Bloodstream infections (BSIs) caused by Candida are a significant cause of morbidity and mortality. Geographical variations exist in the epidemiology of candidemia, with a paucity of data in the many low- and middle-income countries. We performed a retrospective study of candidemia from 2017 to 2022 at a 289-bed teaching hospital in the Dominican Republic (DR). A total of 197 cases were reviewed. Overall mortality rate was 49.2%. Age and vasopressor use were associated with mortality. The most prevalent Candida species were C. tropicalis and C. parapsilosis. C. albicans was 12% resistance to amphotericin B. These findings underscore the importance of understanding local epidemiology and may help inform empiric therapy and the development of treatment guidelines in the DR.

The content learned in paediatric cardiology fellowship is variable depending on the socio-economic and geographic setting in which training takes place and may result in knowledge gaps. We highlight the key lessons learned from a recent case-based learning session, hosted by Heart University, between two programmes from different geographic and resource settings.

Human rights courts may be on the cusp of recognizing linkages between the mental health impacts of climate change and human rights. However, several significant obstacles must be overcome before human rights protections are likely to be extended to cover the mental health impacts of climate change. Thus, the push for recognition of human rights protections for people facing mental health harms imposed by climate change must be pursued along with a multifaceted effort that employs regulatory and advocacy strategies alongside litigation, and more clearly establishes the interconnections between mental health, climate change, and human rights.

Sleep is essential for the health of midlife women, yet the barriers (factors that impede) and facilitators (factors that support) to achieving adequate sleep, particularly among working-class women in Mexico City and broader Latin American contexts, remains insufficiently understood. This study aims to provide a nuanced understanding of the factors influencing sleep among working-class midlife women in Mexico City. A mixed-methods approach, combining quantitative data (epidemiologic measures) and qualitative data (ethnographic interviews), was employed among women enrolled in a Mexico City cohort. We used epidemiologic data to describe sleep and its correlates in a sample of 120 women, incorporating both self-reported (questionnaires and sleep diaries) and behavioral (actigraphy-based) measures of sleep. A subset of 30 women participated in in-depth ethnographic interviews to explore determinants of sleep, including barriers, facilitators and coping strategies to compensate for sleep loss. Our findings reveal that many women experienced poor sleep, with 43% reporting insomnia-related difficulties and 53% experiencing short sleep duration. Barriers included family-related stress, particularly caregiving responsibilities, economic instability, and mental health challenges. In response to sleep loss, women often resorted to coping mechanisms, such as caffeine consumption and napping, and the use of natural remedies. This study highlights the critical role social factors, including family dynamics and caregiving roles, in shaping sleep health outcomes. Sleep, as an inherently social behavior, is strongly influenced by these contextual factors. These findings underscore the importance of considering psychosocial and cultural contexts in interventions aimed at promoting healthy sleep in midlife women.

During outbreaks of diseases like cholera, HIV/AIDS, H1N1, and Ebola, governments often impose international border restrictions (for example, quarantines, entry restrictions, and import restrictions) that disrupt the economy without stopping the spread of disease. During COVID-19, international travel restrictions were ubiquitous despite initial World Health Organization recommendations against such measures because of their limited public health benefit and the potential for imposing a range of harms. Why did governments adopt these measures? This article argues and finds evidence that governments use international border restrictions as security theatre: ‘measures that provide not security, but a sense of it’. Quantitative analysis of original data on states’ first border restrictions during the pandemic suggests that behaviour was not just driven by the risk of COVID-19 spread. Instead, nationalist governments, which are likely to be attracted to policies associating disease with foreigners, were more likely to impose border restrictions, did so more quickly, and adopted domestic measures more slowly. A case study of the US further illustrates the security theatre logic. The findings imply that overcoming or redirecting governments’ attraction to security theatre could promote international cooperation during global health emergencies.

In the decade since the first edition of Global Health Law was published, the world has moved incrementally towards global health with justice, at least by one basic metric: life expectancy has edged up globally, with more rapid gains in low- than high-income countries. But to look around the world, global health with justice still seems a distant dream. Health gaps between people in rich and poor countries remain shocking and unconscionable—as do health inequities within countries. The pandemic also gave salience to profound health injustices—from injustices in access to lifesaving vaccines to gaping disparities in morbidity and mortality based on income, race, and national origin. So did the Trump administration’s decision to pause, and then slash, foreign assistance, bringing an end to lifesaving programs around the world. Guided by the overarching theme of justice, these reflections canvass the history of global health law as a field and discuss developments and challenges in the field across four core themes: multilateralism; equitable distribution of the benefits of scientific advancement; global health law for the poly-crises; and human rights and equity.

The article examines the historical development of global health from its genesis in colonial-era tropical medicine, to the creation of the World Health Organization – formed to advance health rights for all. The authors call for continued reforms to the global health governance system to mitigate the enduring impact of colonialism.

Colonialism has produced the global health system, and decoloniality must inform global health law. This article considers the foundational impact of colonialism on the global health system and advocates for adopting decoloniality as a crucial framework to reshape global health law. Through a historical lens, it examines how European colonialism established power dynamics and structures that continue to influence contemporary global health governance. This article calls for overcoming enduring challenges by emphasizing the urgency of dismantling outdated and unjust systems that perpetuate health inequities and hinder effective interventions. It argues for a paradigm shift toward epistemically inclusive, ethical, and equitable practices, emphasizing the active participation of marginalized communities in health policymaking. By addressing the root causes of health disparities and decoupling health systems from racial capitalism, a decolonial approach promises a more just and effective future for global health law.

I write in tribute to my friend Larry Gostin, who has long emphasized that accountability and governance are central to global health policy.

This reflection considers the contribution of Prof Larry Gostin to global health law and the lessons for climate action.

Global health law in theory and practice can either work to ameliorate the devastating consequences of colonialism, class hierarchies, and structural racism in health, or it can ratify and exacerbate them. It can protect, under protect, overprotect, or fail to protect – it is not and cannot be neutral. Global health law reflects the choices and practices of States and other actors, which includes both action and inaction. Inaction or silence on the part of global health law is a choice that ratifies the status quo of coloniality, class exploitation, and structural racism in health.

This article first describes shifts in human rights law that have led to improvements in the realization of sexual and reproductive health and rights (SRHR) over the last decade. The article does so, however, with careful attention to the structural factors beyond formal legal mechanisms that may undermine the ability of governments, even with the best of intentions, to fully develop the necessary robust health and justice systems. Second, this article considers two additional factors: the political economy factors that enable or limit the ability of States to realize SRHR, as well as the growing evidence base that supports positive legal transformation.