Abstract: Background and Objectives: Central sensitization (CS) has been identified as a significant factor influencing persistent pain and dissatisfaction following total knee arthroplasty (TKA). However, its effect on unicompartmental knee arthroplasty (UKA) remains largely unexplored. Unlike TKA, UKA preserves most native knee structures, with less bone cut, leading to different postoperative pain mechanisms. Nevertheless, the revision rate for unexplained pain following UKA is higher than after TKA. This study investigates the influence of preoperative CS on pain and dissatisfaction after UKA. Materials and Methods: This retrospective cohort study included 121 patients who underwent primary UKA for medial compartment osteoarthritis of the knee. Patients were screened for CS preoperatively using the Central Sensitization Inventory (CSI) and categorized into a CS group (CSI ≥ 40; n = 26) and a non-CS group (CSI < 40; n = 95). Clinical outcomes, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS), and patient satisfaction, were assessed at the 2-year postoperative follow-up visit. A multivariate regression analysis was used to determine the risk factors for postoperative dissatisfaction. Results: The CS group reported significantly worse postoperative WOMAC pain, function, and total scores than the non-CS group (all p < 0.05). FJS was also significantly worse in the CS group than in the non-CS group (64.4 vs. 72.7, respectively, p = 0.005). Patient satisfaction was significantly lower in the CS group than in the non-CS group (65.4% vs. 95.8%, respectively, p < 0.001). The multivariate logistic regression analysis demonstrated that patients with a CSI score ≥ 40 had an 11.349-fold increased likelihood of dissatisfaction after UKA (95% CI: 2.315 – 55.626, p = 0.003). Conclusions: This study underscores the importance of recognizing CS as a critical determinant of postoperative pain and functional recovery following UKA. Patients with high CSI scores experience greater pain, increased joint awareness, and overall poorer satisfaction despite technically successful surgeries.

Abstract: Background/Objectives: Although self-compassion practice has been more and more popular in the literature in recent years, the area of social work knows very little about it. To be self-compassionate is to treat oneself with love and respect. The aim of this study was to investigate at the relationship between social workers' professional quality of life (compassion satisfaction, secondary traumatic stress, and burnout) and self-compassion. Methods: The sample consisted of 177 social workers in PHC in Greece. The Self-Compassion Scale (SCS), the Professional Quality of Life Scale (ProQOL-5), and the participants' personal, demographic, and professional information were all included in an electronic questionnaire that they had to fill out. Results: The study's findings showed that although 43.2% of participants exhibited high levels of self-compassion, burnout and secondary traumatic stress were at low to moderate levels among the participants. Apart from the secondary traumatic stress and humanity dimensions, both the dimensions and the overall self-compassion scale showed a strong relationship with the aspects of professional quality of life. Burnout and secondary traumatic stress were significantly reduced, and compassion fulfilment were increased in environments that were supportive, socially supportive, work-related, hobby-filled, and religious. Conclusions: The integration of self-compassion into a comprehensive and methodical approach to employee wellness has the potential to enhance the physical and mental health of workers in healthcare environments.

Abstract: Background: Patient satisfaction is one of the key indicators of healthcare quality. In the study, we assess satisfaction with visits to primary healthcare (POZ) and specialised ambulatory healthcare (AOS). Methods: This web-based cross-sectional study was conducted in a representative sample of 725 patients from the Polish population in June 2023. The study employed the Patient Expectations Scale, comprising 18 statements addressing various aspects of a medical visit. Results: The average satisfaction rating for the medical visit was 7.41 (±2.34) out of 10, with a median of 8. Strong correlations were found between overall visit satisfaction and specific aspects of the doctor–patient interaction. The highest correlations were observed for expressions of empathy and support, such as "showed concern" (r = 0.73) and "encouraged me" (r = 0.68), as well as for clear communication about treatment ("presented a probable course of treatment" – r = 0.62) and disease consequences (r = 0.55). Presenting test results (r = 0.51) and treatment recommendations (r = 0.63) were also significantly associated with overall satisfaction (all p < 0.001). Conclusions: Research shows that patients reported higher satisfaction with specialised ambulatory care (AOS) than with family medicine (PR), mainly due to better communication, encouragement, and concern from AOS doctors. Improving healthcare quality in Poland requires not only financial and organisational efforts but also a focus on patient expectations, supported by regular use of satisfaction measurement tools.

Abstract: Zoonoses are diseases that are transmissible between animals and humans. This study aimed to evaluate the perception of high school students from private (n=62) and public (n=70) schools about the prevention and control of zoonoses through a questionnaire with socioeconomic questions and knowledge about zoonoses. It was found that 98% of the students were between 15 and 18 years old, and that they lived with their families, which were mostly made up of four to seven people. The main activity of the families of students from private schools was commerce, while that of public schools varied. Dogs were the animal most mentioned as domestic animals in the residence by students (71%) and they lived inside the houses. Most of the animals did not receive frequent veterinary care. Lack of knowledge of the concept of zoonoses was found in 66% of students from public schools and 48% of students from private schools. Education of the population and improved sanitation were the alternatives most chosen by interviewees as measures that would help prevent zoonoses. The results obtained emphasize the importance of university outreach programs involving professionals, faculty, and students committed to sharing quality information with the community, particularly those lacking access to such knowledge. In conclusion, it is essential to focus on increasing the flow of information and implementing actions in schools to provide students with concise knowledge about One Health and zoonotic diseases prevention.

Abstract: Parents are primary “supporters” for helping their children cope with feelings of anxiety, a significant concern for many young children. The current study examined parents’ perceptions of an anxiety management manual. Parents reviewed an anxiety coping manual for elementary school-aged children. This manual explained how anxiety influences the body and emotions as well as presenting cognitive-behavioral anxiety management strategies. The strategies included breathing, imagery (superhero to fight worries and imagine your favorite place), relaxation, talking to supportive others, and using distraction. Twenty-one parents were interviewed to determine their perceptions of the manual and of worry for today’s children. Qualitative analyses were performed to determine themes in the data. Results indicated that parents would use the manual and learned new strategies for helping their child with worry. Parents felt that today’s children are worrying more about serious things like school performance and family stressors. Future research needs to examine parent implementation of the strategies over time to determine if the use of anxiety management strategies is related to lower levels of worry for young children, if the strategies reduce anxiety-related stress, and if prevention minimizes the impact of anxiety on emotional functioning.

Abstract: Microcirculatory oscillations known as flowmotion are a recognized feature of blood flow that reflect the functional state of the vascular system. Many diseases are associated with impaired flowmotion, especially diseases that are accompanied by hypoxia. Low frequency myogenic oscillations (0.052–0.15 Hz) are an important regulator of microvascular adaptation to hypoxia. Here, we study the myogenic component of flowmotion using the FMSF–PORH (Flow Mediated Skin Fluorescence–Post Occlusive Reactive Hyperemia) technique. Myogenic oscillations were strongly activated under hypoxic conditions caused by occlusion of brachial artery or intermittent hypoxic treatment. A strong correlation was noted between the hypoxia sensitivity parameter HS (the intensity of myogenic oscillations activated by hypoxia) and the normoxic myogenic flowmotion parameter VM (the intensity of myogenic oscillations under normoxia conditions). If HS is considered as a direct measure of the microcirculation response to hypoxia, then VM can be considered a measure of the microcirculation's readiness to provide this response. The assessment of myogenic activity under normoxia conditions could thus provide a simple and rapid diagnostic tool for health care practitioners.

Abstract: Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a devastating global health concern. Hypervirulent-strains are on the rise causing morbidities and mortalities worldwide. In tertiary care hospitals, critically-ill, invasive-procedures, pediatrics, and geriatrics are at risk. It is not clear how the strains specialized in humans in a clonal-genome. This study investigates the influence of age-, gender-, and source- (clinical, ICU vs. non-ICU)-specificity profiles in the evolution into hospital-associated (HA-MRSA) versus community-associated (CA-MRSA) lineages. Methods: 253 non-duplicate S. aureus isolates were obtained from May 2023 to March 2025). Patients were stratified by age and gender in ICU and non-ICUs. Standard microbiology methods and CLSI guidelines were used for identification and susceptibility testing, with cefoxitin and oxacillin disk diffusions and molecular diagnosis confirming MRSA. Mann-Whitney U and Chi-square tests assessed demographic distributions, clinical specimen sources, and MRSA/MSSA prevalence. Results: Of 253, 41.9% originated from ICUs (71% male, 29% female) and 58.1% from non-ICU wards (64% male, 36% female). In both settings, MRSA colonized the two extremes of age (10–29 and 70+) for males and females, with different mid-life peaks or declines by gender. However, the overall demographic distribution did not differ significantly between ICU and non-ICU groups (p = 0.287). Respiratory specimens constituted 37% and had the highest MRSA rate (42%), followed by blood (24.5%) and wounds (10.3%). In contrast, MSSA dominated wound (20.3%). Overall, 73.9% were resistant to cefoxitin and cefotaxime, whereas vancomycin, linezolid, daptomycin, and tigecycline remained highly effective. Younger non-ICU patients (10–29) had higher MSSA, whereas older ICU ones showed pronounced HA-MRSA profiles. By the virtue of methicillin-resistance, all MRSA were classified as multidrug resistance. Thus, MRSA colonization of the two extremes of life mostly in ICU seniors and the dominance of invasive MSSA and CA-MRSA patterns in non-ICU youth, imply early age- and gender-specific adaptations of the three lineages. Conclusion: MRSA colonizes both ICU and non-ICU populations at extremes of age gender-specificically. High β-lactam-resistance underscores the importance of robust stewardship and age- and gender-specific targeting in screening. These findings also indicate host- and organ-specificity in sequalae of MSSA, CA-MRSA, HA-MRSA evolutionary-dynamics emphasizing the need for continued surveillance to mitigate MRSA transmission and optimize patient outcomes in tertiary care settings.

Abstract: This brief report presents six-month interim results from a twelve-month pragmatic program evaluation investigating the impact of the NuvoAir Home Service (NAHS) in COPD patients. Patients in the evaluation group received remote monitoring and personalized chronic care management through the NAHS platform. Results: 190 NAHS participants compared to 570 propensity matched controls: All-cause hospitalizations 31% Decrease (p = 0.13) All-cause days hospitalized 52% Decrease (p = 0.05) All-cause readmissions 45% Decrease (p = 0.40) All-cause ED visits 5% Decrease (p = 0.71) All-cause outpatient office visits 9% Increase (p = 0.16) Avoidable hospitalizations 42% Decrease (p = 0.05) Avoidable days hospitalized 43% Increase (p = 0.15) Avoidable readmissions 77% Decrease (p = 0.06) Avoidable ED visits No Change (p = 0.99) Avoidable outpatient office visits 12% Increase (p = 0.09) These interim data indicate that NuvoAir Home Service had a clinically significant positive impact on hospital utilization, no change in ED utilization, and a small increase in outpatient visits, though not all preliminary data met statistical significance.

Abstract: The COVID-19 pandemic is rapidly proliferating through Thailand and globally. Therefore, implementing an effective surveillance and prevention system operated by Village Health Volunteers (VHVs) would greatly help effective control of this crisis. Background/Objectives: This study aimed to explore the evolution of Community Medical Sciences (CMS), and predict the correlations with Emerging Infectious Disease Solving (EIDS) of the population under the ongoing emerging infectious disease. Methods: This survey study and surveillance of 1,550 VHVs, data were collected using a questionnaire with a reliability score of 0.915. Data were analyzed by descriptive statistics, path analysis. Results: revealed that the CMS of VHVs was good level of 76.70% (mean = 139.70±4.82). The path coefficients showed that quarantine commitment (β =.172), full lockdown measures (β =.020), social support (β= -.604), Health Literacy (HL) (β= -.707), and CMS of VHVs (β = 0.206). They were the largest direct effect on emerging infectious disease. Conclusions: The full lockdown measures, health literacy (HL), and CMS of VHVs have the largest direct effect to COVID-19 infections. In addition, the CMS competency of VHVs proved effective and appropriate in providing health care support, and surveillance for protection against EID.

Abstract: Background/Objectives: Helicobacter pylori (H. pylori) is a significant global health issue causing chronic gastritis, peptic-ulcer, and gastric-malignancies. Unfortunately, many, particularly in the Middle East, continue to exhibit alarmingly rates of prevalence. This study aimed to elucidate local epidemiological patterns of H. pylori and examine its histopathological impact on the gastric mucosa. Methods: This retrospective-cross-sectional study included 805 symptomatic adults (329 males, 476 females) who underwent endoscopic evaluation at King Salman Hospital, Ha’il, Saudi Arabia. Biopsies from the antrum and body were processed using routine formalin-fixation and paraffin-embedding. Staining with hematoxylin-eosin (H&E) and Giemsa permitted assessment of chronic gastritis and detection of H. pylori. Data was evaluated by IBM SPSS (version 23, IBM Corp., Armonk, NY) for associations between infection, histopathology, and patient-characteristics. Results: A total of 727 (90.3%) were H. pylori positive with marginally higher rates in females (91.2%) than males (89.0%). Infection spanned all age-groups, reaching 100% in males aged 60–80 years. Chronic GI-complications were identified in 726 (99.9%), with chronic gastritis being the most profound histopathologically (19.3%). Lymphoid-aggregates in 93.0% biopsies, reflected a pronounced immune-response. Advanced lesions, including metaplasia (0.8%), atrophy (0.3%), and lymphoma (0.1%), were uncommon, though indicative of potential malignant-progression. Both sexes exhibited universal symptoms of gastritis, dyspepsia, and heartburn, whereas vomiting, nausea, and weight loss showed minor variability. No statistically significant gender-based differences emerged (p>0.05). Histopathology consistently revealed chronic active-gastritis with glandular-distortion, lymphoplasmacytic infiltration, and occasional mucosal erosions. Giemsa staining further confirmed abundant spiral-shapes underscoring a high bacterial-load. Conclusion: These findings highlight the age-specific persistently elevating rates of H. pylori significantly associated to chronic-gastric-inflammatory complications. Although advanced gastric lesions remain rare, the potential for malignant transformation underscores the importance of early detection, timely eradication therapy, and vigilant follow-up to avert severe disease outcomes.

Abstract: Background: Pseudobulbar affect (PBA) is a disorder characterized by involuntary episodes of crying or laughing that are disproportionate or inappropriate to the social context. It is frequently observed in neurological disorders, including dementia, but often remains underrecognized due to diagnostic challenges. This study aimed to determine the prevalence of PBA in dementia patients, explore its relationship with neuropsychiatric symptoms, and assess differences across dementia subtypes. Methods: This single-center, cross-sectional study included 212 participants (159 dementia patients and 53 healthy controls). Participants were assessed using the Center for Neurologic Study-Lability Scale (CNS-LS), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Geriatric Anxiety Scale (GAS), and Apathy Evaluation Scale (AES). Statistical analyses included independent t-tests, one-way ANOVA, and Pearson correlation tests. Results: The prevalence of PBA among dementia patients was 53%, significantly higher than in the healthy control group (p = 0.021). PBA scores were highest in vascular dementia (VD) and frontotemporal dementia (FTD) patients, with significantly lower scores in Alzheimer’s disease (AD) and Lewy body dementia (LBD) (p < 0.001). A significant positive correlation was found between PBA and both depression (GDS) and anxiety (GAS), while a borderline negative correlation was observed with cognitive function (MMSE). No significant relationship was detected between PBA and apathy (AES). Additionally, caregivers reported laughing or crying episodes in 70% of dementia patients, despite the underrecognition of PBA in clinical practice. Conclusion: PBA is a prevalent but underdiagnosed neuropsychiatric symptom in dementia, with its occurrence varying across subtypes. VD and FTD patients exhibit the highest PBA scores, whereas AD and LBD patients show similar scores to healthy controls. The strong association between PBA, depression, and anxiety highlights the need for systematic screening in dementia care. Raising awareness and conducting further research on the pathophysiology of PBA may improve diagnosis and treatment strategies, ultimately enhancing patient outcomes.

Abstract:

Background/Objectives: Lasmiditan is a newly developed drug for the acute treatment of migraine attacks, but factors associated with its efficacy remain unclear. This study aimed to confirm the efficacy of lasmiditan started at 50 mg under various dosing conditions and identify factors associated with its efficacy. Methods: There were four reasons for prescribing lasmiditan: add-on to triptan, ineffectiveness of triptan, side effects of triptan, and triptan contraindicated. Lasmiditan was started at a dose of 50 mg. Efficacy of lasmiditan was defined as the disappearance of headache or a 50% or greater reduction in headache intensity within two hours after dosing. This study included 108 patients with migraine who took lasmiditan. Results: The results for efficacy and the side effects of lasmiditan were as follows: effective without side effects (22), effective with mild side effects (32), ineffective (14), and severe side effects (40). The efficacy rate of lasmiditan 50 mg was 50.0% (54/108). The following factors were found to be associated with lasmiditan efficacy: sex, migraine classification, calcium channel blockers, and anti-calcitonin gene-related peptide monoclonal antibody (CGRP-mAb) treatment. The overall incidence of side effects was 66.7%, and the dropout rate was 37.0%. Somnolence was more prevalent in the effective group, and other side effects were more prevalent in patients who dropped out due to side effects of lasmiditan. Conclusions: Lasmiditan is likely to be effective in male, severe migraine classification, and receiving CGRP-mAb treatment. If mild somnolence is a side effect, the drug can be continued and may be effective.

Abstract:

Healthcare sector has always been one of themost important industries for humankind. As ArtificialIntelligence is automating several industries, use of AI andmachine learning based algorithms in healthcare is anincredible idea to improvise the way we look towards andperform healthcare. One of the best ways to bring an AI/MLbased change in healthcare is through first-hand diagnosis ofdiseases. There are numerous blood related diseases, presence,or risk of which can be assessed through analysing the basicblood report of a patient. Developing a machine learningmodel to perform this analysis and flash the comments ‘risk’or ‘no risk’ on screen in seconds would be a big advancementin the diagnosis sector, saving a lot of time and man force. Thisresearch paper develops machine learning models to performthis first-hand blood related disease risk assessment and alsoexplores the processing of these black-box models throughexplainable AI (XAI) to ensure the trustworthiness of thesemodels for using them at scale. The machine learning modelstrained and tested for the blood disease risk assessment areLogistic Regression, Decision Tree, Random Forest andXGBoost and the best test accuracy obtained from thesemachine learning models is 100%. The feature contributingthe most to the prediction as recorded by XAI are MCV,MCH, HBG and HBA.

Abstract: Background/Objectives: Quantitative Sensory Testing (QST) is one of the most reliable methods for assessing Fibromyalgia Syndrome (FMS). Despite its importance, there are still controversies regarding the correct interpretation of evoked responses, as they may vary depending on the protocol, individual characteristics, disease severity, and other factors. This study aims to examine how QST has been applied as an outcome measure in FMS. Methods: We considered three databases (Medline, Embase, and Web of Science) until June 2024. From a total of 2,512 studies, 126 (39 RCTs and 87 non-RCTs) were selected for full reading after assessment for risk of bias and eligibility criteria. These criteria included at least one type of QST and a clear diagnosis of fibromyalgia (FMS). Results: Results highlighted a lack of standardization in QST, as no reported protocols were followed and there was no specific number of tender points tested for FMS. Additionally, there was inconsistency in the selection of sites and types of tests conducted. Conclusions: This heterogeneity in methodology may affect the comparability and interpretation of results, underscoring the urgent need for standardized guidelines for conducting QST in fibromyalgia studies. A clear understanding of how QST has been measured could prompt a reevaluation of current approaches to FMS assessment, leading to more accurate interpretations and, ultimately, improved management of this complex condition. Keywords: quantitative sensory testing; fibromyalgia; pain measurement; CPM; temporal summation; sensory function.

Abstract: Applying digital health interventions (DHIs) in primary health care (PHC) is a possible strategy for achieving universal health coverage (UHC). Australia’s implementation of DHIs in PHC has shown both successes and challenges across diverse populations. This scoping review synthesised evidence from 60 studies, focusing on digital health interventions, PHC, successful care measurement, and the Australian context. Findings indicated that DHIs improved healthcare accessibility and efficiency but still face challenges in ensuring quality care, particularly for Culturally and Linguistically Diverse (CALD) and First Nations populations due to language barriers and regional digital gaps. Ineffective governance, limited resources, and increased workloads further hinder DHI implementation. While DHIs presented high-quality outcomes for the general population and some CALD groups, affordability remains a barrier for others. Tailored or co-designed DHIs for minority populations show more tremendous community engagement success compared to general interventions. To conclude, DHIs for PHC in Australia enhance healthcare delivery but require addressing inequities in access, governance, and resource allocation to ensure inclusive progress toward UHC. Policymakers and healthcare managers must prioritise these gaps to create more equitable healthcare systems.

Abstract: 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 this study, we compare LLMs from Google, OpenAI, Meta, Mistral, Cohere and Anthropic using a previously established evaluation methodology and explore improving their accuracy with RAG. We found that GPT-4o from OpenAI and Claude Sonnet 3.5 from Anthropic were the top performers with them only missing 0.5% of ground truth conditions that were clearly inferable from the available data; RAG further improved this error rate to 0.2%. While the results are promising, more diverse datasets, hospital pilots and close collaboration with physicians are needed to get a better understanding of the diagnostic ability of these models.

Abstract:

Background: Functional gastrointestinal disorders, including irritable bowel syndrome (IBS) and functional abdominal bloating, are prevalent in gastroenterology. The unclear pathogenesis complicates the development of effective therapies, which may be pharmacological or non-pharmacological in nature. Objective: This pilot study aimed to evaluate the efficacy of a food supplement containing probiotics, digestive enzymes, and Melissa officinalis extract in patients suffering from IBS and functional abdominal bloating. Methods: We conducted a randomized, double-blind, placebo-controlled, monocentric trial involving adult patients diagnosed with IBS and functional abdominal bloating. Participants were randomly assigned to receive either the active product or a placebo for 20 days. The primary outcome measure was the change in the global Visual Analogue Scale (VAS) for satisfaction. Secondary measures included symptom scales related to bloating and abdominal pain. Results: A total of 31 participants were enrolled, with 29 completing the study. Patients receiving the active supplement reported a positive effect in the global VAS for satisfaction and demonstrated improvement in most secondary symptom scales compared to the placebo group. However, no statistically significant differences were found between the active and placebo groups, the treatment resulted in a higher tendency to improvement in patient-reported outcomes compared to the placebo group. Conclusion: This pilot study provides valuable insights into non-pharmacological therapies for IBS and functional abdominal bloating. Although the results were promising, larger studies with longer treatment durations and based on more complex approach also including diet intervention and psychological support are needed to fully evaluate the long-term effects of probiotics and the active ingredients in the supplement.

Abstract: Social media has emerged as a transformative platform for healthcare professionals, offering unprecedented opportunities for awareness, knowledge exchange, and advocacy. This study explores the multifaceted impact of social media on the professional and public roles of healthcare providers. By analyzing the use of social platforms for disseminating medical information, fostering patient engagement, and promoting public health campaigns, we identify how healthcare professionals navigate challenges such as misinformation, ethical dilemmas, and professional boundaries. The study further examines the role of social media in advocacy, enabling professionals to influence healthcare policies, amplify marginalized voices, and address systemic inequities. A mixed-methods approach combining quantitative analysis of social media trends and qualitative insights from healthcare practitioners provides a comprehensive understanding of the benefits and limitations of these platforms. Findings indicate that while social media enhances professional visibility and fosters community engagement, it also necessitates a balance between ethical responsibility and professional credibility. This research underscores the need for targeted training and guidelines to optimize social media usage among healthcare professionals, ensuring it serves as a tool for positive transformation in healthcare advocacy and practice.

Abstract:

Background: Historically, immunization programmes have focused on infants, children, and women of reproductive age. COVID-19 vaccination prompted countries to vaccinate adults. This manuscript provides a global overview of adult immunization post COVID-19 pandemic. Methods: We summarized WHO Strategic Advisory Group of Experts on Immunization (SAGE) recommendations by adult group and analyzed the data reported in 2024 (2023) by WHO Member States (MS) via the WHO/UNICEF electronic Joint Reporting Form on Immunization (eJRF) on national immunization schedules, and from other sources by WHO region and income group. Results: WHO policy recommendations exist for most of the licensed vaccines targeting adults; however, the inclusion in national immunization schedules is higher in high-income (HICs) and middle-income (MICs) countries. For pregnant women, 90% of MS reported vaccination against COVID-19 (65% in low-income countries [LICs]), 63% against tetanus-containing vaccines (73% in LICs), 57% against influenza (4% in LICs), and 21% against pertussis-containing vaccines (all MICs and HICs). For health workers, 91% against COVID-19 (92% in LICs), 59% against influenza (4% in LICs), and 25% against hepatitis B (10% in LICs). For adults with chronic diseases, COVID-19 vaccination data were not available, 58% against influenza, and 23% against pneumococcal disease. For older adults, more than 90% of MS across all income groups reported COVID-19 vaccination, 59% against influenza (8% of LICs versus 89% of HICs), 17% against pneumococcal, and 7% against herpes zoster. Conclusion: The disparities in adult immunization policies across income groups highlight the need to improve access and strengthen vaccination efforts. A life course approach is essential to maximize the full potential of immunization across all ages.

Abstract:

Background: Aging is a global phenomenon closely associated to changes in cognitive function and mental health. These conditions substantially burden public health systems and adversely affect the quality of life of older adults. This study aimed to examine changes in depressive symptoms and cognitive function over a 12-month follow-up period in a cohort of Brazilian older adults attending primary care. Methods: This observational, longitudinal study included a randomized sample of individuals aged ≥60 years residing in São Paulo, Brazil, and registered at a Primary Healthcare Unit (PHU). Data collection involved administering a sociodemographic and health questionnaire along with two validated instruments: the Geriatric Depression Scale-15 (GDS-15) and the Mini-Mental State Examination (MMSE). Linear regression models were used for the analyses. Results: A total of 368 older adults were included, being 63% men and with a mean age of 74.65 years. After one year, depressive symptoms showed a notable increase, with the mean GDS-15 score rising from 5.97 to 7.48 (Cohen-d = 0.542). Likewise, there was a decrease in the mean MMSE score ranging from 19.11 to 18.88 (Cohen-d=0.216). Adjusted regression analyses revealed that depressive symptoms at baseline (B = 0.696; p = 0.048; R² = 0.19) and cognitive function at baseline (B = 0.444; p < 0.001; R² = 0.26) were predictive of their respective deteriorations over the follow-up period. Conclusion: Depressive symptoms and cognitive decline place a significant burden on public health systems in aging societies. These findings underscore the importance of continuous monitoring and early intervention strategies to mitigate their impact and enhance the quality of life for older adults.