
WHO members adopt a 'pandemic agreement' born out of the disjointed global COVID response
GENEVA — The World Health Organization's member countries on Tuesday approved an agreement to better prevent, prepare for and respond to future pandemics in the wake of the devastation wrought by the coronavirus.
Sustained applause echoed in a Geneva hall hosting the WHO's annual assembly as the measure — debated and devised over three years — passed without opposition.
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Medscape
7 minutes ago
- Medscape
Visa Hacks: Network That's Fuelling Germany's Care Boom
According to the Bertelsmann Foundation, the German care system is under mounting pressure; demand is set to rise by 50% by 2030, while the workforce is shrinking. If the current trends continue, Germany could face a shortfall in nearly 500,000 full-time caregivers. This gap is a major opportunity for qualified foreign nursing staff. Thorough preparation can ensure stable employment and long-term careers. The following five tips show what is important when entering the German healthcare system, from the recognition of professional qualifications to successful integration into everyday working life. 1. Secure Recognition Anyone wishing to work in Germany as a nursing professional must have their foreign qualifications officially recognised. The federal state authorities are responsible for recognition; this is an example of the process for Bavaria. This process is required by law and ensures that professional knowledge and skills are comparable to the German training standards. Each federal state assesses the equivalence of your training, practical experience, and knowledge of law and professional ethics. Non-EU nationals fall under the Professional Qualifications Assessment Act. If gaps are identified, you can either complete an adaptation course — combining theoretical instruction with practical training — or pass a proficiency test comprising written, oral, and practical exams to demonstrate the necessary professional competence at the required level. Many educational providers such as maxQ, FIA Academy, apm Weiterbildung GmbH, and RENAFAN Academy for Nursing Professions offer targeted preparation courses for the knowledge test — valuable support on the path to successful recognition. Costs range from €500-€2 500, often subsidised by employers or supported by grants from the Federal Ministry of Labour and Social Affairs or initiatives like 'Triple Win.' 2. Language Skills Professional qualifications are insufficient; applicants must also have sufficient German language skills. Language plays a central role in everyday professional life, whether in conversations with patients, documenting care services, or in collaboration with colleagues from different professional groups. Recognition typically requires a B2 level under the Common European Framework of Reference for Languages (CEFR), demonstrating advanced proficiency and the ability to hold technically demanding conversations. Start learning German as early as possible — ideally in your home country — to accelerate integration and reduce delays. 3. Visa and Residence Permit Non-EU care workers must secure work visas and employment permits before arrival. The prerequisite is usually a concrete job offer from a hospital, care home, or outpatient service and proof that the recognition process has begun or been completed. The further this process is advanced, the greater the chances of faster processing of the visa application. In many cases, the visa can also be applied with the aim of obtaining professional recognition in Germany, for example, through an adaptation course or a knowledge test. Admission to the labour market is also required. The Federal Employment Agency issues permit and verify that all conditions are met. This distinguishes between general visas for qualified professionals and special regulations for individual regions of origin. Under the Western Balkans regulation (§ 26 (2) Employment Ordinance), nationals of Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia, and Serbia may start work before formal recognition, provided they have an approved job offer and the Federal Employment Agency approves it. High demand can lead to long waits for embassy appointments. 4. Recruitment Agencies Many candidates use placement agencies for support with applications, employer selection, organising immigration, and accommodation. However, not all agencies run reliably. While reputable agencies charge reasonable fees and provide clear, written contracts in your language or English, others may place excessive costs, place workers in exploitative conditions, or withhold passports. Insist on contracts detailing salary, hours, leave, notice periods, duties, and training are clearly defined. Avoid vague fees, long commitment periods, or repayment clauses. Reputable employers pay at least the public sector tariff and often provide mentoring, housing assistance, in-house training, and clear career progression structures. It is also a good sign that employers themselves or through cooperation programs, such as those of the Federal Employment Agency and the German Society for International Cooperation, provide transparent information about the procedure and do not demand any financial advance payments. 5. Embrace Integration A job alone is not enough; true integration comes through social participation. Look for welcome guides, tandem partnerships, and intercultural training to build community ties. Recognition and proficiency test preparation courses offer networking opportunities. Engaging with colleagues, professional associations, or regional nursing chambers will help you settle both professionally and personally. EU professionals Nursing professionals from EU member states benefit from simplified procedures in Germany. Their professional qualifications are recognised automatically, eliminating the need for a complex recognition process. This significantly accelerates entry into the German labour market for many nurses. Although an elaborate recognition procedure is usually unnecessary, applicants must demonstrate German skills at the B2 level (CEFR) to work in Germany. Conclusion Pursuing a nursing career in Germany is achievable but requires patience, preparation, and support. Early research, reputable resources, commitment to verbal language, and cultural integration will greatly enhance your prospects.


Medscape
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- Medscape
Pediatric HS Linked to Obesity, Acne, Other Comorbidities
A meta-analysis of 19 studies found that pediatric patients with hidradenitis suppurativa (HS) show an increased rate of medical and psychiatric comorbidities, including obesity. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 19 observational studies (14 US studies), which included 17,267 pediatric patients with HS (76.7% girls; mean age, 12-17 years) and 8,259,944 pediatric patients without HS. The primary outcome was the prevalence of comorbidities in pediatric patients with HS. The main categories included metabolic, endocrinologic, inflammatory, psychiatric, dermatologic, and genetic comorbidities. TAKEAWAY: In the meta-analysis, the most prevalent condition in patients with HS was acne vulgaris (43%), followed by obesity (37%), anxiety (18%), and hirsutism (14%). Obesity showed moderate certainty association with HS in children, with prevalence ratios ranging up to 2.48, odds ratios ranging from 1.27 to 2.68, and hazard ratios up to 1.52 ( P < .001). < .001). Researchers also found a probable association between depression and HS (moderate certainty), with all studies reporting a higher incidence among patients with HS. An association with diabetes was reported in three studies (low certainty). IN PRACTICE: 'Given the significant risk of chronic comorbidities and negative sequelae in pediatric HS, our findings highlight a need for comprehensive comorbidity screening clinical guidelines in this population and emphasize the involvement of multidisciplinary teams to achieve this,' the study authors wrote. SOURCE: The study was led by Samiha T. Mohsen, MSc, University of Toronto, Toronto, and was published online on June 11 in JAMA Dermatology . LIMITATIONS: Several of the included studies were graded as low quality, and most studies did not compare the risks of comorbidities between the two groups. Most of the studies were from the US, which could limit generalizability. Significant heterogeneity was reported across the studies. DISCLOSURES: The funding source was not disclosed. Three authors reported receiving grants, personal fees, and honoraria from multiple pharmaceutical companies, including AbbVie, Novartis, UCB, Incyte, Novartis, Celltrion, Leo Pharma, Pfizer, Sanofi, and the Pediatric Dermatology Research Alliance. Other authors reported no conflicts of interest.


Medscape
34 minutes ago
- Medscape
Balanced Crystalloids Excel in Sepsis Fluid Resuscitation
A network meta-analysis of randomized trials found that balanced crystalloids reduced 90-day mortality more than low-molecular-weight hydroxyethyl starch and saline in patients with sepsis or septic shock and ranked highest for reducing the need for renal replacement therapy (RRT) and blood transfusion. METHODOLOGY: To compare various fluid resuscitation strategies, researchers conducted a network meta-analysis of 28 randomized controlled trials, which included 8770 patients with sepsis or septic shock (mean ages, 3-73 years). The intervention group received one or more of the following fluid supplements: Balanced crystalloids, saline, isooncotic albumin, hyperoncotic albumin, low-molecular-weight hydroxyethyl starch, high-molecular-weight hydroxyethyl starch, and gelatin. The control group received placebo or standard treatment. The study outcomes were 28-day mortality, 90-day mortality, the incidence of acute kidney injury, and the need for RRT and blood transfusions after treatment. TAKEAWAY: Balanced crystalloids reduced 90-day mortality compared with low-molecular-weight hydroxyethyl starch (risk ratio [RR], 0.84) and saline (RR, 0.89) and reduced the need for RRT compared with high-molecular-weight hydroxyethyl starch (RR, 0.59; 0.3-0.99). The surface under the cumulative ranking curve analysis showed that balanced crystalloids were the best fluid to reduce 28-day mortality (71.4%), 90-day mortality (86.3%), and the need for RRT (75.5%) and blood transfusions (72.2%). The same analysis showed that hyperoncotic albumin was the most effective in reducing the incidence of acute kidney injury (74.5%). IN PRACTICE: "In conclusion, BC [balanced crystalloids] demonstrates superiority over both L-HES [low-molecular-weight hydroxyethyl starch] and saline in reducing mortality in sepsis and septic shock patients, while Hyper-Alb [hyperoncotic albumin] is most effective in minimizing renal injury," the authors wrote. "However, given the current limitations, further high-quality, multicenter, large-sample RCTs [randomized controlled trials] are essential for more comprehensive analyses," they added. SOURCE: The study was led by Jiao Long, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China. It was published online on June 4, 2025, in The American Journal of Emergency Medicine. LIMITATIONS: Studies examining the combination of balanced salt solutions with colloids or albumin were scarce. Variability in the doses of resuscitation fluid across studies may have affected the consistency of the findings. Additionally, the studies included in the analysis were published only in English, which may have led to selection biases. DISCLOSURES: This study was not supported by any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declared no known competing financial interests or personal relationships that could have influenced the work reported in this paper.