US life expectancy now lags significantly behind the majority of high-income countries, having grown more slowly since 1980 for reasons that are not evident and have been debated. An exploratory system dynamics model is presented that reproduces the full pattern of US life expectancy from 1960 to the present. Multiple socioeconomic and behavioral factors help to explain the historical pattern, two of them apparently most responsible for the stagnation since 1980: the growth of obesity and the leveling off of growth in social spending. Some of the factors in the model are traced back to earlier causes, and obesity’s growth in particular is traced back to excess growth in private health care spending and its adverse effect on workers’ wages. The model’s base run does a good job of reproducing a variety of historical time series data going back to the 1960s, and counterfactual testing produces plausible results. The model may thus be considered a reasonable starting point for more conclusive future modeling of US life expectancy.

Background: Cardiovascular diseases (CVDs) and their risk factors are increasing with associated disability and mortality burden globally, especially in low- and middle-income countries, including Cameroon. Physiotherapist-led health promotion (PLHP) interventions provide opportunities to improve health and reduce this burden. Understanding physiotherapists' practice, confidence, and perception is crucial for designing effective, context-specific PLHP interventions. Methods: This qualitative study explored physiotherapists' practice, perceptions, and confidence in delivering PLHP to pwCVDs in Cameroon. Results: Sixteen participants completed the interviews and analyses of the transcripts generated three main themes which included 1) Perception of Physiotherapists’ role in health promotion (HP), 2) Current practice of PLHP 3) Competence in delivery of PLHP. Physiotherapists believe that delivering HP interventions in practice is within their professional role. Current HP practice was limited to exercise, physical activity and dietary/nutritional interventions. Participants reported a lack of knowledge and formal training in PLHP delivery. Conclusion: Despite strong interest in HP, HP practice among physiotherapists is limited in scope, under-resourced and limited by a lack of confidence in delivering behavioural change interventions. These findings are relevant for the design of appropriate clinical training and policies for the care of pwCVDs.

Digital weight-loss services (DWLSs) that supplement continuous lifestyle coaching with Semaglutide therapy have shown promise in delivering continuous and effective obesity care. However, the extent to which lifestyle coaching approach and Semaglutide brand influences patient engagement and program effectiveness is unknown. This study retrospectively analyzed several engagement markers and weight loss percentage over 16 weeks in a large Semaglutide-supported DWLS in the UK. The comparative analysis found that patients who received lifestyle coaching that was proactive and personalized sent a statistically higher number of messages to their health coach (M=19.37 vs M=8.55) and opened the program app more frequently (M = 49.31 days vs M = 40.06 days) than patients whose coaching was reactive and standardized. Mean 16-week weight-loss was 10.1% in the proactive group compared to 8.9% in the reactive group, but the difference was not statistically significant. A two-sample t-test found that female patients (M = 9.76) tended to lose more weight than male patients (M = 6.88), (t(152) = 1.89 , p = 0.04). The findings add vital layers of nuance to the emerging literature on Semaglutide-supported DWLSs, indicating that a proactive, personalized coaching approach leads to better patient engagement with DWLS health coaches and that Wegovy has a comparable effect to Ozempic as a supplement to DWLS coaching. Future research should seek to conduct comparable investigations of other obesity services and over a longer period.

Background: In recent years, undernutrition has remained a significant public health issue in Tu-nisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0-23 months; Methods: The study included 3265 children aged 0-23 months from the 2011-2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition; Results: The prevalence of stunting, wasting, and underweight in infants and children aged 0-23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0-5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunt-ing, wasting, and being underweight have increased by 22%, 16%, and 70% respectively. Infants aged 0-5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Small birth weight, and dura-tion of breastfeeding > 12months had significantly higher odds of being underweight; Conclu-sions: This study shows that infants aged 0-5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher odd of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition ser-vices, improve parental education, and implement community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.

Housing is the most regulated type of building. Standards significantly influence the design and construction quality, often making universal design more expensive and challenging to implement. This study aims to review current Spanish regulations on accessibility in the housing sector, to promote non-discriminatory and independent access, while ensuring the safety of each resident. The research is exploratory and qualitative, involving a systematic bibliographic review through an exhaustive search of regulations in force until December 2023. In Spain, there are three laws (from 1999, 1960 and 2022), three decrees (from 2006, 2013 and 2015) and a national plan from the regulatory framework. The main regulation, the Technical Building Code, outlines the accessibility, safety and habitability requirements that buildings must adhere to. The most recent is Law 6/2022 on Cognitive Accessibility. Spain has robust legislation with innovative approaches and ambitious goals. However, there is a lack of societal awareness that housing is a fundamental right and that the regulations must be upheld. Several proposals for improvement have been made. These suggested changes address the specific challenges of each region and promote more inclusive and adaptable projects for all people from the early stages of design.

Clinical microbiology studies and systematic reviews have largely concluded that SARS-CoV-2 RNA is rarely present in the urine of COVID-19 patients. Thus, wastewater surveillance has largely focused on human stool and defecation as the relevant matrix and behavior. But, the over-performance of wastewater testing during near-source surveillance, especially in settings where on-site defecation is presumed to be de minimis such as aircraft and non-residential schools, suggests the possibility of SARS-CoV-2 RNA input from a non-fecal source. To revisit the possibility of urine as an explanation, data was compiled from 45 studies reporting on SARS-CoV-2 RNA in the urine of 1,924 COVID-19 patients. In general, the reporting quality was low with most studies (86.7%) failing to report even basic details such as the volume of urine collected. Only 11 reported quantitative data and of these only a single study reported its experiments to the standards established for publication of quantitative PCR data. Taking the data at its face value, the pooled prevalence of urinary SARS-CoV-2 RNA shedding was 11.3% (95%CI: 8.4 - 14.3), which roughly agrees with previous analyses. However, the percentage of variability in the estimate attributable to heterogeneity between studies (I² = 93.66%) warrants careful consideration. Notably, for the 8 studies reporting sufficient workflow information, the observed urinary RNA shedding prevalence was normally distributed (r² = 1.00) as a function of the volume of urine being assayed in a single PCR reaction (i.e., the equivalent sample volume, ESV). The study achieving the highest ESV (83.3 µL of urine) detected SARS-CoV-2 RNA in urine sediments of 95.5% of COVID-19 patients. Conversely, during two studies achieving ESVs of only 2 µL and 11.7 µL of urine, SARS-CoV-2 RNA was not detected in the urine of 72 and 132 patients, respectively. For wastewater surveillance of COVID-19, these observations suggest the rarity of SARS-CoV-2 RNA in urine may be a methodological artifact. Further, the data on which rarity is presumed are of low quality. Beyond COVID-19, the findings demonstrate that clinical studies, by virtue of their design to answer clinically relevant questions, could produce datasets subject to large biases that make them less useful when assessing the feasibility of wastewater surveillance of infectious agents. Wastewater surveillance practitioners must carefully consider the appropriateness and limitations of clinical data considering the important differences between the methods and aims of the two disciplines. Given the great potential of wastewater testing, clinical and environmental microbiologist should collaborate to produce robust quantitative datasets for reliable feasibility assessments for both community and near-source public health surveillance.

The different sociocultural context and lifestyle may influence oral health. To evaluate the interference of these factors, we conducted a quantitative-qualitative cross-sectional study. The research was carried out in a private dental office, in an urban area, and in the Family Health Unit (USF), in a rural area. Fifty patients of each location participated on the research. A semi-structured questionnaire covering sociocultural profile, oral hygiene habits, drug consumption, use of medicinal plants, and antibiotics usage was applied. Also, laboratory tests to evaluate the tendency to have dental decay and Streptococcus sp colony counting was performed. There was no significant difference between patients in the two groups regarding gender, race, marital status, type of residence, number of residents in the same household, and type of employment. Private clinic participants were more prone to consuming alcohol and/or cigarettes and reported to brush the teeth more often. There was no association between salivary acidity and higher biofilm bacterial density. The usage of medicinal plants was more evident in the public service. Data presented here revealed that social inequality between private and public dental assistance are greater from the point of view of investment in public health for the population with difficult access and not from cultural or educational level diversity.

Speech Sound Disorders (SSDs) are prevalent communication problems in children that pose significant barriers to academic success and social participation. Accurate diagnosis is key to mitigating life-long impacts. We are developing a novel software solution -- the Speech Movement and Acoustic Analysis Tracking (SMAAT) system to facilitate rapid and objective assessment of motor speech control issues underlying SSD. This study evaluates the feasibility of using automatically extracted 3-Dimensional (3D) facial measurements from single 2-Dimensional (2D) front-facing video cameras for classifying speech movements. Videos were recorded of 51 adults and 77 children between 3 and 4 years of age (all typically developed for age) saying 20 words from the mandibular and labial-facial levels of the Motor-Speech Hierarchy Probe Wordlist (MSH-PW). Measurements around the jaw and lips were automatically extracted from the 2D video frames using a state-of-the-art facial mesh detection and tracking algorithm, and each individual measurement was tested in a Leave-One-Out Cross-Validation (LOOCV) framework for its word classification performance. Statistics were evaluated at the alpha = 0.05 significance level and several measurements were found to exhibit significant classification performance in both the adult and child cohorts. Importantly, measurements of depth indirectly inferred from the 2D video frames were among those found to be significant. The significant measurements were shown to match expectations of facial movements across the 20 words, demonstrating their potential applicability in supporting clinical evaluations of speech production.

Background: Menstruation is a natural physiological process experienced by 1.8 billion girls, and pre-menopausal women globally, and can be experienced about 300 times in a woman’s lifetime. Even though menstruation is a sign of normal female reproductive functions and marks an important transition into womanhood for adolescent girls, it is bounded by several taboos, myths, misbeliefs, or misconceptions in low-and middle-income countries including Ghana. Hence, the topic and cultural practices around menstruation are rarely discussed, and the experiences of young girls during menarche and early menstrual life remain poorly captured. This study explored the cultural construction of menstruation in the Ghanaian context. Methods: This study was qualitative and adopted an exploratory study design. We used purposive and convenience sampling procedures for sampling five Senior High Schools and participants in the Volta Region of Ghana. 15 Focus Group Discussions (FGD) were conducted. This comprised five FGDs for female students, five FGDs for teachers, and five FGDs for parents. For each of the FGDs, 10 to 12 participants were sampled to participate in the discussion. Data were audio-recorded, transcribed, translated, and imported into MAXQDA qualitative analysis software 2022 version for analysis. Data were coded and analyzed using a thematic analysis. Results: We found that there are a myriad of socio-cultural beliefs and practices that are associated with menstruation in Ghana. These beliefs such as menstrual blood is unclean and practices like celebration of menarche, and upholding some menstruation-related cultural/tribal taboos including household restrictions, religion, and social restrictions were identified. Our findings revealed that myths have long enveloped the facts about menstruation. Conclusion: Cultural and social practices regarding menstruation depend on girls’ education, attitude, family environment, culture, and beliefs, pointing to the need for public health officials in the Ghanaian society to provide more culturally oriented education to the general public on menstruation and the impact of some conservative socio-cultural practices on the menstrual health of adolescents.

Aim: To determine the clinical performance association of periodontal disease with diabetes mellitus, using an umbrella review. Material and Methods: An information search was carried out up to August 2023 in the following electronic databases: PubMed, Cochrane database, Scopus, SciELO, Google Scholar and OpenGrey. We included studies that were systematic reviews (SR) with or without meta-analysis, without time and language restrictions, that evaluated primary studies that evaluated the association between periodontal disease with diabetes mellitus. Literature or narrative reviews, rapid reviews, intervention studies, observational studies, preclinical and basic research, abstracts, comments, case reports, protocols, personal opinions, letters, and posters were excluded. The AMSTAR-2 tool was used to determine the methodological quality of the included studies. Results: The preliminary search yielded a total of 577 articles, discarding those that did not meet the selection criteria, leaving only 17 articles. An association was found between periodontal disease and diabetes mellitus (type 1 and type 2 diabetes mellitus and gestational diabetes mellitus). Conclusion: Based on the results and conclusions of the SR with a high overall confidence, periodontal disease is associated with the onset of type 1 and type 2 diabetes mellitus and gestational diabetes.

Influenza behavior depends on several characteristics: the agent itself, the host response, and environmental changes that determine seasonality, presentation, disease severity, lethality, and intensity of contagion. Vulnerable populations, such as the elderly, people with underlying diseases, and incomplete vaccination status, can influence disease presentation and epidemiology. These information changes are necessary for existing surveillance systems. Special surveillance of human and animal diseases is necessary, considering recent outbreaks and epidemic waves of viral diseases such as avian influenza. This study analyzed the impact of the COVID-19 pandemic on influenza vaccination coverage in Mexico and Central America. We used existing data and information in the countries and what was reported to WHO and UNICEF on administrative coverage of influenza vaccination reported by the countries, and the PAHO surveillance databases for influenza and other respiratory viruses. Influenza vaccine application varies in Central American countries and Mexico. Vaccination schedules have been adapted following WHO and PAHO recommendations, and considering the epidemiological, organizational conditions and financial realities of each country. Surveillance systems must be prepared for a possible “tridemic” in humans involving influenza, SARS-CoV-2 and respiratory syncytial virus (RSV). Influenza-associated disease was considerably affected during the COVID-19 pandemic. Given the preventive measures implemented, cases were unusually low during 2021-22, but cases increased sharply in 2022-23 caused by influenza A and influenza A H1N1 pdm09, with some isolated cases of influenza B.

Background: Objective training load indexes (TL) used in resistance training lack of physiological significance. This study aimed to provide a muscle physiology-based approach for quantifying TL in resistance exercises (RE). Methods: Following individual torque-velocity profiling, fifteen participants performed isokinetic leg extension exercise sessions at low (C1), moderate (C2), and high (C3) intensities. Systemic and local physiological responses were measured, and sessions were volume-equated according to the "volume-load" (VL) method. Results: Significant differences were found between sessions in terms of mechanical work (p

The global burden of drug-resistant tuberculosis (DR-TB) continues to challenge healthcare systems worldwide. There is a critical need to tackle DR-TB by enhancing diagnostics and drug susceptibility testing (DST) capabilities, particularly for emerging DR-TB drugs. This endeavor is crucial to optimize the efficacy of new therapeutic regimens and prevent the resistance and overuse of these invaluable weapons. Despite this urgency, there remains a lack of comprehensive review on public health measures aimed at improving the diagnostics and DST capabilities. In this review, we outline strategies to enhance the capabilities especially tailored to address the challenges posed by resistance to new DR-TB drugs. We discuss the current landscape of DR-TB drugs, existing diagnostic and susceptibility testing methods, notable gaps and challenges in these methods, and explore strategies for ensuring fair access to DST while narrowing these disparities. The strategies include public health interventions aimed at strengthening laboratory infrastructure, workforce training, and quality assurance programs, technology transfer initiatives, involving drug developers in the DST development, establishing national or regional referral hubs, fostering collaboration and resources pooling with other infection control efforts, extending testing access in underserved areas through public-private partnerships, advocating for lowering costs or loans at low-interest, remote technical support, and implementing mandatory molecular surveillance monitoring. This review underscores the urgent need to enhance DST capacities for new DR-TB drugs and identifies opportunities for innovation and improvement. Assessing the extent of the global health impact of these measures is crucial to ensure their effectiveness in combating DR-TB.

Background: Osteoarthritis (OA) is a common health condition that often requires procedures like total hip arthroplasty (THA). Rehabilitation plays a crucial role in managing OA, especially in supporting recovery and improving outcomes following THA. Given the rising demand for THA and the significant impact of OA on mobility and quality of life, effective rehabilitation strategies are essential. This study investigates the impact of virtual reality (VR) therapy on the psychological and functional outcomes of female patients undergoing rehabilitation post-THA. Methods: This pilot randomized controlled trial was conducted with 24 female patients aged 60 and older. Participants were randomized into two groups: a control group receiving 4-week standard rehabilitation and an experimental group receiving standard rehabilitation plus VR therapy. Psychological and functional statuses were assessed using the Hospital Anxiety and Depression Scale (HADS), Perception of Stress Questionnaire (PSQ), and various functional tests before and after the intervention. Results: The experimental group showed significant improvements in psychological outcomes, with a 53% reduction in overall HADS scores and a 43% reduction in PSQ scores. Functional improvements were also observed, with significant increases in Tinetti Test, Barthel Index, and Rivermead Motor Assessment scores. In contrast, the control group showed no significant changes in psychological parameters and less pronounced functional improvements. Conclusions: VR therapy effectively enhances psychological well-being and functional recovery in women undergoing rehabilitation post-THA. These findings suggest that integrating VR therapy into standard rehabilitation protocols could improve outcomes and should be considered in future rehabilitation strategies.

Background/objective: A retrospective study was conducted to access better understanding of the prevalence and risk factors of OIs in HIV-positive individuals, informing targeted interventions and enhancing overall health outcomes. Methods: Medical records 212 of patients (61.79% female, 38.21% male) were accessed to extract relevant information for the study. Fisher’s exact test revealed significant associations between gender, substance abuse, healthy diet practices, and having single or multiple partners with the development of opportunistic infections. Results: A total of 212 HIV-positive patients were enrolled, with a majority being female (61.79%) and adults aged between 25 and 65 years (68.87%). Most participants were single (83.02%), unemployed (66.9%), and had a history of substance abuse (61.79%). The prevalence of opportunistic infections was 15.09%, with pulmonary tuberculosis being the most common (75%), followed by extrapulmonary tuberculosis (18.75%) and herpes zoster (6.25%). Females were less likely to develop opportunistic infections compared to males (OR=0.26; 95% CI: 0.12 to 0.57; p=0.0007). Patients not using substances were less likely to develop opportunistic infections (OR=0.32; 95% CI: 0.13 to 0.82; p=0.0170). Those with unhealthy diet practices were significantly more likely to develop opportunistic infections (OR=8.46; 95% CI: 3.56 to 20.53; p

This study aimed to determine the correlation between inter-limb asymmetries and physical per-formance metrics in adolescent female tennis players. Methods: Twenty-five female tennis players (age: 13.29 ± 0.98 years; weight: 52.52 ± 7.31 kg; height: 162.91 ± 6.02 cm) consented to participate in the study. Performance was evaluated using various variables, including bilateral and unilat-eral countermovement jump (CMJ), bilateral and unilateral horizontal jump (HJ), 180º change of direction (180COD) conducted with both the right and left legs, and a 20-m sprint. The systematic bias was evaluated by one-way repeated measures analysis of variance, Pearson’s correlation test for relationships between variables, and the kappa coefficient for consistency in the asymmetry direction. Results Significant relationships were found between CMJ Asymmetry and the varia-bles HJR (r=-0.47) and HJL (r=-0.44). In addition, significant relationships were found between HJ Asymmetry and the variables CMJR (r=-0.60) and CMJL (r=-0.54), HJR (r=-0.64), HJL (r=-0.67), CMJ (r=-0.55) and HJ (r=-0.52). Conclusion Jumping tests are important indicators of performance loss in female tennis players. In addition, no significant correlation was found be-tween the 180COD and performance tests, suggesting that asymmetries in COD do not affect jump performance or speed. Based on these results, it is recommended to integrate individualized pro-grams for each athlete to reduce asymmetries.

Background: Delhi State AIDS Control Society (DSACS) addressed critical integration of services for Orphan and Vulnerable Children (OVC) in context of HIV. They bridged the policy and implementation divide by formulating a multisectoral-strategy in April 2012, creating a model of "Continuum-of-Care for People-Living with HIV (PLHIV), OVC & Children-Affected-by-HIV (ChABH)” in Delhi. With input from the National Commission for Protection of Child Rights, DSACS sensitized political and administrative machinery about needs and challenges related to HIV/AIDS. DSACS developed an incentive-based system for Antiretroviral Therapy (ART) adherence, incorporating safeguards and robust monitoring. Delhi Government's sustained financial commitment and DSACS programmatic-innovation provide a scalable blueprint for India and global initiatives. Description: This ongoing Delhi Government's scheme focuses on household-economic-strengthening of PLHIV as an incentive for broader behaviour change based-on specific eligibility conditions. Beneficiaries fall into four categories: PLHIV, including children on ART; double orphan HIV positive children (OCI); destitute children living with HIV/in institutional care (DCI); and double orphan ChABH in community-based care in Delhi. Category-wise fixed-monthly financial assistance is released to beneficiaries via direct-bank-transfers leveraging Aadhaar-platform to eliminate corruption. Adherence to treatment is mandatory to continue cash-transfers. Linkages with other schemes established to maximize impact. Lessons learned: In its 11-year evolution, Delhi model has grown from 1110 to 6467 beneficiaries, including 6383 PLHIV, 34 double OCI, 50 DCI, and 27 double orphan ChABH, with 5875 (90.8%) currently active excluding beneficiaries who expired (n=328), migrated/ transferred out of Delhi (n=115), opted-out ART/or lost-to-follow-up (n=135), and 14 CABA who turned major. Steady progress and 98% ART adherence mark positive outcomes. DSACS eased eligibility criteria in 2018, facilitating hurdle-free enrollment, while responding to cost-inflation by enhancing financial assistance, showcasing program adaptability. Achieving >95 ART adherence has significantly boosted survival rates, underscoring program's positive impact on beneficiary health. The scheme's INR 14,69,35,600 expenditure in 2022-23, just 0.13% of Delhi Health Department's plan-outlay, signals a cost-effective investment. Extrapolating this nationally would represent 1.5% of India's Health Ministry's current plan-outlay. Conclusions/Next steps: This innovative model is implementable on large-scale in India and around the globe but requires not only financial commitment but also coordinated efforts, policy adjustments, and collaboration between various stakeholders.

(1) Background: The COVID-19 pandemic has raised concerns about the impact of underlying medical conditions on the health outcomes of people living with HIV (PLWH). This study aimed to assess how pre-existing chronic medical conditions affect the health outcomes of PLWH infected with COVID-19. (2) Methods: A retrospective study using data from the Minnesota Fairview network (January 1, 2020 - December 31, 2022) was conducted. Fisher’s Exact Test, Kruskal-Wallis rank sum test, and ordinal logistic regressions with Benjamini-Hochberg (BH) adjustment on p-values were used to assess the influence of chronic conditions on COVID-19 severity, adjusting for age and gender. (3) Results: Among 216 records, significant associations were found for stroke, chronic kidney disease, lung disease, and neurologic conditions (p<0.05). Type 1 diabetes was marginally significant (0.05<p<0.1). After adjusting for age and sex, stroke (p=0.0008, BH-adjusted p=0.0044) and chronic kidney disease (p=0.0003, BH-adjusted p=0.0033) significantly increased the risk of severe COVID-19 outcomes. (4) Conclusions: Pre-existing medical conditions should be considered in the clinical management and public health interventions for PLWH with COVID-19. Tailored strategies are essential to mitigate the higher risk of severe outcomes in PLWH with specific chronic comorbidities.

Healthcare waste presents a global environmental and public health issue, with the U.S. generating over 5 million pounds annually. Hospitals have initiated programs to reduce waste and enhance recycling, with encouraging outcomes. At our tertiary medical center, disparities in municipal waste disposal across departments led to targeted research in the Surgical Intensive Care Unit (SICU). We evaluated the effectiveness of an educational intervention aimed at improving red bag waste management. Pre-intervention audits assessed waste sorting, followed by one-minute staff presentations and infographics near disposal bins. Post-intervention audits revealed a significant reduction in inappropriate municipal waste in red bag bins, analyzed using Fisher’s exact test. Interviews suggested staff lacked recollection of prior red bag waste training, underscoring the value of continuous education. While effective, limitations included sample size and generalizability. Future studies should explore additional strategies to further improve waste disposal practices and address training gaps.

Which measure is the most effective for solving health disparities, biological or economic? It is indispensable to delve into the factors of health disparities to answer this question. Our last paper in this journal analyzed the multi-dimensional factors of psychological health disparity under COVID-19 in Japan. This paper extends the analysis to physical health to explore the issue and proposes the concept of psychosomatic health, bridging the physical and psychological dimensions. It was found that　the factors of physical health disparities were close to those of psychological health. According to this new analysis concerning psychosomatic health disparity, not only biological factors but also socio-economic-political factors are essential for the psychosomatic health disparities in the static analysis． In addition, the ethico-political factor of justice/fairness plays a critical role in the dynamic analysis concerning the suppression of the damage to well-being by COVID-19. The result suggests the importance of multi-dimensional communitarian interventions, utilizing the term in political philosophy: it evaluates societal-community intervention as well as biological, political, and economic measures. Therefore, this study implies that, on this empirical basis, public deliberation with the ethical dimension and counting the relative weight of these factors with the temporal dimension in allocating resources is proposed as a theoretically desirable method of the new comprehensive intervention.

The COVID-19 pandemic led to cancellation of elective surgeries, leading to decreased surgical volume and training for residents. This effect was pronounced in medically underserved areas, such as Far Rockaway, New York. The goal of this study was to understand the impact of the pandemic on surgical volumes at St. John’s Episcopal Hospital, a safety net hospital serving Far Rockaway. Operating Room Data, containing surgical volumes for Ophthalmology and five other surgical branches from January 2018 through February 2022, was analyzed between four waves of the pandemic. For each field, average surgery case counts between the waves were compared using two-tailed t-test. In several fields, there were significant drops in surgical volume between the pre-covid era and the first wave. Ophthalmology cases fell by 29.7% (p

The presence of fecal indicator bacteria in therapeutic mineral waters (TMWs) represents an important factor that can alter their chemical properties and therapeutic effect, correlated with an increased health risk for patients. The purpose of study was to evaluate the interrelationship between the level of contamination with coliform bacteria/Escherichia coli determined by the culture-dependent method and the concentrations of major ions, trace elements and gases in mineral waters that are used for curative or prophylactic purposes. Coliform bacteria showed a degree of survival modulated by the physical-chemical profile of TMWs, their viable count being statistically correlated with T°C, pH, TDS, EC and major ions (Mg2+, Ca2+, Fe2+, Cl-, HCO3-, SO42-). The prevalence of E.coli bacteria was not sen-sitive to the oscillation of the values of T°C; pH; TDS; EC of TMWs, but on the other hand, for the concentration variations of Cl-, HCO3-, total miner-alization from the composition of lakes/bathing pools, a positive correla-tion was identified with its numerical density. For sulfurous TMWs, the results showed a negative correlation between H2S concentration and the level of CB or E.coli, and in carbonated TMWs, CO2/CB values varied di-rectly proportionally, while E.coli evolved numerically independently of CO2 concentration fluctuations, as expected, being aerobe/facultative an-aerobic bacteria.

A vast amount of non-biodegradable waste is generated during mining and processing operations of dimensional stones such as marble. This, over the years has become a global nuisance by damaging the environment through means of more than one. Therefore it has become necessary to find a technique to safely dispose or reuse marble waste. This paper reviews the impact of replacement of the conventional materials by marble waste was studied in terms of fresh, mechanical and durability properties of concrete. The air pollution caused by the dust generated in the process of crushing and extracting marble can cause serious problems to the general physiological functions of plants and it affects human life as well. Therefore, the objectives of this study were to assess the air quality of areas with marble factories and areas without marble factories, where the concentration of particulate matter in terms of total suspended particles (TSP) was determined. This paper also reviews some eco-innovation options considering the pollution caused, consumption of water and electricity and the disposal of marble waste and their waste.

Phubbing - the act of snubbing someone by concentrating on a smartphone - is claimed to be an increasing, even normative, behaviour receiving more research attention. However, evidence about the adequacy of instruments that allow screening for phubbing is limited. Thus, the main purpose of the present study was to analyze the psychometric properties of the Phubbing scale in a sample of adolescents and young adults, and present a reliable and valid short form. The final sample included a total of 1351 adolescent students (54.25% males), aged between 12 and 21. A two-dimensional model of a short version of the PS with 6 items (PS-6) displayed appropriate goodness of-fit indices. Strong measurement invariance for the two-dimensional model across gender and educational level was confirmed. McDonald’s Omega coefficients for the Communication, the Obsession, and the Total score of the PS-6 were 0.617, 0.669, and 0.701, respectively. The PS-6 was positively associated with several indicators of psychological difficulties and negatively associated with psychological well-being and self-esteem. The present study contributes valuable information about the psy-chometric adequacy of the PS-6, a short instrument that allows screening for Phubbing in adoles-cents and young adults.

In Åhlberg (2021, 2022b), I presented evidence for 57 health-promoting substances that all green vascular WEPs contain. I continued searching for health-promoting substances in the plant cells' basic structures and processes. While reading research reports of five invasive species, I found eight more health-promoting substances all green vascular wild edible plants have. This article adds eight new substances to the earlier 57, bringing the total to 65. This is a novel finding for which I provide research evidence. I present the latest research on five invasive wild edible plants (WEPs) species. Each contains at least the same 65 health-promoting substances and a varying number of species-specific health-promoting substances. Each WEP has 1) shared health-promoting substances that all green vascular plants have and 2) species-specific health-promoting substances. I also present how many of these substances prevent Alzheimer’s disease, according to experimental research.

Detection and quantification of disease-related biomarkers in wastewater samples, denominated Wastewater Based Surveillance (WBS), has proven a valuable strategy for studying the prevalence of infectious diseases within populations in a time and resource-efficient manner, as wastewater samples are representative of all cases within the catchment area, whether they are clinically reported or not. However, analysis and interpretation of WBS datasets for decision-making during public health emergencies, such as the COVID-19 pandemic, remains an area of opportunity. In this article, a database obtained from wastewater sampling at wastewater treatment plants (WWTPs) and university campuses in Monterrey and Mexico City between 2021 and 2022 was used to train simple clustering and regression-based risk assessment models to allow for informed prevention and control measures in high-affluence facilities, even if working with low-dimensionality datasets and a limited number of observations. When dividing weekly data points based on whether the seven-day average daily new COVID-19 cases were above a certain threshold, the resulting clustering model could differentiate between weeks with surges in clinical reports and periods between them with an 83.3% accuracy rate. Moreover, the clustering model provided satisfactory forecasts one week (79.2% accuracy) and two weeks (72.9%) into the future. However, the prediction of the weekly average of new daily cases was limited (R2 = 0.452, MAPE = 180.2%), likely because of insufficient dimensionality in the database. Overall, while simple, WBS-supported models can provide relevant insights for decision-makers during epidemiological outbreaks, regression algorithms for prediction using low-dimensionality datasets can still be improved.

A contribution of Epstein-Barr Virus (EBV), Human Cytomegalovirus (HCMV), and certain types of Human Papilloma Virus (HPV) to the overall pathogenesis of upper airways cancers seems a priori reasonably conceivable. The existing evidence mostly relates them to nasopharyngeal squamous and undifferentiated carcinomas; indications emerge about their involvement in other upper airways cancers too. Markers of EBV, HCMV, HPV16, HPV18, (and Mycoplasma pneumoniae as a negative control) were searched in a series of 68 samples of neoplastic tissues from 57 patients diagnosed with different upper airways cancers. The results provide clues in favor of an actual role of EBV, HCMV, and HPV18, in the web of causation of upper airways squamous and undifferentiated carcinomas, possibly of upper airways adenocarcinomas too.

Purpose: The study aims to investigate racial disparities in fall-related injuries among Black and White breast cancer survivors who received chemotherapy, focusing on the risks associated with different chemotherapy regimens. Methods: This retrospective cohort study involved 11,400 breast cancer survivors (Stage 1-3) treated with chemotherapy between January 1, 2019, and December 31, 2023. Chemotherapy types studied include Doxorubicin, Cyclophosphamide, Paclitaxel, Docetaxel, and Carboplatin. Logistic regression and descriptive analyses were used to assess fall risk associated with each chemotherapy type, stratified by race. Results: The overall fall-related injury rate was higher among Black survivors (14.7%) compared to White survivors (10.0%), with a significant difference in fall risk between the two groups (p < 0.001). Fall risk was notably elevated for Black patients treated with Cyclophosphamide, Docetaxel, and Carboplatin. Conclusions: The findings highlight significant racial disparities in fall-related injuries among breast cancer survivors receiving chemotherapy. These disparities may be influenced by socioeconomic factors and healthcare access. Implications for Cancer Survivors: Interventions targeting fall prevention and equitable healthcare access are critical to reducing these disparities among Black breast cancer survivors.

Background: Front-of-package labelling (FoPL) is shown to be effective in assisting consumers make healthier food choices. Several countries are implementing various types of FoPL systems. Objective: This study explored consumers’ perceptions and understanding of three different FoPLs and their insights into features that could influence the effectiveness of the symbols in Kenya Methods: A qualitative study was conducted in four Counties in Kenya; Nairobi, Mombasa, Garissa, and Kisumu. Data was collected through twelve focus group discussions with 137 adults drawn from diverse socio-demographic and socio-economic backgrounds. Three FoPLs were assessed: Red and Green (RG) Octagon, Red and Green Octagon with icons and text (RGI), and the Black Octagon Warning label (WL). The FGDs explored participants’ perceptions of the symbols’ visibility and memorability, their understanding, potential effectiveness, and cultural appropriateness. Printed images displaying four different commonly consumed products bearing specific FoPLs were used during data collection. Data was analyzed thematically and organized using NVivo version 14.0. Results: Results showed that Kenyan consumers had varied perceptions about the proposed FoPL symbols. Majority of the participants found the black Octagon WL to be most visible and memorable due to its good blend of black and white colours. Although the RG octagon symbol and RGI octagon symbols were also found to be eye-catching due to their bright colours, it emerged that the different colours often confused some participants on their meaning. Most participants understood the WL compared to the RG and RGI because they found the additional text more educative. Generally, the WL was preferred as the symbol most likely to influence consumer purchase behaviours and food consumption. All the three FoPLs tested were found to be culturally appropriate. Conclusions: The Black Octagon Warning Label is the most easily visible and understood among the three FoPLs tested and has the potential to influence purchase and consumption behaviours among Kenyan consumers. Although the RG and RGI symbols are visually appealing to many, confusion related to different colours could affect their effectiveness. Consumers need to be educated on the use of FoPLs to ensure they discourage the purchase and consumption of unhealthy foods.

During the Covid-19 pandemic, although the experience of workers and managers was examined, the role, experiences and functions of supervisors was relatively underexplored, with no investigation into their changing health and safety responsibilities. This project attempted to fill this gap. Twenty supervisors across Canada were interviewed for an hour. A Framework Method guided the study. We used a conceptual framework of 10 supervisor functions to help direct the data collection, identify codes, manage and organize the data analysis, and identify major themes which were highlighted in the findings. What was found was that since supervisors did not have access to workers’ homes, they could not execute most of their OHS functions. They were obliged to give workers more control over how and when they worked. They Increased their communications with their workers in response to workers’ psychological health concerns. Notably, supervisors reported that they were under extreme stress. A hybrid work environment, with workers sometimes working at home, has become the new norm. Supervisor stress will continue to escalate unless upper management provides more support, supervisors get training on how to deal with the psychological health and safety of workers, and supervisors’ responsibilities are re-defined for at-home workers.

Introduction: Despite the well-documented benefits of smoking cessation interventions, the implementation and success of these programs in primary care settings often encounter significant barriers. A primary care provider’s personal smoking status has been identified as a potential barrier to tobacco treatment delivery. The aim of this qualitative study is to explore the experiences and perspectives of primary care providers regarding their role in, delivering smoking cessation interventions to patients based on their personal smoking status. Materials and methods: Semi-structured interviews were conducted with 22 primary care providers from 6 public primary care units in Central Macedonia Region, Greece. Thematic analysis was used to analyze data. Results: Healthcare providers who are current smokers may face unique challenges in effectively counseling patients on smoking cessation. On the contrast, non-smoking and especially previous smoking healthcare providers were noted to exhibit greater confidence and efficacy in delivering cessation support, often serving as role models for patients aiming to quit smoking. Participation in structured cessation training programs often catalyzed personal reflection among healthcare professionals regarding their own smoking behaviour. Conclusions: Personal smoking status of primary care providers impacts the delivery of tobacco treatment, affecting their credibility and effectiveness in providing cessation support. Understanding the complex factors that influence the delivery of smoking cessation interventions in primary care is crucial, as these settings represent a vital point of contact for reaching individuals who smoke and providing them with the necessary support to quit.

The relationship between the global climate crisis associated with environmental risks and occupational hygiene has not been extensively studied. This study develops a framework for identifying how climate change and the climate crisis could impact the workplace environment, workers, and occupational morbidity, mortality, and injury. A framework based on a review of scientific literature published from 2012-2024 that addresses climate risks, their interaction with occupational hazards, and their effects on the workforce. Eight categories of climate-related hazards are identified: increased high temperatures, dust and air pollution, sun and cosmic ultraviolet exposure, pandemics, and infectious diseases, diseases transmitted by insects and changes in ecosystems, industrial occupational diseases, changes and crises in the built environment, and extreme weather events. It is important to consider the possibility of interactions between known hazards and new conditions and the productivity of workers, especially those who are most at risk of heat-related illnesses.

A cross-sectional survey was distributed to 1322 members of a 1-on1 personalized strength training studio. 366 respondents (n=134 male and n=232 female), all aged over 20 years reported considerable training experience; 55% of males and 42% of females reporting 5+ years. Data were analyzed and reported descriptively with differences &gt;5% identified based on use of the 5-point likert scale, sample size and nature of the observations. Disparity between males and females were identified; males reported higher perceptions of managing effort, technique, and programming without supervision compared to females. Safety was noted as being more important to females compared to males. Qualitatively, additional themes were raised including analogy of the personal relationship between trainer and trainee being similar to that of medical professionals. This was validated where participants discussed their adaptations from supervised strength training including quality of life in aging, and recovery from medical conditions and injury. Data is discussed in context of a previous body of literature suggesting males falsely report higher confidence in tasks compared to females, particularly in relation to effort, role models, and verbal encouragement. This research proves beneficial for strength training practitioners in enhancing their understanding and expectations of clients, as well as hopefully proving insightful in engaging more people in strength training.

Introduction: Chronic ulcers significantly burden healthcare systems, requiring precise measurement and assessment for effective treatment. Traditional methods, such as manual segmentation, are time-consuming and error-prone. This review evaluates the potential of artificial intelligence (AI)--powered mobile apps for automated ulcer segmentation and their application in clinical settings. Methods: A comprehensive literature search was conducted across PubMed, CINAHL, Cochrane and Google Scholas databases. The review focused on mobile apps that use fully automatic AI algorithms for wound segmentation. Apps requiring additional hardware or needing more technical documentation were excluded. Vital technological features, clinical validation, and usability were analysed. Results: Ten mobile apps were identified, showing varying levels of segmentation accuracy and clinical validation. However, many apps did not publish sufficient information on the segmentation methods or algorithms used, and most lacked details on the databases employed for training their AI models. Additionally, several apps were unavailable in public repositories, limiting their accessibility and independent evaluation. These factors challenge their integration into clinical practice despite promising preliminary results. Discussion: AI-powered mobile apps offer significant potential for improving wound care by enhancing diagnostic accuracy and reducing the burden on healthcare professionals. Nonetheless, the lack of transparency regarding segmentation techniques, unpublished databases, and limited availability of many apps in public repositories remain substantial barriers to widespread clinical adoption. Conclusion: AI-driven mobile apps for ulcer segmentation could revolutionise chronic wound management. However, overcoming limitations related to transparency, data availability, and accessibility is essential for their successful integration into healthcare systems.

Child malnutrition is a critical public health concern that significantly hampers children's physical and mental development and has serious economic repercussions. The World Health Organization (WHO) attributes half of all deaths among children under five to malnutrition, with long-term consequences such as lower educational achievement, decreased productivity, and deepened poverty. The economic impact of child malnutrition extends beyond public health, imposing substantial costs on health systems, households, and the broader economy. This study estimated the burden of child malnutrition in Colombia among children up to four years old using a Markov chain model from a societal perspective. The model simulated six health states, integrating direct and indirect costs, with epidemiological data and international literature guiding the transition probabilities. Surveys were conducted with caregivers to assess indirect costs. Results indicated that malnutrition accounted for 419.84 Disability-Adjusted Life Years (DALYs) per 1,000 inhabitants. The total cost of malnutrition over four years was approximately USD 243.58 million, with an annual average cost of USD 60.89 million, with 65% of the burden falling on households. The findings emphasize the significant economic and health burden of child malnutrition, underscoring the importance of early and comprehensive interventions. Investing in child nutrition can improve health outcomes, reduce economic strain, and enhance productivity, making it a crucial priority in health and economic development agendas.

Breast cancer is currently the second leading cause of death worldwide, accounting for 15% of all deaths (8.2 million deaths). Approximately 20% of breast cancer diagnoses are triple-negative breast cancer (TNBC), a type of cancer that lacks receptors for estrogen (ER negative), progesterone (PR negative), and human epidermal growth factor receptor 2 (HER2/neu negative). Consequently, TNBC doesn’t respond to hormonal or targeted therapies, making it challenging to treat due to its rapid growth, metastasis, and high recurrence rate within the first three years of therapy. Alternative chemotherapies are needed to address this problem. Pharmacological dose of vitamin C (high-dose VC) has been identified as a potential treatment for some cancer cells. The present study aimed to evaluate whether VC has a therapeutic effect on TNBC using MDA-MB-231 cells as the model. MTT assay, Hoechst 33342 staining, Nuclear ID Red/Green staining, Rhodamine 123 staining, and Western blot analysis were employed to test the hypothesis that pharmacological dose of VC can kill TNBC cells. Upregulation of Apaf-1, caspases -3, -6, -7, -8, and -9, inhibition of matrix metalloproteinases (MMP-2 and MMP-9), reduction in cell cycle protein expression, and enhancement of tumor suppressor proteins such as p53 and p21 indicated that pharmacological dose of VC has promising anti-cancer properties in the treatment of TNBC.

Background/objective: Weight regain after bariatric surgery has serious health consequences, and disordered eating behaviors (DEB) may be involved in it. We compared DEB symptoms after bariatric surgery between patients with low vs. high ratio of weight regain (RWR) and investigated associations between DEB symptoms with weight regain and time since surgery. Meth-od: Ninety-four patients who had undergone laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy and had not attended follow-up with the multidisciplinary healthcare team for at least one year were recruited. RWR was calculated with respect to maximal weight loss by the nadir weight achieved after surgery. They were allocated into two groups according to the RWR, defined as high RWR (≥20%) or low RWR (

Background: Gait analysis systems are crucial for rehabilitation but are often time-consuming and less accessible in low and middle-income countries like Brazil. GAITWell^® was developed to address these challenges with its modular and portable design for automated gait data extraction and analysis. This study evaluates its methodological properties. Methods: GAITWell^® uses discrete binary sensors on interconnected plates to collect gait data, analyzed via the DBSCAN algorithm. Each plate measures 44 cm x 37 cm and features an 11 x 7 discrete sensor array with 4 cm spacing. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC), standard error of the mean (SEM), and Bland-Altman plots. Concurrent validity was evaluated by comparing the GAITWell^® measurements with those obtained from the Qualisys Pro-Reflex through correlations. Results: Participated 38 healthy young adults, including 18 females (47.4%). The sample had an average age of 33.2 years (SD 13.0) and an average BMI of 26.6 kg/m² (SD 5.4). Correlations between GAITWell^® and Qualisys ranged from moderate to very high for most gait variables, except stride length (r = .360, p < .05). ICC_2,1 showed moderate to good agreement for most variables, except for double support times, cadence, and base of support. Preliminary analysis suggests that increasing the sensor resolution to 1.2 cm x 1.2 cm could potentially decrease the measurement error from 2 cm to 0.6 cm, representing a theoretical reduction of 70%. Conclusions: While low resolution affected GAITWell^® reliability, it remains a promising tool. Future research should focus on enhancing sensor accuracy to improve reliability.

Abstract: Despite the significant advancements in hearing aid technology, adoption rates remain low, with stigma continuing to be a major barrier. This review aims to systematically assess the origins and current state of hearing aid stigma, as well as explore potential strategies for allevi-ating it. The review examines societal perceptions, psychological impacts, and recent technolog-ical advancements that can influence hearing aid adoption and reduce stigma. Methods: A systematic review of literature from peer-reviewed journals and reputable sources was conducted, analyzing papers on hearing aid stigma, adoption rates, and technological solu-tions. The articles were categorized by their focus on either stigma causes, societal factors, or technological advancements aimed at improving adoption. Results: The review identifies stigma as a complex, multifaceted issue driven primarily by ageism, disability perception, and the association of hearing aids with aging and incapability. Despite technological improvements, the studies surveyed listed stigma as a major factor in non-adoption. Technological advancements such as artificial intelligence in sound processing, multifunctional features, and innovative design have shown potential in reducing stigma and improving user experience. Conclusions: Alleviating the stigma of hearing aids requires a multi-pronged approach, com-bining improvements in technology with changes in societal perceptions. Multifunctional devices, advanced signal processing, and aesthetic improvements can drive adoption, but broader public health campaigns and education are also essential to changing societal attitudes and fostering greater acceptance of hearing aids.

Background/Objectives: This study aimed to evaluate the effects of an 8-week combined plyometric and resistance training program on the physical fitness of adolescent girls aged 12 to 15 years. The objective was to determine whether combined training (CT) would yield greater improvements in performance measures compared to resistance training (RT) alone. Methods: Forty-seven adolescent girls were randomly assigned to either the CT group or the RT group. Performance measures such as the 20-meter sprint, squat jump, vertical jump, handgrip strength, and flexibility (sit and reach test) were assessed before and after the 8-week interven-tion. Changes in these measures were analyzed to compare the effects of the two training ap-proaches. Results: The CT group showed a significant reduction in sprint time (-6.5%) compared to the RT group (-4.1%), although the difference was not statistically significant. Squat jump height im-proved significantly by 5.6% in the CT group compared to 1.1% in the RT group (p < 0.05). Simi-larly, vertical jump height increased by 6.7% in the CT group and by 2.4% in the RT group (p < 0.05). Handgrip strength improved by 7.5% in the CT group and 4.6% in the RT group, with no significant differences between the groups. Flexibility showed slight, non-significant improve-ments in both groups. Conclusions: The findings suggest that combined plyometric and resistance training is more ef-fective in enhancing explosive power, specifically squat and vertical jump performance, in ado-lescent girls compared to resistance training alone. These results highlight the potential of com-bined training programs for improving overall physical performance in this population.

Compounds of natural origin found in varying quantities in plant-based products constitute a highly significant category, possessing structural significance as well as the capacity to regulate oxidative processes. The activity of these compounds may be modulated by the composition of the biological milieu in which they operate, the pH of the environment, or the presence of metal cations in plants or plant extracts. This work shows the synthetic methodology and the optimization process that took place to synthesize a catechin-copper complex which demonstrated antioxidant activity tested for iron chelation ability, hydroxyl radical test and inhibition of lipoxygenase (15-LOX) activity. Antidiabetic assay was performed by determination of the alpha-amylase and alpha-glucosidase inhibition assays and the antibacterial activity showed results against Staphylococcus aureus and Candida albicans. The complex was characterized by FT-IR, UV-VIS and EDX techniques and the biological activity assays were tested in triplicate to fully confirm the activity.

In December 2019, the so-called “coronavirus disease 2019” (COVID-19) began. This disease is characterized by heterogeneous clinical manifestations, ranging from an asymptomatic process to life-threatening conditions associated with a “cytokine storm”. This article (narrative review) summarizes the epidemiologic characteristics and clinical manifestations of COVID-19 and multi-system inflammatory syndrome in children (MIS-C). The effect of the pandemic confinement on vitamin D status and the hypotheses proposed to explain the age-related difference in the severity of COVID-19 are discussed. The role of vitamin D as a critical regulator of both innate and adaptive immune responses and the COVID-19 cytokine storm are analyzed. Vitamin D and its links to both COVID-19 (low levels of vitamin D appear to worsen COVID-19 outcomes) and the cytokine storm (anti-inflammatory activity) are detailed. Finally, the efficacy of vitamin D supplementation in COVID-19 is evaluated, but the evidence supporting vitamin D supplementation as an adjuvant treatment for COVID-19 remains uncertain.

Background/objective: Background: Eating behaviors (EB) correlate with weight loss after bariatric surgery (BS). Therefore, investigation of EB could guide interventions before the achievement of insufficient weight outcomes. Method: A prospective cohort of 85 patients undergoing Roux-en-Y Gastric Bypass (RYGB, 84.7% female, mean age 44.7±9.3 years) was included. After six months from RYGB, EB patterns, including cognitive restraint (CR), uncontrolled (UE) and emotional eating (EE), were assessed using the Three-Factor Eating Questionnaire R21 (TFEQ-R21). History, physical examination, and anthropometric assessment were collected pre- and 12 months postoperative. Patients were divided based on the percentage of excess weight loss (%EWL&lt;80% or ≥80%) and EB patterns were correlated with weight outcomes at 12 months. Results: The %EWL≥80% group demonstrated significantly higher scores in CR and EE compared to %EWL&lt;80% (p&lt;0.001 and p=0.01, respectively). UE scores were similar between groups (p=0.41). At 12 months postoperative, the %EWL≥80% group had negative correlations between CR and BMI and positive correlations between CR and EWL (rho=-0.33 and rho=0.29; p=0.04). Multiple logistic regression considering %EWL≥80% as the aim outcome revealed that CR had a significant influence (OR=1.037; p=0.058), while age (OR=0.962; p=0.145), sex (OR=2.984; p=0.135), UE (OR=0.995; p=0.736), and EE (OR=1.017; p=0.296) did not. Conclusion: EBs influence outcomes after BS, and a model using TFEQ-R21 predicted them. CR six months post-surgery was the strongest predictor of higher EWL at 12 months. Further research is needed to understand the relationship between restrictive EB and BS outcomes, possibly identifying strategies to prevent disordered EB in patients with higher scores.

Common hops (Humulus lupulus L.) are essential in brewing, contributing to the bitterness, flavor, and aroma of beer, and are widely used in supplements for their antibacterial, anti-inflammatory, and antioxidant properties. However, despite their broad applications, the allergenic potential of common hops remains underexplored, particularly in comparison to the closely related Humulus japonicus. This study aimed to investigate the allergenic potential of common hops. Immunoreactivity of hop stalks, leaves, and cones with antibodies recognizing major allergens of birch (Bet v1a), mugwort (Art v1), and timothy (Phl p5b), as well as three sera from pollen-allergic patients, was assessed using slot blot and Western blotting techniques. Phosphate-buffered saline extracts of hop stalks, leaves, and cones from three cultivars were analyzed via slot blot while Western blotting was used after SDS-PAGE protein separation. Results revealed strong immunoreactivity in native hop proteins, although fewer protein fractions were identified in denatured samples. Nevertheless, the cross reactivity of hop proteins with pollen allergens was confirmed, suggesting that hop proteins may contribute to sensitization in pollen-sensitive individuals. These finding focus the potential allergenic risk of common hops.

Red blood cell (RBC) alloimmunization and antibodies formation against non-self-antigen on red cells may occur after blood transfusion, pregnancies or other exposures. The RBC alloimmunization rates varies from 2% to 6% according to recent studies. The antibody screen is performed to identify or confirm the presence of antibodies in patient’s serum or plasma, as a preoperative or pretransfusion tests. The antibody identification process and major crossmatch are provided to improve the safety of red blood transfusion administration. I report three examples associated with clinically significant single and multiple alloantibodies. Ultimately, I summarize key points for a clinical transfusion practice.

Background: The dynamic nature of today’s organizations, inclusive of educational institutions require employees to have self-leadership attributes. Several factors in an academic environment can affect the self-leadership necessary for the optimal performance of nurse educators. This study aims to explore nurse educators’ understanding of self-leadership and their perspectives on how this phenomenon can be promoted to create a healthy work environment in an educational setting. Methods: An exploratory, descriptive qualitative design was adopted. Data were collected through focus group interviews with nurse educators at four educational institutions in South Africa, then subjected to Tesch’s qualitative content analysis. Results: Two themes emerged, namely, Self-leadership means nurse educators being supported to take own initiatives, with its four sub-themes, and A supportive healthy academic work environment, with its four sub-themes. Conclusions: Aca-demic institutions who work collaboratively with nurse educators and support them in self-leadership practices contribute to the creation of healthy work environments.

Limited evidence on hepatitis A seroprevalence among HIV-exposed uninfected (HEU) children compared to their HIV infected (HIV) and unexposed uninfected (HUU) counterparts compromises rational vaccine decision-making. This study comprised of a retrospective health facility-based population of children aged 1 month – 12 years. Archival sera were tested for markers of acute (anti-HAV IgM) or past (total anti-HAV) HAV infection. Subgroup analysis was conducted based on HIV exposure or infection status. Of 513 participants, 54% (277) were male and the median age was 10 (IQR: 4 – 25) months. The median maternal age was 29 (IQR: 25 – 34) years. An anti-HAV seropositivity of 95.1% (117/122 [95% CI 90.2-98.4]) was found among those ≤6 months of age, indicative of the rate of transplacental antibody transfer. Among 1–12-year-olds, hepatitis A seroprevalence was 19.3% (37/192 [95% CI 14.1-25.7]), while 1.1% (2/188 [95% CI 0.12-2.76]) had evidence of acute infection. Compared to HIV-exposed subgroups (HIV=60%, 6/10 [95% CI 27.4-86.3] and HEU=45%, 9/20 [95% CI 23.8-68]), hepatitis A seroprevalence among HUU children was low (29.2%, 47/161 [95% CI 22.4-37.0]). Natural immunity among HIV -exposed and -unexposed children in South Africa is insufficient to protect against severe liver complications associated with HAV infection later in adulthood.

Background: Bloodstream infections (BSIs) pose a major health risk to hemodialysis patients, significantly contributing to morbidity and mortality. This study aimed to identify the bacterial pathogens responsible for BSIs in this population, analyze clinical and laboratory profiles, and identify risk factors associated with poor outcomes. Methods: This retrospective study was conducted at Sohar Hospital, Oman, analyzing cases from January 2018 to December 2022. Data were obtained from e-health records, focusing on patient demographics, bacterial etiology, antibiotic susceptibility, and clinical outcomes. Statistical analysis included t-tests, Mann-Whitney tests, chi-square, and Fisher’s exact tests, with univariate odds ratios calculated for mortality associations using the R package GTSUMMARY. Results: Among 1332 hemodialysis patients, 148 (11.1%) developed a BSI, with an average age of 60.43±14.46 years. Infections were more common among females (54%) and those over 60 years. The predominant comorbidities were hypertension (86%) and diabetes mellitus (74%). The main causative agents were coagulase-negative staphylococci (29.7%), Staphylococcus aureus (20.3%), Pseudomonas aeruginosa (12.2%), and Klebsiella pneumoniae (8.8%). Gram-negative bacteria showed high susceptibility (80-100%) to carbapenems and piperacillin-tazobactam, while Gram-positive bacteria exhibited 80-100% susceptibility to amoxicillin-clavulanic acid and universal sensitivity to linezolid and vancomycin. Conclusions: BSIs in hemodialysis patients at Sohar Hospital are associated with high morbidity and mortality rates, underscoring the need for prompt empirical antibiotic therapy and targeted treatment adjustments based on culture results. This study highlights critical mortality-associated factors, offering valuable insights for improving patient management and survival outcomes in this vulnerable population.

Background: Cancer remains a leading cause of death worldwide. The progress in effective treatment has been hampered by challenges in personalized therapy, particularly in patients with comorbid conditions. The integration of artificial intelligence (AI) into patient profiling offers a promising approach to enhancing individualized anticancer therapy. Objective: This narrative review explores the role of AI in refining anticancer therapy through personalized profiling, with a specific focus on cancer patients with co-morbid migraine. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Google Scholar. Studies were selected based on their relevance to AI applications in oncology and migraine management, with a focus on personalized medicine and predictive modeling. Key themes were synthesized to provide an overview of recent developments, challenges, and emerging directions. Results: AI technologies such as machine learning (ML), deep learning (DL), and natural language processing (NLP) have become instrumental in discovery of genetic and molecular biomarkers to cancer and migraine. These technologies also enable predictive analytics for assessing the impact of migraine on cancer therapy in co-morbid cases, predicting outcomes and provide clinical decision support systems (CDSS) for real-time treatment adjustments. Conclusion: AI holds significant potential to improve the precision and effectiveness of cancer management and therapy, particularly for cancer patients with co-morbid migraine. Nevertheless, challenges remain over data integration, clinical validation, and ethical consideration, which must be addressed to appreciate the full potential for outlines approach.

Background: Intestinal helminthiases and schistosomiasis are among the neglected tropical diseases targeted by the World Health Organization (WHO) for elimination as a public health issue by 2030. For this, it is important to determine their distribution and predicting factors, after a decade of mass deworming campaigns. In particular, such information is scarce among pre-school aged children who have not been the target for epidemiological studies and schistosomiasis deworming activities. This cross-sectional study and secondary data analysis focused on preschool-aged children and was aimed to determine the prevalence of intestinal helminthiases (Ascaris, ankylostoma, trichirus trichura, taenia) and Schistosomiasis, and identify the factors associated with them in Rwanda.

Methods: Data from 4,675 preschool-aged children randomly selected from 17 districts endemic to Schistosoma mansoni were analyzed. Parasitological assessment was performed using the Kato Katz technique. Having at least one intestinal helminthiasis or schistosomiasis case was considered a positive outcome. A structured questionnaire for childcare guardians, literature, and GIS were used to collect information regarding environmental factors. Data were aggregated at village level to calculate village prevalence used in depicting the distribution of intestinal helminthiases and schistosomiasis. Descriptive analysis was performed, and prevalence was assessed as a measure of frequency. The chi-square test was used for bivariate analysis whereas logistic regression was used for multivariable analysis. The confidence level was set at 95%, and the decision was made based on the P-value. Odds ratios (ORs) were assessed as a measure of association. STATA 15 and ArcGIS software were used in this study.

Results: The prevalence of intestinal helminthiases and schistosomiasis among preschool-aged children was 20.3%. Ascaris was the most prevalent parasite in this study (15%). Being older than 24 months, having self-employed parents, residence, fetching water into the lake or water body, land cover, clay soil, and high LST are predictors of intestinal helminthiases and schistosomiasis among preschool-aged children in Rwanda.

Conclusion: The prevalence of 20.3% is moderate and in the march towards the elimination of these parasitic infections, deworming activities should be coupled with water supply, reinforcement of the use of Early Child Development (ECD), relocating people living in proximity of wetlands and water bodies, and health education are key interventions in preventing preschool-aged children to get intestinal helminthiases and Schistosomiasis.

Healthcare is undergoing a technological transformation, particularly in robotic surgery and arti-ficial intelligence (AI) applied to cytology. These innovations are improving the precision and effi-ciency of both surgical procedures and laboratory diagnostics. Robotic systems, such as the Da Vinci, enable surgeons to perform complex procedures with enhanced control and precision, leading to minimally invasive surgeries with reduced recovery times. This technology has signifi-cantly impacted urological, cardiac, and gastrointestinal surgeries, and its use is expected to grow. In cytology, AI automates the analysis of cell samples, leading to faster and more accurate diag-noses, especially in detecting diseases like cervical cancer. AI reduces errors and enhances diag-nostic accuracy by identifying complex patterns in cellular images. Predictive analytics, driven by big data, also allows for personalized treatments based on patient-specific data. However, these technologies face challenges, including high costs, ethical concerns, data privacy issues, and resistance from healthcare professionals. Continuous training is essential for medical personnel to effectively adopt these tools. Furthermore, the rise of telemedicine and telesurgery, supported by advancements in 5G, offers new opportunities for remote care but also introduces risks, such as depersonalization of medical care and technological barriers. Ultimately, while robotic surgery and AI hold great promise for improving clinical outcomes, their successful integration will depend on addressing these challenges and ensuring that healthcare professionals are adequately prepared for the digital future.

Background: Physical-sports habits in adulthood constitute one of the predictors of physical, psychological and social health within healthy lifestyles. Methods: The Acquired Healthy Lifestyle Assessment Scale was applied to a sample of 788 subjects between the ages of 22 and 72 and the dimension that makes up physical-sports practice habits was analyzed. Results: 74.4% of adults have habits of physical sports practice that are not healthy or unhealthy, 18.8% tend towards health and only 6.9% are healthy. Pearson's 2 tests show a significant association between men and healthy habits, without observing changes associated with the age variable. The t-student and one-factor ANOVA tests confirm the relationship between the level of health and physical-sports practice habits depending on sex and age. Conclusions: It is necessary to promote preventive programs to increase participation in the practice of physical and sports exercise in the adult population that has unhealthy or unhealthy levels of lifestyle.

Mosquito-borne diseases are a major public health issue. The United States has experienced mosquito-borne disease outbreaks, including West Nile virus, Zika, dengue, and malaria, highlighting widespread risk across the country. In the United States, exposure to mosquito vectors primarily occurs outdoors. Individuals experiencing unsheltered homelessness are particularly vulnerable to mosquito-borne diseases due to their increased exposure to mosquito vectors, limited access to healthcare, and high prevalence of underlying conditions. This review aims to examine the literature on mosquito-borne disease infections among individuals experiencing homelessness in the United States between 1999 and 2024. Our search strategy used Boolean methods on PubMed, Scopus, and Web of Science to select relevant publications. Two queries were used: the first query focuses on individuals experiencing homelessness and mosquito-borne diseases, and the second one focuses on epidemiological analyses of mosquito-borne disease outbreaks in the US. Only studies reporting at least 1 infection among individuals experiencing homelessness were included. Our search resulted in the identification of 347 studies. After screening them, 8 were ultimately included in this review. Half of the studies identified West Nile virus among individuals experiencing homelessness and the other half reported cases of malaria. These studies show that individuals experiencing homelessness are more exposed to mosquitoes, face a higher risk of infection, and have an increased likelihood of hospitalization due to mosquito-borne diseases compared to the general population. The full extent of mosquito-borne disease exposure among individuals experiencing homelessness remains unclear. With climate change and globalization, there is a consensus in the literature showing an increasing risk of mosquito-borne disease transmission in the next decades, and we have already started to witness this increasing trend. Therefore, we argue that developing policies aimed at providing homeless populations with housing during mosquito-borne disease outbreaks could be instrumental in protecting this segment of the population and promoting health equity.

Background/Objectives: To understand the lived experiences of the informal caregivers of people with chronic noncommunicable diseases and their interpretations of the significance of that care. The perspectives of men and women interacting with people in a situation of chronicity are examined. Methods: This qualitative phenomenological-hermeneutic study was based on Van Manen’s comprehensive and interpretative vision. Criterion-oriented non-probability random sampling was used. In-depth interviews were used to collect the information. Twenty caregivers participated in the study. Results: The following five themes emerged: transformation of the caregiver’s world; uncertainty of care; tireless guardianship and unwavering devotion; isolation and emotional exhaustion; and imbalance between caring for others and the self. Conclusions: The experience of informal caregivers reveals that both men and women face significant challenges, albeit from gender-differentiated perspectives and experiences. Men and women elaborate different meanings of caregiving, reflecting their gender roles and expectations. Therefore, an inclusive and equitable approach that recognizes and addresses these gender differences is essential in order to improve the support and quality of life for all informal caregivers, respecting and valuing their unique voices and experiences. An inclusive and equitable approach that recognizes gender intersections is required to improve support and the quality of life for caregivers.

Introduction: Early childhood caries is a significant public health problem among preschool children. The COVID-19 pandemic, which restricted dental services, altered family dynamics, affected child development, and created new demands on caregivers, may have exacerbated this issue. Objective: Analyze the occurrence and severity of caries and identify associated factors in preschool children attending public municipal daycare centers in Salvador, Bahia, Brazil, Methodology: A cross-sectional epidemiological study was conducted to investigate caries in children aged 2 to 5 years in 2022 and 2023. Caries was assessed using the decayed, extracted, filled, and missing teeth (DEFT) index, and prevalence was calculated. Sociodemographic, family dynamic, dietary, and healthcare utilization data were obtained through a questionnaire. After descriptive and exploratory analyses, robust Poisson multivariable regression was conducted at a 5% significance level, considering socioeconomic, psychosocial, and behavioral aspects. Results: A total of 440 preschoolers participated, with a mean age of 55 months. The majority were Black or mixed race (88.86%) and female (52.73%). The prevalence of caries was 30.91% and the mean DEFT score was 1.1. In the multivariable analysis, low family income (up to one minimum wage) and not playing outdoors during the pandemic were associated with a higher prevalence of caries. Conclusion: The prevalence and severity of caries remain high, and the pandemic has contributed to the maintenance of this epidemiological scenario. Public health measures and policies promoting social justice should be planned to improve oral health conditions in childhood

Background: Over the past two decades, the Copenhagen Psychosocial Questionnaire (COPSOQ) has been established as a valid instrument to measure psychosocial stress at work. Currently, the COPSOQ international network is responsible for monitoring and improving COPSOQ. In 2019, a new questionnaire was published, and the Greek version is now being validated. Methods: The measurement qualities of the Greek COPSOQ III have been explored in accordance with the usual requirements of a validation study as defined by DIN EN ISO 10075-3. A sample of observations from 2,189 participants surveyed with the COPSOQ in Greece was used to validate the current version with appropriate statistical analyses. Exploratory factor analysis was used to assess the statistical relationships for many scales. Results: With its 108 items and 40 scales, the Greek COPSOQ III includes all psychosocial work factors that have been internationally validated and remain compatible with approximately 72% of the COPSOQ III German version content. In addition to the primary results, congruence with widely used theoretical approaches such as the demand-control (−support) model (DCM) or the job demands-resources model (JDR) is generally satisfactory. In summary, our validation study for the Greek COPSOQ III version showed adequate reliability and validity, which is in line with the findings of the COPSOQ III questionnaire from other European countries, and it is also compatible with the validation of the German COPSOQ III (Lincke, 2021). Our regression analysis revealed that 34 psychosocial work factors (34 “context” scales) could adequately predict the scores of the satisfactory and health scales (6 “outcome” scales). The analysis also revealed the top five (5) predictors (context variables) for each of the six (6) “effect” scales (outcome variables). Conclusions: With the launch of COPSOQ III in Greece, current and new workplace psychosocial aspects could be explored. COPSOQ III (GR) is a beneficial instrument for enterprise research and risk assessment.

Two-Dimensional Nuclear Magnetic Resonance (2D NMR) spectroscopy has become a cornerstone in pharmaceutical research, offering enhanced structural elucidation capabilities for complex molecules. This technique overcomes the limitations of one-dimensional (1D) NMR by providing detailed insights into molecular interactions through the use of advanced spectroscopic methods like COSY, HSQC, and HMBC. In pharmaceutical applications, 2D NMR plays a crucial role in drug characterization, quality control, formulation development, and the structural analysis of natural products. Recent technological advancements such as high-field spectrometers and cryogenic probes have further improved the sensitivity and resolution of 2D NMR, making it indispensable for ensuring drug quality and intellectual property protection. This article delves into the principles and applications of 2D NMR in the pharmaceutical industry, highlighting its critical contributions to drug discovery, development, and quality assurance. Additionally, it addresses the future prospects of 2D NMR in areas like metabolomics, structural biology, and the development of new analytical tools. Despite its numerous advantages, 2D NMR presents challenges such as high operational costs, complexity in data analysis, and sensitivity issues when dealing with low-concentration samples. The article concludes by discussing the ongoing advancements in 2D NMR technology and its evolving role in pharmaceutical innovation.

The measurement of shoulder range of motion (ROM) has gained value within the healthcare field. Thanks to modern technology, goniometers have been developed as mobile applications; however, the reliability and validity of many of these apps have not been established. Such is the case of reliability of the OnForm app and validity of the My ROM app, object of this study. Methods: With data obtained from both apps from the measurement of bilateral external and internal rotation (at 90º of shoulder abduction) of 49 subjects, four different tests were run: inter-observer, test-retest, and intra-observer and one for validity. The statistical method applied was the intraclass correlation coefficient (ICC). Results: Both, OnForm and My ROM obtained in all the tests, significant results that prove that they are valid and reliable tools for athletes’ assessment. Conclusions: Both OnForm and My ROM are valid and reliable tools for daily use in clinical practice. They may be used by a single evaluator, they are easy to find with a convenient price, and the availability of the results is immediate.

Objective: To explore the acceptability and feasibility of conducting comprehensive, community-based, hy-brid (in-person and virtual) mental health screening and feedback with diverse youth in the community. Methods: The Screening and Support for Youth intervention provides comprehensive assessment and thera-peutic feedback in community settings including symptoms, diagnoses, functional impairment, suicide, and clinical risk. Symptom severity, seven diagnoses and suicidality were assessed with the Kiddie Computer-ized Adaptive Test. Functional impairment was evaluated by youth self-report on the Weiss Functional Im-pairment Rating Scale. Measures were scored according to nationally developed norms and an algorithm was developed to aggregate symptoms and functioning to determine clinical risk. The results were discussed with participants in a motivational interview to promote insight and engagement in an online intervention. Results: Methodological innovations included using a QR code for recruitment, integrated in-person and virtual participation, and expansion from in-person recruitment within the schools to virtual engagement with youth throughout the community. The final sample included disproportionately more Black or African American and Hispanic youth as compared to school and community statistics, suggesting that hybrid re-search may facilitate recruitment of diverse populations. Qualitative interviews indicated that the screening and feedback raised youth awareness of their wellbeing and/or distress, its impact on their functioning, and engagement with options for improving wellbeing. Conclusion: Hybrid research, developed as a necessity during the pandemic, proved advantageous to the feasibility and acceptability of community-based recruit-ment of at risk, minoritized youth.

On average, one in ten patients die because of a diagnostic error and medical errors are the third largest cause of death in the US. While LLMs have been proposed to help doctors with diagnoses, no research results have been published on comparing the diagnostic ability of many popular LLMs on an openly accessible real-patient cohort. In thus study, we compare LLMs from Google, OpenAI, Meta, Mistral, Cohere and Anthropic using our previously published evaluation methodology and explore improving their accuracy with RAG.

The sustainability of social security is increasingly important to countries worldwide, yet the impact of regulation on social security remains controversial. Most scholars and policymakers focus primarily on the influence of social regulation on social security, while to varying degrees neglecting the effects of market regulation. This study employs data on the relaxation of market regulation (RMR) from the Marketization Index of China’s Report (MICR) and balanced panel data for 31 provinces in China from 2008 to 2019. Using instrumental variable methods to address endogeneity issues in the model, we empirically evaluate the impact of China's RMR on the level of social security (SSL) and its underlying mechanisms. The conclusion indicates that for every standard deviation increase in the intensity of RMR by local governments, there is a 2.25% increase in SSL. The study also found that social security expenditure and efficiency serve as mediating variables for the impact of RMR on SSL, but it did not support the mediating role of social security fairness. These findings offer valuable insights for optimizing regulation and social security reform in China, as well as useful references for other emerging market economies in identifying priorities for their coordinated regulatory and social security reform.

Objectives: Marburg virus disease (MVD), caused by the Marburg virus, is a severe zoonotic viral hemorrhagic fever with high mortality that threats the Global Health Security. Marburg virus is on the WHO list for the next pandemic-prone pathogens it always emerges in outbreaks. Considering it is current involvement in outbreak in Rwanda, there is an urgent need for up to date information to inform policymaking, resources mobilization, strategic planning and guide the implementation of cost-effective response strategies. Methods: Through technical and scientific consultancies with experts and reviewing publicly existed knowledge, we collected and synthesized available information about the disease and summarized it into a brief evidence to inform policymakers, public health leaders, and frontline responders in developing and implementing cost-effective prevention and control measures. Results: We have identified the historical outbreaks and geographical distribution of MVD, main clinical signs and diagnostic tools, primary reservoir, transmission dynamics and case management protocol. More importantly, we summarized the best practices for multisectoral One Health strategy for the prevention and control of MVD outbreaks including strict implementation of WASH and infection prevention measures, isolation of infected humans and animals, contact tracking for confirmed cases, and International Health Regulations (IHRs 2005). High risk populations such as frontline responders including healthcare providers and community health worker should be prioritized for the experimental vaccination. Conclusions: In lack of licensed treatment or vaccine, cost-effective preparedness and response strategy to MVD should focus on preventive measures including community engagement, reduced contact between humans and reservoirs, supportive care and isolation of patients, and proper waste management.

Chronic neck and back pain is prevalent among dental professionals, stemming from the static and often awkward positions required during clinical practice. This longitudinal study investigates the effectiveness of Refractive loupes, an ergonomic intervention, in mitigating such musculoskeletal issues among undergraduate dental students. Despite being advocated for posture improvement, traditional loupes may exacerbate neck pain due to prolonged static neck positions. However, the impact of ergonomic loupes, designed to maintain neutral neck positions, remains unexplored.This study enrolled undergraduate dental students from the UK and Australia, provided them with Refractive loupes, and tracked their neck and back pain scores over two years. Participants completed pre- and post-intervention questionnaires assessing pain levels, posture, and loupe use history. Results indicate a significant reduction in pain incidence (15.5%) post-refractive use, with 30.6% of participants reporting pain at the study's end compared to 46.1% at the beginning of the study. Notably, 92.3% reported improved posture ratings despite 39.1% experiencing increased pain, suggesting additional factors contributing to pain development beyond posture alone.Further analysis reveals that later adoption of Refractive loupes correlates with increased pain, suggesting a potential preventive benefit if initiated earlier in dental education. Additionally, a comparison of traditional loupe users with their non-loupe-using counterparts indicates more significant pain reduction among the loupe-using cohort post-refractive use, highlighting the need for more extensive studies in this area.In conclusion, Refractive loupes effectively reduce musculoskeletal pain among undergraduate dental students. Nevertheless, challenges persist, warranting continued research into optimal intervention timing and the role of the loupe type used in pain mitigation.

Wastewater-based epidemiology (WBE) is a promising approach that has been used to monitoring the exposure to pathogens and understanding the status of disease outbreaks in defined population groups. Viral RNAs of SARS-Cov-2 and influenza A and B were detected and quantified by two commercial kits in three wastewater treatment plants (WWTP) selected in different regions of Canton Ticino (Switzerland). We have monitored the presence of SARS-CoV-2 during two big waves of pandemic, from March 2021 until June 2023, when number of confirmed cases and tests decreased. The presence of influenza A and B viruses was investigated from October 2022 to June 2023. We confirmed the presence of SARS-CoV-2 and influenza A and B in all the WWTP monitored; RNA concentration in wastewater could be correlated with clinical cases confirming that WBE is a powerful tool to monitor diseases dissemination supporting the management of an epidemic.

Regulation (EU) 2016/429 establishes new extensive guidelines for managing transmissible animal diseases, including zoonoses. The Commission Implementing Regulation 2018/1882 classifies diseases into five categories based on their prevalence and the required response, ranging from eradication to surveillance. Key aspects of the regulations concern emphasis on animal traceability, biosecurity, wildlife pathogen control, sustainable farming, and the reduction of the impact of diseases on both public and animal health, as well as on the environment. These align with the European Green Deal, the Farm to Fork Strategy and the One Health approach. In Italian inner areas—similarly to other European regions that are fragile, remote from major service centers, and often neglected—agropastoral and agri-food activities are beneficial for tourism, commercialization of typical foods, and recreational activities. In these areas including the Molise Region, the activation of optional programmes within the framework of the aforementioned regulations could help control infectious animal diseases that are not subject to mandatory eradication but cause income loss and trade restrictions, such as infectious bovine rhinotracheitis and paratuberculosis, a suspected zoonosis potentially linked to Crohn's disease in humans. These programmes could boost the economic income of local extensive breeding, counteract depopulation, and protect human and animal health.

Background: Rabies, a zoonotic disease caused by the Lyssavirus genus, is widely distributed and a significant cause of human death in Africa and Asia. This study aimed to investigate human rabies exposure and associated risk factors in Northwest Ethiopia. Methods: The study encompassed four zones, seven districts, and four kebeles from each district. The research team developed a questionnaire for data collection. Results: A total of 642 households were interviewed. The present study highlighted an exposure to rabies of 10.47%.”. Over 98% of residents displayed a strong understanding of rabies, with 99.69% correctly identifying rabies as a zoonotic disease. However, 80.22% of the interviewees believed that traditional medicine can treat the disease. Only 21.93% of victims were subjected to post-exposure prophylaxis. More than 87% of exposed residents were affected by the dogs. Of that, 48.70% were bitten by their own dogs. Metema district had the highest risk of exposure (p < 0.001) compared to the other six that were investigated. Dog ownership (p<0.05) and a higher number of households (p<0.01) were also identified as risk factors for rabies exposure. Conclusion: Residence, low education levels, high household density, free-roaming dogs, and dog ownership are key risk factors for rabies exposure. Public health awareness campaigns are crucial to emphasize the risks associated with animal bites.

The genus Ajuga (Lamiaceae family) comprises approximately 300 species. Species within this genus are widely used in traditional medicine and are known for their diaphoretic, antiseptic, hemostatic, and anti-inflammatory properties. However, they are scarcely used in official medicine. Therefore, the study of one of the most common species, Ajuga reptans L., holds promise for developing new medicinal products for clinical and pharmaceutical applications. In aqueous and aqueous-alcoholic extracts of A. reptans herb, 8 organic acids, 16 amino acids, 20 phenolic compounds, 10 volatile substances, and 9 phytosterols were identified. The assay of the main groups of biologically active substances in the obtained extracts was determined. Experimental results demonstrated that A. reptans herb extracts are practically non-toxic, exhibit hepatoprotective activity in experimental carbon tetrachloride-induced hepatitis, moderate anti-inflammatory activity in carrageenan-induced oedema models, and possess significant local hemostatic and wound-healing properties. The most significant reduction in bleeding was caused by applying the aqueous extract, reducing bleeding time by 40.6%. The aqueous-ethanolic A. reptans extract (50% ethanol) demonstrated complete wound healing after 9 days of its local administration. This extract also has the most pronounced hepatoprotective and anti-inflammatory effects. A. reptans extracts are capable of inhibiting the growth of microorganisms and showing higher activity against gram-positive bacteria. Notably, the antimicrobial activity of the extracts increases in direct correlation with the ethanol concentration as an extracting agent. A. reptans herb extracts are promising agents for implementation in official medicine as wound healing and hepatoprotective remedies.

Tandem mass spectrometry (TMS) has emerged as a critical analytical tool in pharmaceutical sciences, playing a pivotal role in ensuring the rational use of medications. This article explores the applications of TMS across various stages of drug development, quality assurance, and patient care, highlighting its precision and reliability in advancing therapeutic efficacy. TMS facilitates the accurate identification and quantification of drug compounds, ensuring that pharmaceutical products meet high standards of purity and potency. By detecting even trace levels of impurities or contaminants, TMS strengthens the quality control processes critical to patient safety. In the realm of pharmacokinetics and pharmacodynamics, TMS enables detailed monitoring of drug absorption, distribution, metabolism, and excretion (ADME), allowing for a better understanding of drug behavior in the human body. It is also instrumental in therapeutic drug monitoring (TDM), ensuring that medication levels remain within therapeutic windows, thus optimizing dosing regimens and minimizing adverse effects. Additionally, TMS supports personalized medicine approaches by assessing drug interactions and tailoring treatments to individual patients. Through its application in drug discovery, development, and therapeutic monitoring, TMS serves as an indispensable tool for fostering rational medication use, contributing to more effective, safe, and personalized pharmaceutical care.

Globally, the transport sector is a major contributor to air pollution. Currently in the UK, vehicle emissions contribute significant amounts of nitrogen oxide (NOx) and particulate matter (PM) pollution in urban areas. Low-emission zones policies have been used as an intervention to tackle air pollution, and in this context, the UK launched the Low- Traffic Neighbourhood scheme. This study investigates the impacts of the Low- Traffic Neighbourhood in Kings Heath, Birmingham, UK, to evaluate its impact in reducing air pollution and local community perspectives about the scheme and perceived impacts on health and well-being. The study employs a mixed-method ap-proach comprising air quality monitoring assessment and a survey questionnaire involving 210 residents. The findings reveal an increase in active travel and a reduction in air pollution levels in the years after the implementation of the scheme, although the area is still non-compliant with the 2021 WHO air quality guidelines. Nonetheless, the scheme has a polarizing effect and created a division within the local community about the overall scheme acceptance and spatial distribution of the scheme’s benefits. The study underscores the importance of comprehensive baseline data, long-term community engagement, and integration with broader urban planning initiatives to enhance the success of future Low-Neighbourhood Traffic schemes.

This paper provides an overview of the social reasons that lead women to consider egg cryopreservation, as well as the attitudes and knowledge of women towards this procedure. Methods: For the creation of this article, a literature review was carried out both in the existing medical literature and in search engines. The key points are 1. The main reasons women choose to delay childbearing are the lack of a suitable male partner, education and career advancement, and financial instability. Women feel societal and family pressure to have children, even though they may not feel ready. 2. Women's attitudes towards egg cryopreservation vary. While some are open to the idea, many are opposed to it, especially when it is used for non-medical reasons. There are concerns about the success rates, health risks, and ethical implications of the procedure. 3. The legal and regulatory framework around egg cryopreservation differs across countries. Some countries allow it only for medical reasons, while others have more permissive policies. The issue of who should bear the financial cost of the procedure is also debated. 4. There is a need to better educate women, as well as healthcare providers, about fertility decline and the options available for preserving fertility, including egg cryopreservation.

Cone-beam computed tomography (CBCT) has become a vital tool in implantology, playing a key role in both pre- and post-surgical phases. Preoperatively, CBCT provides detailed three-dimensional evaluation of anatomical structures, offering precise information on bone quality and quantity, as well as the location of critical structure. This accuracy enhances surgical planning, reducing intra- and postoperative risks and ensuring more precise implant placement. Post-surgically, CBCT is equally important for monitoring osseointegration and detecting potential complications, such as failed integration, infections, or implant misalignment. Its high-resolution imaging capabilities enable clinicians to make accurate therapeutic adjustments, improving treatment outcomes. Overall, CBCT improves decision-making in implantology, offering greater predictability and safety compared to traditional two-dimensional radiography, significantly enhancing the success rates of implant-based oral rehabilitation procedures.

New vaccination programs need a method to measure success based on pre-defined outcomes evaluated over pre-specified time frames. Reimbursement of newly approved vaccines is often reliant on simulated projections that approximate real-world scenarios, due to limited long-term data availability. Adjustments to reimbursement prices are infrequent, barring instances of market competition-induced price erosion through tender processes. Consequently, comprehensive monitoring of the vaccine effect (VE) for an adequate duration to evaluate the success of vaccination programs remains rare. Such data are essential to inform expectations of vaccine effect and the timeline for measurable success of the investment. An example is provided here by the 15-year assessment of the rotavirus vaccination program in Belgium (RotaBIS study spanning 2005 to 2019 across 11 hospitals). The vaccination program started in late 2006 and yielded sub-optimal outcomes. Long-term VE surveillance data provided insights into infection dynamics, disease progression, and vaccine performance. The presented analysis introduces novel conceptual frameworks and methodologies. Cost-effectiveness analysis (CEA) evaluates the initial target vaccination population, considering the effectiveness of direct and indirect effects of the vaccine, compared with a historical group that is unvaccinated. Cost-impact analysis (CIA) covers a longer period and considers the whole vaccinated and unvaccinated population in which the vaccine has direct and indirect effects. The success index ratio of CIA over CEA outcomes evaluates the vaccination performance. Good performance has ≤ 1 index value combined with a low CEA. This measure is therefore a valuable aid for new vaccine introductions. It supports the establishment of robust monitoring protocols.

An elderly male, with recent COVID-19 and cardiovascular comorbidities, had a prolonged hospitalisation due to periprosthetic joint infection and bacteraemia, post hip hemiarthroplasty. Despite the initial clinical improvement while under targeted antimicrobial therapy, low-grade fever and signs of myelosuppression later occurred. In the May-Grünwald-Giemsa stain of peripheral blood smear (PBS), pseudohyphae among RBCs and phagocytosed blastospores in neutrophils and monocytes were detected, indicating candidaemia and not contamination of the stain. Echinocandin treatment was immediately initiated, and Candida albicans was identified, using multiplex PCR, from the obtained blood cultures. Despite the early initiation of antifungal therapy and the removal of the CVL (central venus line), the patient passed away within the next twenty-four hours. Candidaemia is a leading cause of nosocomial bloodstream infections with very high morbidity and mortality and is associated with multiple risk factors (surgery, CVLs, prolonged hospitalization, concomitant bacterial infection, broad-spectrum antibiotics, immunosuppression). The isolation from blood cultures is the gold standard for candidaemia diagnosis. Detection of candidaemia by PBS is extremely rare, requires an experienced microscopist, and is considered to be an emergency. Clinical suspicion, early laboratory identification, and immediate clinician notification can lead to prompt antifungal treatment.

A specific key point in liver cirrhosis is the decreased metabolic capacity for drugs. So medicines which are metabolized by oxidative biotransformation play a great role in liver pathology. Responsible for the drug metabolism that takes place in liver during illnes, are three cytochrome P450 (P450 or CYP) gene families in liver microsomes (CYP 1, CYP2 and CYP3). In attention of various studies, is cytochrome P450. Folowing the currently aim,we try to assess the effect of liver disease on multiple CYP enzymes by use of a validated cocktail composed of medicins. Liver diseases are associated with metabolic activity changes It is important to know and to tell a little bit about different directions in cirrhosis diagnostic, including laboratory tests or management ideas.

Data on antimicrobial resistance in Burkina Faso’s agricultural sector is still limited. The study assessed the occurrence of extended spectrum β-lactamase -producing Escherichia coli (ESBL-Ec) and Klebsiella spp. (ESBL-K) in lettuce, environment, and gardeners’ stools in market gardens in Ouagadougou, Burkina Faso. A total of 356 samples were collected from three vegetable gardens (76 lettuce, 76 soil, 62 manure, 63 irrigation water and 79 human stools). ESBL-selective medium was used for initial selection of ESBL-producing bacteria, and the isolates were further identified using biochemical tests. Antibiotic susceptibility test was performed using the disk diffusion method. The overall prevalence of ESBL-Ec and/or ESBL-K in the samples was 232/356 (65.2%). Of the lettuce samples, the prevalence of ESBL-Ec was 19/76 (25.0%) and ESBL-K 33/76 (43.4%). In the market gardens environment, the prevalence of ESBL-Ec was 32/201 (15.9%) and ESBL-K 124/201 (61.7%). In the gardeners’ stools the prevalence of ESBL-Ec was 42/79 (53.2%) and ESBL-K 24/79 (30.4%). Two ESBL-K isolates were found to produce NDM carbapenemase. Due to the high prevalence of ESBL-producing bacteria, which may also be carbapenemase producers, it is necessary to monitor pathogens in agricultural products with a "One Health" approach to limit and prevent infections in the population.

The research for this paper began several years ago in a graduate medical statistics class where I was told that “certain ethnic and cultural groups just have worse medical outcomes than others”. This paper looks at the different major divisions of our population and then; 1) develops a framework for understanding which groups are affected by the differences in medical access and outcomes, 2) attempts to document some of the reasons for these differences, and 3) offers some conclusions and possible first steps to improve the health of these groups and our society’s ability to provide care for the entire population.

Background/Objectives: Prospective cohort studies are useful for studying how biomolecular status affects risk of adverse health outcomes. Less well known is that the longer the follow-up time, the lower the apparent effect due to “regression dilution.” Here we evaluate how follow-up time affects the relationship between serum 25-hydroxyvitamin D [25(OH)D] concen-tration and incidence of stroke and major cardiovascular events (MCEs). Methods: Findings re-garding the relative risk (RR) of stroke and MCEs with respect to serum 25(OH)D concentrations at baseline from prospective cohort studies were plotted against mean follow-up time. Fifteen studies from mainly European countries and the United States were used for stroke, with nine studies for MCEs. Linear regression analyses were performed for follow-up periods of up to 10 years. Results: For stroke, the linear regression fit for 1–10 years is RR = 0.34 + (0.065 × follow-up [years]), r = 0.84, adjusted r2 = 0.67, p <0.001. No significant change was evident for studies with follow-up periods of 10–20 years. For MCEs, the linear fir for 1–8.1 years is RR = 1.61 ‒ (0.074 × follow-up [years]), r = 0.75, adjusted r2 = 0.49, p = 0.03. Discussion: The shorter the follow-up period, the greater the apparent effect of vitamin D in reducing risk of stroke and MCEs. In addition, the apparent effect of higher 25(OH)D concentration found for the shortest follow-up time is more than twice as high as the estimate based on averaging the results for all studies without considering follow-up time. Mechanisms have been found to explain how higher serum 25(OH)D concentrations could reduce risk of stroke and MCEs. Randomized controlled trials have not shown that vitamin D supplementation significantly reduces risk of either stroke or MCE, probably because risk of both outcomes increases rapidly below 15 ng/mL (38 nmol/L) and it is difficult in Western developed countries to enroll enough participants with concentrations that low. Nonetheless, vitamin D’s role in reducing risk of stroke and MCE can be considered causal on the basis of an evaluation of the evidence with respect to Hill’s criteria for causality in a biological system. Conclusions: Serum 25(OH)D concentrations above 20 ng/mL are associated with significantly reduced risk of stroke and MCEs in an apparent causal manner. Raising serum 25(OH)D concentrations to >20 ng/mL should be recommended for everyone likely to be at risk for stroke or MCE and indeed in the general population.

Parental willingness is a prerequisite for childhood immunization. This study evaluated whether parental vaccination readiness and willingness, measured using the modified Japanese 7C Vaccination Readiness Scale, predicted vaccination behavior. In December 2021, 2 months before the approval of COVID-19 vaccination for children aged 5–11 years in Japan, we asked 1,190 parents of children in this age groups about their intention regarding vaccinating their children against COVID-19 using an online modified 7C Vaccination Readiness Scale, consisting of seven components, namely, Confidence, Complacency, Constraints, Calculation, Collective responsibility, Compliance, and Conspiracy. The modified 7C components were analyzed for model fit and association with parental intention using structural equation modeling. The model fit of the modified 7C scale was good (goodness-of-fit index: 0.98), and the factor loadings and model fit for parental readiness were high (standardized factor loadings: 0.84). In January 2024, we asked the same parents about their children's COVID-19 vaccination status (valid responses: 536). The components of the modified 7C scale were compared with actual vaccination behavior. Parents with a low readiness to vaccinate their children against COVID-19 had a high actual non-vaccination rate. The use of the modified 7C scale may assist in the development of childhood vaccination interventions.

Maintaining patient trust, providing quality care, and safeguarding patients' rights and safety, all of which require strong adherence to ethical principles. This study assessed the key differential factors influencing healthcare ethics (HCE) practice in two Ghanaian hospitals. This study employed an analytical cross-sectional design, utilizing simple random sampling to recruit 382 healthcare professionals. Bivariate analysis was conducted using Chi-square tests and T-tests, while Random Forest analysis was applied to identify variables of relative importance to HCE practice. The study found no significant differences in HCE knowledge or practices between the facilities. However, in both facilities, knowledge of HCE significantly influenced HCE practice, indicating that individuals with better knowledge of HCE were more likely to practice HCE. Further, the analysis identified age, knowledge, education, and facility type as the most relevant factors in general. In the sub-analysis, the key factors varied between facilities: for Facility A, age, knowledge, gender, and the intention to change profession were most relevant, while for Facility B, knowledge, education, gender, and age were the dominant factors. HCE training programs should be tailored to meet the unique needs of each facility to ensure effectiveness since factors influencing HCE may vary by facility.

This study investigates the impact of environmental factors on intradialytic blood pressure in hemodialysis patients, using a four-year retrospective analysis. Employing a Generalized Estimating Equation (GEE) model, we examined the associations between clinical variables, meteorological conditions (temperature, humidity, wind speed, and precipitation), and blood pressure outcomes, including systolic blood pressure (SBP) and mean arterial pressure. Our results reveal that higher temperatures, increased humidity, and stronger wind speeds are significantly associated with lower SBP and mean arterial pressure. In contrast, higher daily precipitation correlates with elevated mean arterial pressure. Among clinical factors, erythropoiesis-stimulating agent (ESA) dosage shows a positive association with both SBP and mean arterial pressure while a history of intradialytic hypotension and increased interdialytic weight gain are negatively correlated. Additionally, serum potassium levels were inversely related to SBP and mean arterial pressure. These findings highlight the importance of incorporating environmental variables into predictive models for intradialytic blood pressure management. We propose tailored interventions, such as weather-adapted fluid management strategies, personalized treatment plans, and patient education, to mitigate potential adverse effects. This study provides a foundation for enhancing patient-centered care and improving the quality of life for hemodialysis patients amid global climate changes.

The recreational waters of hotels are widely used by locals and travelers all around the world and this impacts public health. In this regard, WHO frequently offers recommendations - especially in the COVID-19 era - so operators and managers of public pools, hot tubs or splash pads should continue to follow. This study aims to evaluate the microbiological results of COVID-19 sanitation protocols in recreational waters in hotels during the summer periods of post-COVID-19 (2020–2022) and compare them with those of pre-COVID-19 (2019). We found positive samples for different parameters in the period of 2019: 11.5 % for total coliforms (18/157), 12.2% for common aerobic bacteria (19/156), 2.9% for E. coli (5/170), and 18.2% for P. aeruginosa (27/148). For the pandemic years, the percentages of positive samples were: 8.1% for total coliforms (40/493), 1.3% for common aerobic bacteria (7/526), 1.3% for E. coli (7/526), and 18.4% for P. aeruginosa (83/450). The study found that the relative risk (RR) from the presence of P. aeruginosa in recreational waters with chlorination 25°C. Although non-compliance decreased at the beginning of the pandemic due to strict health protocols, this gradually stopped.

Although highlands of East Africa lack the geo-ecological landmarks of Rift Valley fever (RVF) disease hotspots to participate in cyclic RVF epidemics, they have recently reported growing numbers of small RVF clusters. Here, we investigated whether RVF cycling occurred among livestock and humans in the central highlands of Kenya during inter-epidemic periods. A 2-year prospective hospital-based study among febrile patients (March 2022 - February 2024) in Murang’a County of Kenya, was followed by a cross-sectional human-animal survey. A total of 1,468 febrile patients were enrolled at two clinics and sera tested for RVF virus RNA and antiviral antibodies. In the cross-sectional study, humans (n=282) and livestock (n=706) from randomly selected households were tested and questionnaire data used to investigate sociodemographic and environmental risk factors by multivariate logistic regression. No human (n=1,750) or livestock (n=706) sera tested positive for RVFV RNA. However, 4.4% livestock and 2.0% humans tested positive for anti-RVFV IgG, including 0.27% febrile patients who showed 4-fold IgG increase and 2.4% young livestock (&lt;12 months old), indicating recent virus exposure. Among humans, odds of RVF exposure increased significantly (P&lt;0.05, 95% CI) in males (aOR:4.77, 2.08–12.4), those consuming raw milk (aOR 5.24,1.13–17.9), milkers (aOR:2.69, 1.23–6.36), and participants residing near quarries (aOR:2.4, 1.08–5.72). In livestock, sheep and goats were less likely to be seropositive (aOR: 0.27, 0.12–0.60) than cattle. The increase in RVF disease activities in the highlands represents widening geographic dispersal of the virus, and greater risk of more widespread RVF epidemics in future.

This case report describes the innovative treatment of a 73-year-old woman with a Solitary Fibrous Tumor (SFT) using Selective Internal Radiation Therapy (SIRT) with Yttrium-90 resin microspheres. SFTs are rare tumors that pose significant treatment challenges, particularly in cases of recurrence or when the disease has metastasized. Systemic therapies often have limited effectiveness. In this case, the patient initially presented with a pelvic mass that was surgically resected, but she later developed metastatic disease in the liver. After experiencing severe side effects from targeted therapy with sunitinib, SIRT was chosen as an alternative treatment. Remarkably, the patient achieved substantial tumor reduction and symptom relief following this novel intervention. To our knowledge and following extensive literature search, this is the first documented instance of treating SFT with SIRT. It provides new insights into its potential as a therapeutic strategy, especially for cases where conventional treatments are inadequate or cause intolerable side effects. The success of SIRT, in this case, highlights its potential as a less invasive, locally targeted treatment option and may offer new hope for patients with similar conditions.

Tailored Skincare and Wellness Solutions for HIV-Positive Individuals: Addressing Skin Conditions, Joint Pains, and Memory Loss. Research Topic This research aims to explore tailored skincare and wellness solutions for HIV-positive individuals, specifically focusing on addressing skin conditions, joint pains, and memory loss. The research question revolves around developing innovative and effective medical approaches to improve the quality of life for this population. Research Importance The topic is crucial as it addresses the unique challenges faced by HIV-positive individuals, highlighting the need for tailored healthcare solutions. By understanding and addressing the physical symptoms associated with HIV, such as skin conditions, joint pains, and memory loss, the research contributes to enhancing the overall well-being and quality of life of individuals living with HIV. Research Method The research encompasses a comprehensive analysis of existing literature, including studies on dermatological problems, musculoskeletal issues, and cognitive impairments in HIV-positive individuals. Additionally, the development of a proposed skincare and serum line, RadientResilience, is based on a careful consideration of pharmacological effects and the unique skin conditions of this population. Research Findings The research findings emphasize the prevalence of dermatological conditions as a significant marker for HIV in affected populations. Furthermore, the study highlights the importance of thorough clinical assessment and the potential use of specific compounds and ingredients to alleviate joint discomfort in HIV-positive individuals. Research Conclusions The interpretations and conclusions drawn from the research underscore the need for tailored medical approaches to address the unique healthcare needs of HIV-positive individuals. The proposed skincare and serum line, RadientResilience, represents an innovative and empowering solution providing effective care for this targeted audience. Research Implications The research has implications for the development of specialized skincare and wellness products tailored to address the specific needs of HIV-positive individuals. Potential challenges in developing and implementing tailored skincare and wellness solutions for HIV-positive people include stigma and discrimination, as well as logistical and financial constraints. As Bouabida, Chaves, and Anane (2023) noted, “Stigma and discrimination are major barriers to HIV care engagement and adherence” (Challenges and barriers to HIV care engagement and care cascade: viewpoint, para. 3). Additionally, the authors highlight that “logistical and financial constraints can limit access to necessary healthcare services” (para. 5). Logistical and financial constraints can limit access to necessary healthcare services for individuals living with HIV by creating barriers such as transportation challenges, limited availability of healthcare professionals, and financial strain related to medical expenses.

Extended-spectrum beta-lactamase (ESBL) -producing and multidrug resistant Enterobacterales pose a major threat to both human and animal health. This study assessed the prevalence of ESBL-producing Escherichia coli (ESBL-Ec) and Klebsiella spp. (ESBL-K) in cattle farms in Ouagadougou, Burkina Faso, using a One Health approach. From May 2021 to September 2022, cattle faeces, farmers’ stools, their drinking water and farm soil samples were collected from semi-intensive and traditional farms. ESBL-selective medium was used to obtain resistant isolates, which were further characterized using biochemical tests. An-timicrobial susceptibility testing was performed using the Kirby-Bauer disc dif-fusion method. ESBL-Ec and/or ESBL-K were detected in 188 of 322 samples (58.0%). The prevalence of ESBL-Ec isolates was 42.2% (136/322) and ESBL-K isolates 24.5% (79/322). Notably, 156 of the 188 ESBL isolates (83.0%) exhibited multidrug resistance. The highest resistance rates were observed against tetracy-cline and cotrimoxazole. Importantly, no isolates showed resistance to mero-penem, which was used to test for carbapenem resistance. This study highlights the presence of ESBL-Ec and ESBL-K among humans, animals and the envi-ronment of the cattle farms. Good hygiene and biosafety practices are essential to limit the potential spread of multidrug resistant bacteria between different inter-faces on farms.

Globally, life expectancy has been increasing, with South Korea reaching an average of 85.6 years. Therethrough, ‘being healthy’ is essential for a high quality of life, and interest in health and disease prevention grew significantly after the COVID-19 pandemic. The pandemic boosted digital health technology adoption, and emphasizing the need for tailored health strategies based on age group. KIHASA conducted the study of digital confidence and health management methods involving the use of digital devices, and it examines differences in digital device use and confidence between 359 young adults (20–39Y) and 641 middle-aged adults (40–69Y). Respondents were asked about their use of digital health tools, such as wearable devices and mobile apps and confidence in using digital systems and managing health via digital tools was assessed using a five-point Likert scale. We an-alyzed the results, and it indicated that while young adults have lower rates of using digital devices for health care, they exhibit higher confidence in using such devices. In contrast, middle-aged adults, despite having lower confidence, report higher usage of digital devices for health care purposes. This study explored differences in digital confidence and health care usage between age group.

Many measles endemic countries with suboptimal coverage levels still rely on vaccination campaigns to fill immunity gaps and boost control efforts. Depending on local epidemiological patterns, national or targeted campaigns are implemented, following which post-campaign coverage surveys (PCCSs) are conducted to evaluate their performance, particularly in terms of reaching previously unvaccinated children. Due to limited resources, PCCS surveys are designed to be representative at coarse spatial scales, often masking important heterogeneities in coverage that could enhance the identification of areas of poor performance for follow up via routine immunization strategies. Here, we undertake geospatial analyses of the 2021 measles PCCS in Nigeria to map indicators of coverage measuring the individual and combined performance of the campaign and routine immunization (RI) at 1x1 km resolution and the ward and district levels in 13 states. Using additional geospatial data sets, we also produced estimates of numbers of unvaccinated children during the campaign and numbers of measles-containing vaccine (MCV) zero-dose children before and after the campaign at these levels and within health facility catchment areas. Our study revealed that although the campaign reduced the numbers of MCV zero-dose children in all the districts, areas of suboptimal campaign and RI performance with considerable numbers of zero-dose children remained. Our analyses further identified wards and health facility catchment areas with higher numbers of unvaccinated children within these areas. Our outputs provide a robust evidence base to plan and implement follow-up RI strategies and to guide future campaigns at flexible and operationally relevant spatial scales.

This systematic review assessed the prevalence of lower back pain (LBP) in equestrian athletes (EA), using PRISMA guidelines. Observational studies published between 2004 and 2024 in English, Portuguese, Spanish, and German were included. The review identified relevant studies through EBSCO, MEDLINE, and SCOPUS (last search 30 August 2024), yielding 14 studies with a total of 4,527 participants. PEO of included studies: population comprised EA, exposure was equestrian sports (ES), and the outcome was LBP. The risk of bias was evaluated using the Observation Study Quality Evaluation tool, and six studies were deemed high-quality. LBP prevalence in EA was higher than in the general and athlete population, with point prevalence ranging from 27.9% to 87.9%. Sport-specific factors, including workload and stable duties, were significant risk factors. Methodological inconsistencies, such as varying definitions of LBP and a lack of standardized exposure assessment, and overall low quality of studies, limited the comparability of findings. This review underscores the need for more high-quality research and tailored interventions addressing both riding and off-horse activities in EA. The review was registered in PROSPERO (ID: CRD42024568577), and the study was funded by the Comprehensive Health Research Centre, Évora University.

Background and clinical significance: Guyon's canal syndrome is a pathological condition caused by compression of the ulnar nerve at the level of the wrist. It is less frequent than other compression syndromes of the upper limb (cubital and carpal tunnel), and different causative agents, including vascular lesions, are described. Among these, aneurysm of the ulnar artery is described in the literature as an infrequent aetiology. Case Presentation: We report the case of a 25-year-old young man with Guyon's canal syndrome caused by an aneurysm of the ulnar artery, who underwent surgical decompression of the Guyon's canal without intervening on the aneurysm. The postoperative course was free of complications, and the patient reported satisfaction, with reduced symptoms. Clinical examination and ultrasound imaging showed mass reduction of the aneurysm in the postoperative period, which appears to be an evolution hitherto undocumented in the literature. Conclusions: Many treatments are available for Guyon's canal syndrome. Past medical and surgical treatments, duration and severity of symptoms, causes, and pathogenesis are important for the therapeutic choice. Surgical treatment based on ligament section and lysis of the Guyon's canal downstream, without any action on the aneurysm and with ulnar artery preservation, determined a reduction in terms of volume, relief of the symptoms, and patient satisfaction. With this case we describe a surgical therapeutic option for the treatment of Guyon's canal syndrome caused by an aneurysm of the ulnar artery, in which surgery is limited to canal decompression and consequential aneurism mass reduction with concomitant relief of symptoms.

Visceral leishmaniasis (VL), or kala-azar, is a severe and potentially fatal form of leishmaniasis, a disease classified under Neglected Tropical Diseases (NTDs). VL primarily affects the internal organs, with symptoms ranging from chronic fever and weight loss to hepatosplenomegaly and anemia. The disease is transmitted by sandflies, with Leishmania donovani and Leishmania infantum being the primary pathogens. Despite various treatment options like liposomal amphotericin B and miltefosine, challenges remain due to drug toxicity, high costs, and limited availability. Alternative therapeutic approaches, particularly those involving phytocompounds, offer promising potential for overcoming these limitations and improving outcomes for affected populations.

Background/Objectives: Respiratory syncytial virus (RSV) is a major cause of severe lower res-piratory tract infections in infants, particularly in vulnerable populations such as preterm new-borns and those with underlying health conditions. The approval of the RSVpreF vaccine for pregnant individuals offers a new strategy to reduce the burden of RSV-associated illness in newborns. The aim of this study was to assess RSV vaccination coverage among pregnant wom-en, identify factors contributing to vaccination hesitancy, and evaluate the knowledge of the bene-fits of vaccination among patients in Poland. Methods: The study was conducted on 668 re-spondents from Poland. The study utilized an original, anonymous questionnaire consisting of 23 questions, which was distributed via social media platforms from July 25 to August 1, 2024. Par-ticipants, including women who had recently given birth or were about to, were recruited through Facebook groups and Instagram. Results: We confirmed that responders with medical back-grounds had statistically greater knowledge about RSV than non-medical individuals. Addi-tionally, indivudals with medical medical backgrounds were more likely to receive the RSV vac-cination during pregnancy, as were patients who obtained vaccination information directly from their physician. Furthermore, a key finding was that patients who had previously received vac-cinations for other diseases, such as influenza and pertussis, were more likely to opt for RSV vac-cination. Conclusions: Vaccination against RSV during pregnancy is a crucial method for safe-guarding newborns from infection and its severe complications. Awareness of RSV and vaccina-tion rates among pregnant women remains low, necessitating educational initiatives and public health campaigns to improve coverage.

Background: Parkinson’s Disease (PD) is a long-term condition, which is more common among people aged 65 years or more. People with Parkinson (PwP) tend to lose motor functions and find themselves in more fatigue and pain, sometimes leading to anxiety, distress and in extreme cases, even depression. So far, there is no cure for PD and they need support from family members, healthcare professionals and carers, as the disease progresses. A large proportion of carers for PwP are their spouses. Progression of PD can result in loss of employment, reduced work hours or premature retirement, for both PwP and their carers. This poses a huge financial burden as income reduces on one hand, and expenses increase on the other. There is a lack of evidence on the societal costs of Parkinson's disease, and this study tries to fill that gap. Objectives: To examine the impact of financial distress on quality of life (QoL) and wellbeing of PwP and their carers in the UK. Methods: A mix of online and postal, cross-sectional survey was administered, which received responses from 853 respondents, out of which 776 were PwP and 546 were carers. The survey sought data on management of the socioeconomic, health and living conditions of PwP and their carers. Net effect of financial distress (cost of healthcare use, non-health expenditure, societal costs and other direct / indirect cost components) on QoL (and VAS scores) as well as wellbeing scores (life satisfaction and happiness scores) of PwP and their primary carers are estimated using simple linear regression models. Results: Financial burden of treatment increase whereas quality of life and wellbeing of PwP decrease with progression of PD. Similar association but of a milder magnitude is observed on quality of life of their primary carers. A strong negative association is found between quality of life of PwP, with financial burden, while holding for demographic and socioeconomic factors, and for disease progression and treatment. The QoL of carers increase up to a financial burden threshold, before it starts declining. This could be because of the increased expenditure in initial phases is associated with improved activities of daily living and lesser reliance on carers. Financial distress is more pronounced among PwP having annual household income below £20,000. Despite a small representation of persons from ethnic minority (5 per cent representation), it is observed that the impact of financial distress could be more pronounced on PwPs from other ethnicities. Also, it would be more on women than on men, irrespective of ethnicity. Conclusion and Policy Implications: Cost of care cuts both ways, reduced or lost employment as well as increased expenses on healthcare. This results into a considerable financial distress and deterioration in quality of life and wellbeing of both PwP and carers. Most carers are spouses of PwPs, thus their physical and psychological health and wellbeing is found to deteriorate with the progression of PD due to increased burden of care. Therefore, informal / family carers should get support in the form of respite care. This can help revitalise their energy and psychological wellbeing. Financial distress indicators need to be explored further.

Neonatal mortality rates in developing countries are influenced by a complex array of factors. Despite advancements in healthcare, Angola has one of the highest neonatal mortality rates in sub-Saharan Africa, with significant contributors including premature birth, intrapartum events, tetanus, and sepsis. This study aimed to identify the primary causes and contributing factors of neonatal mortality among infants admitted to the Neonatology Service at DBPH in Luanda from May 2022 to June 2023. A retrospective matched case-control design was employed, pairing each neonatal death with two surviving neonates based on age and sex. The analysis included 318 newborns, of whom 106 experienced hospital deaths. A stepwise binary logistic regression model was used to examine associations between variables and neonatal mortality. Variables with p < 0.25 in bivariate analysis were included in the multivariate model. Significant factors associated with neonatal mortality included: a low Apgar score at 1 minute (< 7) (OR 2.172; 95% CI: 1.436–4.731); maternal age under 20 years (OR 3.746; 95% CI: 2.172–6.459); home delivery (OR 1.769; 95% CI: 1.034–3.027); and a short hospital stay of ≤ 48 hours (OR 2.791; 95% CI: 1.183–6.587). Addressing these issues requires urgent interventions, including improving Apgar score management through enhanced training for healthcare professionals, supporting young mothers with intensified maternal education, ensuring deliveries occur in appropriate healthcare settings, and improving universal health coverage and referral systems. These measures could be crucial for enhancing neonatal care and reducing mortality.

Loneliness was one of the most prominent emotional experiences during social distancing due to the COVID-19 pandemic. This article aims to shed light on the experiences of loneliness and its relationship with mental health of adolescents in the Da Nang City during the COVID-19 pandemic. Data were collected online in early 2023 after 18 months Da Nang lifted its lockdown. The Strength and Difficulties Questionaire, the Multidimensional Scale of Perceived Social Support and the Negative Experience Scale were used to investigate loneliness among adolescents and effects of protective social factors. A total of 1,262 grade 6 to 12 students responded to the surveys. Results indicated that (1) loneliness was a more prominent emotion experienced by these adolescents during the COVID-19 lockdown; (2) factors contributing to loneliness were related to illness, social distancing, and a lack of care and attention from parents; (3) loneliness reported mostly was short in duration and mild at level, while there was a significant proportion of prolonged loneliness; and (4) Support from family and friends, however, could reduce the risk of mental health problems for the youngsters.

Research question/problem: This comprehensive review and comparative analysis aims to investigate the significance of enhancing oxygen provision in the context of COVID-19, focusing on the implications for healthcare policies and services.Background/context: The study addresses the shift in the oxygen dissociation curve of blood in COVID-19 patients, emphasizing the impact on oxygen delivery to tissues and the challenges it poses for clinical management. It also explores the disruption of healthcare systems due to the pandemic and the integration of social determinants of health in clinical environments.Methodology: The research incorporates a thorough literature review, comparative analysis of diverse approaches to oxygen delivery, and examination of successful interventions through case studies and best practices. Data collection techniques include the review of scholarly articles, case studies, and policy documents.Results/Key findings: The study highlights the imperative for augmented oxygen supply and the significance of maintaining appropriate oxygen saturation levels, especially in the context of respiratory illnesses like COVID-19. It also emphasizes the positive correlation between increased oxygen saturation levels and life expectancy, indicating potential health benefits of enhanced oxygen availability.Conclusions/Implications: The findings underscore the need for a structured approach to oxygen therapy and the importance of equitable distribution of oxygen to underserved regions. The implications of the research extend to enhancing healthcare policies and services regarding oxygen provision during the COVID-19 pandemic, especially in rural and remote areas.

Even today Healthcare-associated infections (HCAIs) remain the most frequent and serious complications in healthcare, with a significant clinical and economic impact. The authors address the causes and conditions that determine this situation and describe them in a comparison with the situation in the Grand Duchy of Tuscany more than two centuries ago and with the instructions that were issued at the time to contain the typhus epidemic of 1817, to increase hospital sanitation and disinfect houses. Today, we know that a crucial element in the fight against healthcare-associated infections (HCAIs) is the definition and implementation of best care practices and other measures, according to a combined program that must be tailored to each healthcare setting. In the early nineteenth century, these approaches originated from experience and chemical knowledge that were becoming established, opening the way to the ideas and experiments of Ignác Fülöp Semmelweis and later of Joseph Lister, who traced the path for the birth of Hygiene. Two centuries later the pioneering vision of the Grand Duchy of Tuscany at the beginning of the 19th century, when preventive measures in the field of public health were still backward and underdeveloped, is still enlightening and surprisingly topical.

COVID-19 highlighted the challenges of public acceptance of public health measures, including mask-wearing and vaccination. which has spurred interest in engineered approaches to reduce infections. Germicidal Ultraviolet (GUV) Energy has been used for decades in hospital rooms to limit TB transmission, but it is expensive to install in the upper part of rooms where it may be used safely. In contrast, FAR-UV energy is a relatively new, flexible technology that can be set up in rooms for moderate costs, and studies thus far indicate it is efficacious and not damaging to eyes or skin. To examine the state of the field, experts in aerosol biology, infection control, and building engineering from academia, government, and industry were convened to inform policy recommendations for future investments, identify research required, and examine policy options for using these technologies. Despite its high efficacy for deactivating several types of microorganisms and pathogens of concern, before FAR-UV technologies may be widely deployed, additional studies are needed to understand potential adverse effects, as well as the best approaches to use, standardize, and regulate the technology. In some environments, the use of FAR-UV can generate ozone, which can react with volatile organic compounds that may be hazardous to human health, such as respiratory tract irritation. Even with these concerns, the demonstrated effectiveness in disease control of both FAR-UV and longer wavelengths of GUV deserve increased policy attention to reduce risks of indoor disease transmission. While potentially useful to counter disease in high-risk indoor environments, further standardization and regulatory measures, as well as research into the production of oxidative compounds is necessary before broad adoption of FAR-UV.

This study investigated the relationship between mental health, physical activity, and weight among Saudi female university students. A cross-sectional survey was conducted to assess participants' risky behaviors, psychological health, and health-related habits. Results revealed that a significant number of students had unhealthy eating habits, low levels of physical activity, and were overweight. While there was a slight trend towards lower physical activity and higher weight among individuals with higher depressive symptoms, these relationships were not statistically significant. The study concludes that factors beyond mental health, such as cultural norms and social support, likely play a more significant role in influencing physical activity levels and weight among Saudi university students. Further research is needed to identify these factors and develop targeted interventions to promote healthier lifestyles.

Understanding the state of the swamp buffalo population in Calayan Island is important to strengthen the conservation and management program in the country. This study aimed to provide insights into the morphology, population structure, and health profile of the swamp buffaloes on the island. In total, 35 fresh blood samples were analyzed using 27 polymorphic microsatellite markers to determine the population structure analysis. Data were gathered for the morphological features of Calayan swamp buffaloes and served as the baseline information for the descriptive traits. Furthermore, samples were tested for surra and brucellosis using PCR and serological tests respectively. Results showed that Calayan swamp buffaloes were morphologically bigger except for body length compared with other populations. Genotype analysis using microsatellite markers showed remarkable discriminatory power to distinguish distinct populations within the tested population and could discriminate subspecies of swamp and river types plus crossbreds. The study also reports the first incidence of surra and brucellosis on the island. Overall, the new insights provided on newly detected Philippine carabao lineage in Calayan Island would be highly recommended for ex-situ conservation and animal health control strategy. The conservation strategy would encompass collecting, cryopreserving, and storing viable germplasms from local swamp buffalo on Calayan Island.

A major cause of genital discomfort in women around the world is bacterial vaginosis, which results from excessive growth of pathogenic bacteria in the vaginal ecosystem. Current treatment consists of antibiotics and/or probiotics, which show favourable therapeutic effects, but also cause problems such as drug resistance and recurrence. Considering faecal transplantation's success, transplantation of vaginal fluid from healthy donors could provide the most effective treatment for bacterial vaginosis. However, experimental treatments have shown that vaginal microbiome transplantation may not be a one-size-fits-all solution. The present article examines the limitations of current standardized therapy, the advantages of vaginal microbiome transplantation, and presents future novel strategies for treating bacterial vaginosis based on current research findings and clinical trials development worldwide.