The Journal of Medicine, Law & Public Health

Responses and Reproductive Outcomes Across Four Ovarian Stimulation Protocols in Poor Responders: A Retrospective Cohort Study

Dania AlJaroudi , Aljazi M. Mnikhr, Amani Abu Shaheen, Motasim Badri — Tue, 30 Jun 2026 00:00:00 +0000

Background: The optimal approach to ovarian stimulation in poor responders remains controversial. This study aimed to compare four stimulation treatment protocols to improve reproductive outcomes in patients undergoing controlled ovarian hyperstimulation prior to in-vitro fertilization/intracytoplasmic sperm injection under gonadotropin-releasing hormone antagonist regimens.

Methods: A retrospective cohort study was conducted among poor responder female patients. The participants were divided into four groups according to treatment protocol—Group 1: High-dose rFSH (≥300 IU) with rLH; Group 2: hMG with rFSH (≥300 IU); Group 3: rFSH (≥300 IU/day) alone; Group 4: hMG (≥300 IU) alone —and followed up to determine their reproductive outcomes.

Results: A total of 157 poor responders were included. Baseline characteristics were comparable across the four treatment groups, with no significant differences in age, BMI, duration of infertility, or basal E2, PRL, and TSH levels. Basal FSH and LH levels showed statistically significant differences between groups (p=0.049 and p=0.007, respectively), although median FSH values were similar overall. Causes of infertility did not differ significantly among groups.

Treatment duration, final E2 levels, follicle numbers, oocyte yield, embryo numbers, and ICSI outcomes were comparable across groups. However, total gonadotropin dose differed significantly, with the rFSH + LH group requiring the highest dose. Pregnancy outcomes—including positive pregnancy test rates, clinical pregnancy, implantation, and live birth rates—were not significantly different among treatment groups. Miscarriage history differed significantly, with the highest proportion observed in the hMG group (p=0.046). Of 135 patients undergoing embryo transfer, 39.3% (n=53) had positive pregnancy tests, resulting in 28 live births. No ectopic pregnancies occurred. Live birth distribution did not differ significantly by age group or treatment regimen (p=0.553).

Conclusions: rFSH doses higher than 300 IU did not significantly alter reproductive outcomes, raising the question of whether such high doses of gonadotropins are advisable in this patient population.

The Newfoundland and Labrador Population Health Index (NLPHI): A Computerized Framework for Population-Level Longitudinal Health Outcome Monitoring

Mirza Niaz Zaman Elin — Tue, 30 Jun 2026 00:00:00 +0000

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.

Enhancing Cross-Level Coordination in Healthcare Incident Command Through Virtual Incident Command System (VICS) Integration

Tue, 30 Jun 2026 00:00:00 +0000

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.

Evolving Jurisprudence on Organ Transplantation in India: An Analytical Study of the Transplantation of Human Organs and Tissues Act

Ruby Dubey — Thu, 02 Jul 2026 00:00:00 +0000

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.

The Unit Commensurability Problem in the Nutri-Score Algorithm: a Construct Validity Analysis

José A. Martínez — Tue, 30 Jun 2026 00:00:00 +0000

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.