidisciplinary expertise, and synchronized monitoring to optimize maternal metabolic outcomes and reduce long-term diabetes risk.
Copyright (c) 2026 Nawaf Alnuwaysir, Kady Alsarhan https://creativecommons.org/licenses/by/4.0
Letter to the Editor: Critique on ‘Acute Myocardial Infarction Complicated by Death in a Young Medically Free Female: A Case Report
This letter responds to the case report "Acute Myocardial Infarction Complicated by Death in a Young Medically Free Female: A Case Report", published in the Journal of Medicine, Law & Public Health in 2025. The authors note that the case is a reminder that acute myocardial infarction, though rare, can occur in young individuals with no past medical history. They observe that chest pain in young women is often underestimated or attributed to non-cardiac causes, that age and gender bias can delay suspicion of infarction, and that clinicians have an ethical responsibility to exclude life-threatening conditions even where the patient profile appears low risk. Beyond individual vigilance, the authors argue for system-level measures: standardised chest pain pathways, timely access to electrocardiography and troponin assays, and gender-specific scenarios in training programmes. They note that a single case cannot support generalisable conclusions, and suggest the original report would have been strengthened by discussion of how emergency protocols and triage systems might be improved to reduce delays in recognising infarction in atypical patients.
Copyright (c) 2025 Mahum Mehfooz, Hadi Raza https://creativecommons.org/licenses/by/4.0
Prevalence of Probable Generalised Anxiety Disorder Among Master of Public Health Students at the University of Ibadan, Nigeria
Introduction: Generalised anxiety disorder (GAD) is a common and debilitating mental health condition characterised by excessive and persistent worry over various aspects of life. GAD poses significant challenges for university students, affecting their physical health, academic performance, and overall well-being. Investigating the prevalence of probable GAD among students of the University of Ibadan allows for targeted interventions tailored to their unique needs. Aim: This study aimed to investigate the prevalence of probable GAD among Master of Public Health (MPH) students at the University of Ibadan in Nigeria. Methods: This was a cross-sectional study involving a total of 170 MPH students, who were selected using a multi-stage sampling technique. A pre-tested, self-administered questionnaire was used to obtain data from the respondents. The GAD-7 scale was adapted to measure anxiety levels, categorising respondents as GAD negative (≤9) or GAD positive (>9). The Chi-square test was used to determine associations between variables at α= 0.05. Results: The mean age of the respondents was 27.5 ±4.7 years, and the prevalence of probable GAD among them was 37.6%. Academic stress (70.6%) was the most reported risk factor for GAD, with a significant association between the prevalence of probable GAD and the respondents’ workload (p=0.006). Conclusion: Prevalence of probable GAD was observed among the respondents, indicating the need to enhance the academic well-being of future public health leaders.
Copyright (c) 2026 Ayobami Joseph Osho, Oyediran Emmanuel Oyewole https://creativecommons.org/licenses/by/4.0
Law Governing Cross-Border Disputes in Prosthetic Dentistry
Medical tourism, including in the fields of prosthetic and maxillofacial dentistry, is a rapidly developing segment of the global healthcare industry. With the development of new technologies, such as 3D printing and dental implants, increasing numbers of patients are traveling abroad for dental treatment. This study demonstrates the complex legal consequences of medical errors in prosthetic dental treatment and clarifies the subtleties of professional fault according to the principles of law, and highlights the dual ergonomic and aesthetic aspects of prosthetic dentistry that differentiate it from direct therapeutic interventions and complicate both demonstration of harm and attribution of responsibility. It addresses the principles of private international law governing conflicts of law, and clarifies how the applicable law is determined when dentist and patient are from different countries, or when treatment has occurred abroad. It also provides a comparison of international regulations and legislation protecting patient rights, such the Oviedo Convention and the World Health Organization Declaration, and exposes the lack, in national laws, of any specific rules governing dental medical liability. The study concludes by stressing the need to increase dentists' understanding of the law, create new ways, such as mediation and arbitration, to settle disputes, and create a unified, global legal framework for medical responsibility in prosthetic dentistry.
Copyright (c) 2025 Shahad Fadhil Bunyan, Attia Suleiman Khalifa https://creativecommons.org/licenses/by/4.0
Translation, Validity, and Reliability of the Arabic Version of the Patient-Experienced Continuity of Care Questionnaire (PECQ)
Background: Continuity of care (CoC) is a cornerstone of effective primary health care. To improve CoC in this setting, it is essential that healthcare administrators evaluate it systematically. One validated tool designed for such purpose is the Patient-Experienced Continuity of Care Questionnaire (PECQ). The PECQ is a Swedish questionnaire that, at the time this study began, had been validated but did not have an Arabic version. Aim: This study aimed to translate the Swedish PECQ into Arabic and to determine the validity and reliability of the Arabic version within the Saudi community. Method: The research followed a multi-step process. The PECQ was translated according to the International Society for Pharmacoeconomics and Outcomes Research guidelines for translation and cultural adaptation. Content validity was assessed using the Content Validity Index (CVI), and internal consistency was measured using Cronbach’s alpha and a correlation matrix. Result: The Arabic version (A-PECQ), developed through a 10-step process, includes 20 items covering four dimensions of CoC: informational, relational, management, and knowledge continuity. An average Scale-level Content Validity Index (S-CVI) of 0.90 was achieved, with 75% of the items rated as having high content validity. Conclusion: The Arabic version of the PECQ demonstrated strong content validity and acceptable reliability, making it a suitable tool for evaluating CoC in Arabic-speaking communities. Although some of its components have moderate CVI values, the A-PECQ continues to be a useful instrument for assessing CoC in primary health care and supports quality improvement programs in this field.
Copyright (c) 2025 Dalal Alshathri, Abdulmunim Alsuhaimi, Refal Albaijan, Dlal Almazrou, Khalid Alkhurayji https://creativecommons.org/licenses/by/4.0
Forensic Injury Interpretation to Aid Criminal Investigations: A Case Series
Background: Injury interpretation, a core component of forensic practice, has the potential to alter the course of an investigation and guide it in the correct direction. Here, we discuss four cases in which the identification, analysis, and interpretation of injuries led the investigating agency to revise their understanding of the cause of death. Aim: This case series aims to highlight the importance of injury interpretation in forensic practice. Methodology: We reviewed the results of all medicolegal autopsies conducted in the Whitefield area of Bengaluru city, India, over the seven-year period from 2015 to 2021, to identify those in which a discrepancy existed between the history submitted by the investigating officer and the autopsy findings. Results: Of 781 postmortem reports, only the current four cases showed a significant difference between the history documented by the investigating officers and the observations of the autopsy surgeons. In one case, the cause of death was reported to be a road traffic accident, but was found by autopsy to be homicide. The second case, found deceased approximately 1.5 km from the main road, was presented as a homicide but found at autopsy to be a road traffic accident. In the third case, there were fatal injuries to the head, a stab wound to the brachial artery in the arm, and injuries to the external genitalia, but the investigating officer had suspected dog mauling as the cause of death. The fourth case involved the mutilated remains of a body discovered on a road, suggestive of multiple runovers. Upon meticulous examination, however, a stab wound was identified on the chest region, causing the investigating authorities to alter the investigation from that of a road traffic accident to that of homicide with concealment of evidence. Conclusion: Accurate and timely injury interpretation plays a significant role in criminal investigations, with the potential to reveal concealed injuries and facilitate justice.
Copyright (c) 2025 Raviraj KG , Shobhana Subrahmanyam, Ananda Reddy https://creativecommons.org/licenses/by/4.0
Failure Rate of Oral Nitrofurantoin in Treating UTIs caused by ESBL-Producing Escherichia coli and Klebsiella pneumoniae : A Retrospective Cohort Study
Background: Urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms limit oral treatment options. Nitrofurantoin is frequently used, but regional data on its activity against ESBL-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) are lacking in Saudi Arabia. This study aimed to determine the 90-day failure rate of oral nitrofurantoin in treating ESBL-UTIs and explore secondary outcomes. Methods: This was a retrospective cohort study conducted at a tertiary hospital in Riyadh, Saudi Arabia. The target population was adult ED patients, discharged on oral nitrofurantoin for UTIs caused by ESBL-EC or ESBL-KP, between February 2021 and June 2024. We aimed to identify the failure rate of oral nitrofurantoin in this population. Treatment failure was defined as any ESBL-positive urine culture within 90 days of treatment initiation. Results: Among 13,421 UTI cases, 347 (2.6%) were ESBL-positive; 41 received oral nitrofurantoin, and 18 met the final inclusion criteria. The 90-day recurrence rate was 22.2% (4/18), with 77.8% having no early recurrence. Three patients had recurrence between 90–180 days. Half of all nitrofurantoin-treated patients were later hospitalized, with severe cases requiring ICU. Conclusion: Nitrofurantoin showed a 22% failure rate in treating ESBL-UTIs, yet remained effective in most cases, especially those involving ESBL-EC. Given its accessibility, nitrofurantoin remains a viable option but requires close follow-up. Larger studies are needed to refine its role in ESBL-UTI management.
Copyright (c) 2025 Ossama Alrehaili , Oussama AlThobyane , Adel Korairi, Rizq Badawi https://creativecommons.org/licenses/by/4.0
Digital Health in Saudi Arabia: A Descriptive Study of User Perspectives, Adoption Rates, Benefits, and Challenges of Digital Health Applications
Background: Digital health applications have emerged as transformative tools within healthcare systems globally. This study investigates the perceptions, adoption, perceived benefits and challenges, and factors involved in the selection of digital health apps among the residents of Riyadh city, Saudi Arabia. Methodology: A cross-sectional study was conducted using a validated, self-administered online questionnaire targeting residents of Riyadh aged 18 years and older. A total of 444 participants were recruited through convenience sampling via social media platforms. Results: Among the respondents, 90% reported using digital health applications, with Sehhaty being the most commonly used. Over 75% rated these applications as effective in improving quality of life (QoL). Key benefits included improved healthcare access, appointment booking, health awareness, and time efficiency. Fitness tracking was the most used app category (57.2%). Despite positive perceptions, 22% reported challenges, including technical difficulties and limited app compatibility. Ease of use was the most important factor (92.1%) when choosing a health app. Conclusion: Digital health applications have been widely adopted in Riyadh and are perceived to enhance QoL through improved access, convenience, and personal health management. The findings highlight strong user satisfaction and a growing interest in preventive care. Expanding digital health features, enhancing awareness, and integrating AI-based tools are recommended to further support health outcomes and national digital health goals.
Copyright (c) 2025 Alia Almoajel, Nawaf Alnuwaysir, Adel Ghazzai Alotaibi, Hanan Alzaidi, Haifa Alturki, Reem Alsaeed, Waleed Alsubhan, Mohammed Almadhi, Mohammed Muhawwis, Shabana Tharkar https://creativecommons.org/licenses/by/4.0
Methotrexate-Induced Hepatotoxicity in a Patient with a History of Alcohol Abuse: Case Report
Methotrexate (MTX) is a widely used treatment for conditions such as rheumatoid arthritis and psoriasis. Although its potential for hepatotoxicity is known, there is limited research on how to prevent this adverse effect, and despite this risk, MTX continues to be frequently prescribed. We present the case of a 56-year-old male with a history of alcohol abuse who developed acute jaundice, malaise, and a positive Murphy’s sign after starting MTX therapy for inflammatory rheumatoid arthritis. The patient was advised to abstain from alcohol due to the shared hepatic first-pass metabolism of both alcohol and MTX, and although he successfully stopped heavy drinking, he continued to consume alcohol occasionally in small amounts. After one month of treatment, the patient developed symptomatic grade 2 hepatic steatosis, requiring emergent plasmapheresis. This case highlights the lack of data on the effects of MTX in patients with prior alcohol abuse and demonstrates how a brief period of MTX use can result in the progression of hepatotoxicity in patients with pre-existing liver damage.
Copyright (c) 2025 Fatih Kaya, Mohammad Jamal Abunawas, Manar Al-Suleh, Ghayda Jarrar, Yare Sahin https://creativecommons.org/licenses/by/4.0
Pharmaceutical Access and the Human Right to Science
Access to medicines is a pertinent human rights issue: inadequate access to necessary medications poses severe consequences, including preventable deaths. The right of access to medicines is recognised as a fundamental aspect of the right to health, which is widely integrated into international and domestic legal systems. A right that has received less attention, however, is the right to benefit from scientific progress and its applications (hereinafter referred to as ‘the right to science’). This is a long-standing right, but has only recently begun to draw attention in the discourse on human rights. There is an interdependence between the two aforementioned rights, primarily in that science is required for the research and development of medicines. Thus it can be argued that, without the right to science, the right to medicines cannot be fully realised. This inquiry lays the foundation for further exploration of the utility of the right to science in alleviating prominent global issues such as inadequate access to medicines.
Copyright (c) 2025 Michelle Brotherton https://creativecommons.org/licenses/by/4.0
Empowering Schools to Tackle Mental Health: A Commentary with Six Recommendations for Engaging Health Educators in Saudi Arabia
Child and adolescent mental health challenges are on the rise globally and in Saudi Arabia, with studies showing high rates of depression and anxiety. Schools present a key opportunity to address these issues through early intervention and education. This commentary advocates for the integration of health educators into school-based mental health strategies in Saudi Arabia. It presents six practical recommendations, including psychoeducation workshops, anonymous feedback systems, and resource hubs, while emphasizing the need for structured training, cultural sensitivity, and cross-sector collaboration. Implementation considerations are also discussed to guide sustainable integration aligned with national policy.
Copyright (c) 2025 Nawaf Alnuwaysir https://creativecommons.org/licenses/by/4.0