Many terms have been used to describe interventions that do not involve the use of pharmacological products in the setting of communicable diseases. Terminology has varied, and terms have included physical, non-pharmaceutical, non-drug, non-pharmacologic, and non-pharmacological interventions, as well as public health measures and public health and social measures. The recent COVID-19 pandemic has highlighted the importance of non-pharmacological interventions (NPIs), and the term is now recognized globally. The use of the terms public health measures or public health and social measures has variably been inclusive of the use of vaccines, which would be considered pharmacological products. Given this background and confusion over terminology and descriptions, we have reviewed this topic to provide clarity regarding nomenclature, taxonomy, and definitions, with the aim of ensuring an explicit shared understanding of any interventions that do not involve pharmacological products, given the importance of conducting NPI evaluations for future epidemics and pandemics.

Telemedicine enhances healthcare access but faces challenges with appointment no-shows. In Peru's health system, telemedicine use has expanded rapidly, yet the no-shows' determinants remain underexplored. To identify demographic, geographic, institutional, and temporal factors associated with telemedicine appointment no-shows at EsSalud's National Telemedicine Center (CENATE), we conducted a cross-sectional analysis of 538,312 scheduled telemedicine appointments representing 309,819 patients using routinely collected data from the EsSalud ExplotaDatos platform in 2023-2024 and multivariate Poisson regressions. The estimated average no-show prevalence rate was 6.4% with the highest rates in pediatric neurology and obstetrics specialties. A higher risk for no-show was observed among males, young adults (18-29 years old), residents of the Eastern macro-region, appointments at primary healthcare centers, morning shifts, end-of-year months, and end-of-workweek days. No-shows are influenced by individual, institutional, and contextual factors, highlighting the need for tailored interventions to enhance appointment adherence and optimize virtual care delivery.

Packaged foods are a major source of dietary sodium worldwide. Nutrition labels often report sodium content in milligrams and a percent daily value; however, these measures are not sufficiently intuitive for comparing sodium content across packaged foods. We propose a new way to use sodium density (mg/kcal) in a serving to bypass nutrition label units. Because the WHO recommended sodium limit for adults (2000 mg/day) and the reference energy intake used on nutrition labels (2000 kcal/day) are numerically identical, a sodium-to-calorie ratio of 1 mg/kcal could serve as a practical guidepost to compare sodium content and support packaged food selection, rather than to provide an individual-level recommendation for daily sodium intake. Sodium density, applied to food log entries, could help consumers identify lower-sodium options among packaged foods, support healthcare professionals in nutrition education design personalized strategies to reduce sodium consumption, and inform developments of nutrition dashboards and AI-driven tracking tools.

Professional drivers face occupational health risks, including prolonged sedentary work, irregular working hours, unhealthy dietary habits and limited opportunities for physical activity. Although behaviourally informed health interventions have gained attention, evidence for professional drivers has not been systematically synthesised. A systematic literature review followed the PRISMA 2020 guidelines. Searches of PubMed, Scopus, Web of Science, ERIC and Google Scholar identified 11 studies, comprising 9 empirical interventions and 2 review articles. Owing to substantial methodological heterogeneity, findings were narratively synthesised. Most interventions combined behavioural strategies, including self-monitoring, goal setting, personalised feedback, coaching and digital support. Physical activity and dietary behaviour were the main outcomes. Overall, integrated behaviourally informed interventions appear promising for promoting healthier behaviours among professional drivers, although more robust long-term evidence is required. These findings provide practical guidance for researchers, employers and policymakers, and contribute to the international evidence base for behaviourally informed occupational health interventions for professional drivers.

In the digital age, addiction terminology shapes understanding, risk perception, and policy response. The label 'behavioral addiction' may be imprecise because substance-related addictions are also expressed through behavior, and it may blur the distinction between intensive use and clinically significant disorder. This Viewpoint examines this terminological problem and proposes a common addiction framework based on impaired control, persistence despite harm, and functional impairment, while preserving differences in exposure route, harm profile, and regulatory needs. It uses 'non-substance addictive disorders' for clinically significant conditions not driven by direct psychoactive substance intake and 'digitally mediated addictive disorders' for conditions facilitated by digital platforms. This framework may help identify harm without pathologizing high engagement, reduce excessive attribution of responsibility to individuals, and guide prevention and regulation toward vulnerable users and reinforcing platform environments. Its policy value lies in supporting harm recognition and facilitating the adaptation of responses across cultural and digital settings.

People with disabilities often experience unmet healthcare needs, and the factors associated with these needs may differ across healthcare service types. This study examined service-specific factors associated with unmet healthcare needs using Andersen's Behavioral Model. We conducted a cross-sectional online survey of 201 people with disabilities registered at a regional health and medical center in South Korea and their caregivers between November and December 2024. We assessed unmet needs for outpatient services, dental care, health screening, and home-visit rehabilitation, and classified independent variables as predisposing, enabling, and need factors. Unmet healthcare needs and their associated factors differed by service type. For outpatient services, assistance required in activities of daily living was associated with unmet need. For dental care, living arrangement, multiple disabilities, and depressive symptoms were associated with unmet need. For health screening, marital status and disability registration duration were associated with unmet need. For home-visit rehabilitation, sex was associated with unmet need. These findings suggest that unmet healthcare needs among people with disabilities should be addressed through service-specific strategies that reflect the distinct barriers and associated factors for each type of care.

Famines are complex systems that change over time, and in which outcomes differ by household situation and livelihood. The "watch" famine system archetype occurs when populations engage in coping strategies to deal with a hunger gap, such as between agricultural harvests, which can interfere with future food production and mask the existence of a crisis to outside observers. I present a framework for modeling household responses to hunger. I used a partial prototype model for agrarian, horticultural, or foraging livelihoods to simulate the role of rationing and foraging as coping responses to insufficient food. Although not all dynamics were included, simulations suggested that while coping mechanisms can improve outcomes, rationing may also produce negative outcomes, due to the increased chance of death with lower energy reserves. I discuss next steps for a more complete framework, generalization to other famine systems, and implications for monitoring and responding to famine systems.

This paper explores the use of system dynamics modeling to better understand the 1998 Bahr el Ghazal famine in southern Sudan. Based on expert interviews and a literature review, it presents a set of causal loop diagrams that clarify the complex dynamics involved in the crisis, demonstrating how three major political 'holds' permitted a self-reinforcing famine system to form. A simulation of this model generates similar outcomes in mortality and malnutrition to those that occurred in the actual crisis. Based on this analysis, the paper suggests several ways that modeling could have supported a more effective response at the time of the crisis and may be able to strengthen efforts to prevent famines in the future.

The 2011-2012 Somalia famine was a complex humanitarian disaster shaped by interacting environmental, economic, social, and political factors. This paper applies a qualitative systems analysis to examine famine structure, dynamics, and archetypes to demonstrate how systems modelling can deepen understanding of famine as a complex system. The study addresses three questions: (1) what key variables and feedback dynamics created pressures and constraints within the Somalia famine system; (2) how system components interacted to produce outcomes such as food insecurity, malnutrition, and mortality; and (3) which system archetypes characterized system behaviour. Using a causal loop diagram (CLD), the study maps interdependencies across environmental, biophysical, economic, social, health, political, and institutional domains within the famine system. The CLD illustrates the specific reinforcing feedbacks that acted as pressures, constraining feedbacks that acted as holds and balancing feedbacks that acted as stabilizers of the system. We observe three key system archetypes: Escalation, Fixes that fail and Shifting the burden. Overall, the study demonstrates that famine emerges from dynamic system interactions rather than isolated drivers, highlighting the value of systems thinking for improving explanation, policy insight, and intervention design in complex humanitarian crises.

Yemen continues to experience one of the most severe child malnutrition and food insecurity crises on the planet. Seasonal synchronization of malnutrition often serves as an early marker of emerging famine. In this study we compiled data collected by the humanitarian agencies on several potential drivers of malnutrition such as food insecurity, conflict events, and environmental indicators (rainfall, temperature, and normalized difference vegetation index) in Yemen from 2018 to 2023. We characterized the seasonality of malnutrition outcomes and explore spatiotemporal synchronization using non-linear time series analyses. Our findings demonstrate significant seasonal profiles in child malnutrition, which could be synchronized with the peak in food insecurity and peaks in environmental indicators. The quantification of seasonal characteristics in term of seasonal peaks and their amplitude pave the way to build strong foundation for deeper understanding of famine evolution from a complex system perspective by defining processes and triggers that amplify malnutrition and escalate faming formation.

This paper explores Fuzzy Cognitive Mapping (FCM) as an analytical approach for understanding famine as a complex, dynamic system. Traditional approaches, such as the Integrated Food Security Phase Classification (IPC), may not fully capture the non-linear interactions among social, economic, political, and environmental factors that contribute to famine. The IPC relies heavily on cross-sectional survey data and expert judgment, which can introduce errors and biases. This study applies FCM to a retrospective case study of the 2017 Ayod County crisis in South Sudan. FCM combines qualitative and quantitative data, facilitating analysis of dynamic systems even with limited data availability. The findings indicate that FCM identified famine-like conditions from March to June 2017, aligning with subsequent survey data, although Ayod was never formally classified in famine by the IPC. Continued testing of FCM is recommended to assess its suitability as part of a revised analytical toolkit for near-real-time famine risk tracking.