Abstract: Objective: To examine the relationship between low-density lipoprotein (LDL) levels and clinical outcomes in hospitalized COVID-19 patients in Northern Greece. Methods: A ret-rospective analysis was performed using data from 208 COVID-19 patients. Lipid profiles [including LDL (low-density lipoprotein cholesterol), HDL (high-density lipoprotein cho-lesterol), and triglycerides], prior antilipidemic treatment, and clinical outcomes were evaluated. Statistical analysis was conducted using SPSS version 19. Patients: 208 COVID-19 patients from Northern Greece. Results: The mean LDL level was 84.12 mg/dL, with no significant differences observed between survivors and non-survivors. Prior an-tilipidemic treatment did not significantly affect outcomes. Elevated triglyceride levels were noted in obese patients (BMI ≥ 30 kg/m²), and lower HDL levels were associated with higher CRP (C-reactive protein) levels. Although LDL levels declined over time in non-survivors, this decrease was not statistically significant. Longitudinal analysis showed normalization of LDL levels post-recovery, while HDL levels remained persis-tently low. Conclusion: Despite observable alterations in lipid profiles, their prognostic significance in this cohort was limited. These findings highlight the need for further in-vestigation into the role of lipid metabolism in the pathophysiology of COVID-19.

Abstract: (1) Background: This study investigated the determinants of COVID-19 mortality and its temporal trends within São Paulo state’s Regional Health Departments (DRS) to inform the development of targeted public health interventions. (2) Methods: Utilizing an ecological study design, we analyzed confirmed COVID-19 cases and deaths (February 2020 – December 2021) obtained from the COVID Panel, incorporating relevant social and health indicators. The Generalized Additive Model for Location, Scale, and Shape (GAMLSS) was used to identify key determinants, and temporal trends in mortality and vaccination rates were analyzed across each DRS. (3) Results: The average mortality rate was 32.0 deaths per 100,000 inhabitants (median 67.9). Higher chronic disease mortality was associated with lower COVID-19 mortality. However, increased proportions of older adults in urban areas, and higher vaccination rates correlated with increased COVID-19 mortality. (4) Conclusions: COVID-19 mortality in São Paulo is shaped by a complex interplay of behavioral, economic, demographic, and environmental factors. Region-specific public health policies should consider these factors, along with geographic, socioeconomic, and budgetary contexts, to effectively address health disparities across the state’s DRS.

Abstract: Breast cancer is the predominant cause of cancer in developing nations, and screening with breast self-examinations and mammograms is crucial in mitigating morbidity and mortality. Nonetheless, geographic disparities in screening methods persist, attributable to socio-demographic variation and healthcare accessibility. This study aimed to analyze the influence of women’s screening practices for breast cancer and the other risks stratified to urban and rural areas in Indonesia. A case-control design was adopted, including all women who had breast cancer in 2014 as the study subjects. The Indonesian Family Life Survey data from 2007, with subjects aged at least 15 years, and from 2014 were used. Unconditional logistic regression was used to analyse the risk factors of breast cancer. After controlling for confounders, the odds of breast cancer diagnosis were higher in women who performed breast self examination (BSE) (aOR 10.22; 95% CI 1.04-50.81 and aOR 11.10; 95% CI 3.32-37.08) and those married before age of 19 (aOR 4.81;95% CI 1.93-6.05 and aOR 5.35;95% CI 1.49-19.7), respectively in urban-rural. In addition, women who had undergone mammography (aOR 48.04; 95% CI 10.33-83.45) had significantly higher odds of being diagnosed with breast cancer in urban. In rural areas, the paternal history of cancer-related death had higher odds of breast cancer (aOR 30.63; 95%CI 6.04-60.41) than those without a parental history of cancer. This study highlights the importance of intensifying national breast cancer screening, including BSE campaigns and expanding mammography infrastucture, particularly in rural areas, for improving breast cancer prevention and early diagnosis.

Abstract: Background: B. Pertussis remains a significant public health concern, with periodic outbreaks despite vaccination efforts. Understanding the temporal trends and seasonality of pertussis incidence is important for improving its surveillance and pre-vention strategies. Objectives: The aim of this study was to examine pertussis trends in Tshwane Health District, South Africa, from 2015 to 2019. Methods: A retrospective time series analysis was performed on reported pertussis cases in the Tshwane Health District from 2015 to 2019. Descriptive statistical techniques and time series decom-position were employed to investigate seasonal patterns. Autoregressive Moving Average (ARMA) models were employed to assess short-term trends, while cubic trend modelling was used to forecast future case trajectories. Residual diagnostics assessed model validity and analysed correlations between pertussis incidence and climate var-iables. Results: The incidence of Pertussis infection incidence exhibited seasonal pat-terns, with peak cases being reported in Spring and Winter. Time series decomposition confirmed annual fluctuations, suggesting potential environmental and social factors influencing disease transmission. The ARMA(4) model provided the best fit for short-term forecasting, while the cubic model effectively captured long-term trends. Residual diagnostics confirmed model reliability. Conclusion: This study highlights the utility of time series modelling in predicting pertussis trends and underscores the role of seasonality and climate factors in disease dynamics. The findings support enhanced surveillance, climate-adaptive interventions, and optimised vaccine timing to mitigate outbreaks. Integrating predictive modelling with public health strategies can improve outbreak preparedness and resource allocation.

Abstract: Background: Sputum culture and smear conversion are key indicators of treatment response in drug-resistant tuberculosis (DR-TB). This study aimed to assess sputum conversion and regimen efficacy among DR-TB patients and identify factors influencing conversion rates. Methods: This retrospective cohort study analyzed medical records of DR-TB patients treated between 2018 and 2020 in the Eastern Cape Province, South Africa. Kaplan-Meier curves, Spearman correlation, and logistic regression models were used to assess time-to-sputum conversion and its predictors. Results: Among the 88% of patients who achieved sputum conversion, the median time ranged from 29 to 59 days. Patients on short treatment regimens converted significantly faster than those on long regimens (p = 7.55 × 10⁻¹⁵), with 90% of short-regimen patients achieving favorable outcomes compared to 52% in the long regimen group (p = 0.0000040). Spearman correlation revealed a weak but significant positive association between comorbidities and conversion time (r = 0.041, p = 0.041). HIV-positive patients had a slower conversion rate than HIV-negative patients, but this association was not statistically significant (χ² = 0.426, p = 0.514). Logistic regression identified older age as a predictor of favorable outcomes (coefficient = 0.039, p = 0.045), while regimen type and HIV status did not show significant predictive power. Conclusions: Shorter treatment regimens significantly improve sputum conversion rates and treatment outcomes. The findings support optimizing DR-TB treatment through personalized regimens based on patient health status and drug resistance patterns. This study provides evidence to enhance TB control efforts in high-burden regions, with implications for global treatment strategies.

Abstract: Background/Objectives: Dentifrice tablets are a new over-the-counter dentifrice form that are gaining global interest. The aim of this microbial study was to investigate the effectiveness of dentifrice tablet (DT) containing nanohydroxyapatite (nHAP) to prevent tooth demineralization. Methods: 120 bovine tooth blocks were randomly assigned to four treatment groups (30/group): Nanohydroxyapatite DT (5% nHAP), placebo DT (Placebo), NaF toothpaste (1100ppm Fluoride), and no-treatment (Control). Blocks were subjected to 7-day demineralization by plaque growth in a mixed-organism Microbial Caries Model. Toothpaste was made into slurry (1 toothpaste:3 water), while DT was thoroughly crushed and homogenized with water (1 tablet:3 water) to slurry. Both slurries were applied twice daily for 2 minutes on each occasion. Demineralization was assessed using Surface Microhardness (SMH) testing before and after plaque exposure. Change (ΔSMH) and percentage change (%∆SMH) in SMH (percentage demineralization [%Dem]), and % demineralization inhibition (%Dem-Inhibition) in each group were calculated. Intra-group (SMH) comparison (paired t-test) and intergroup (%∆SMH) comparison (ANOVA/Tukey’s test) were conducted (α=0.05). Results: Paired t-test indicated significant difference (p<.001) between pre-treatment and post-treatment SMH in all groups. Intergroup comparison based on their %Dem using ANOVA/Tukey’s test showed that Control (29.93±5.58) had significantly (p<.05) higher %Dem than Placebo (22.81±7.47, p<.05), nHAP (13.93±11.31, p<.001), and Fluoride (14.44±10.65, p<.001). Placebo had significantly (p<.01) higher %Dem than nHAP and Fluoride. No significant difference between nHAP and Fluoride. Intergroup comparison based on their %Dem-Inhibition (calculated relative to the control) using ANOVA/Tukey’s test, nHAP (51.74±40.05, p<.01) and Fluoride (50.56±37.21, p<.05) had significantly higher %Dem-Inhibition than Placebo tablet (21.86±5.55). No significant difference in %Dem-Inhibition between nHAP and Fluoride. Conclusions: The present study demonstrated that dentifrice tablets containing 5% nanohydroxyapatite are as effective as NaF toothpastes containing 1100 ppm fluoride in preventing tooth demineralization.

Abstract: Tuberculosis poses serious challenges to healthcare personnel as it continues to be highly prevalent in a developing country like India. Several prominent strategies have been adopted to control this contagious infection, but the incidence rate remains high. Many studies have linked fungal infections and tuberculosis, apparently elevating concerns in the TB elimination program. Hence, it is essential to understand the mechanism underlying TB co-infection and pulmonary mycoses to combat the problems caused by these diseases successfully. In addition, differential diagnosis of TB and fungal infections is equally essential to initiate appropriate treatment. In this review, we have documented the findings of TB and fungal diseases individually and as coinfection, focusing on Indian perspectives. Misdiagnosis of fungal diseases as Tuberculosis in many studies elucidates the need for simultaneous diagnosis of both infections for appropriate diagnosis.

Abstract: Background: While immigrant children often exhibit better breastfeeding practices, they may face challenges in maintaining a healthy diet and engaging in organized sports. Despite the growing immigrant child population in Portugal, evidence on these behaviours, particularly among preschool aged children, remains limited. In this context, this study examines the associations between migrant status and breastfeeding patterns, fruit and vegetable consumption and participation in sports in children living in the Lisbon Metropolitan Area. Methods: Cross-sectional study nested within a cross-sequential cohort was carried out in the Lisbon region between May 2022 and April 2024. Approximately 720 children (49.4% immigrants) born in 2018 and 2020 were enrolled in the study, and data were collected through a face-to-face interview with parents using a structured questionnaire with information on socioeconomic variables, migration history, breastfeeding habits, and children's diet (fruit and vegetable consumption) and physical activity. We used parametric and non-parametric tests to compare migrant and non-migrant children. To quantify factors associated with the main outcomes, we estimated a logistic regression model and calculated crude and adjusted odds ratios and their respective CI95%. Results: Immigrant children were disproportionately represented in socioeconomically disadvantaged families. Breastfeeding initiation rates were higher among immigrant mothers (96.3%vs.87.6%, p < 0.001). Additionally, immigrant mothers had a longer median duration of any breastfeeding (14 vs. 8 months, p < 0.001) and of exclusive breastfeeding (6 vs. 4 months, p < 0.001). Being an immigrant child decreased significantly the odds of consuming three or more portions of fruit (aOR=0.700; CI95%:0.511-0.959; p=0.027) and two or more portions of vegetables per day (aOR=0.489; CI 95%: 0.350-0.684;p<0.001) compared with non-immigrant children. Immigrant children were twice as likely to not engage in sports (aOR=2.185; CI95%:1.512-3.158;p<0.001). Conclusions: The findings highlight the need to address social determinants of health and the challenges faced by immigrant families in promoting a balanced diet and sports participation for their children. Multisectoral, culturally appropriate interventions that support breastfeeding, improve access to healthy food, and encourage sports are crucial to reducing health inequalities.

Abstract: Healthcare in a hospital environment frequently involves patient companions who can serve as reservoirs and transmitters of infection. This study aimed to assess the knowledge and practices of patient companions regarding infection prevention and control (IPC) in healthcare settings of Bobo Dioulasso (Burkina Faso). A cross-sectional study including patient companions was conducted at Sourô Sanou University Hospital (CHUSS) and the Do and Dafra district hospitals. Multilevel linear regression model was employed to assess the associations between companion characteristics and their level of knowledge or practice. The statistical significance level was set at 5% for all analyses. A total of 789 patient companions were included. The average knowledge score on IPC was 32 out of 100. The average score for IPC practices in healthcare facilities was 81.0 out of 100. Male gender (P=0.029), urban residence (P=0.034), widower status (P=0.001), secondary education and above (P=0.000), and awareness (P=0.000) were found to be associated with a higher level of IPC knowledge. Secondary education and above (P=0.010), awareness (P=0.000), CHUSS and Do (P=0.012) were factors associated with good IPC practices. This results showed patient companions deficiency in IPC knowledge and practice. Main factors of this deficit were a paucity of education and insufficient awareness.

Abstract: Background: The burden of cervical cancer is highest in low- and middle-income countries. In the absence of organised screening programmes in Nigeria, opportunistic screening of women of reproductive age seeking maternal healthcare can help achieve increased uptake of cervical cancer screening. This study is aimed at understanding the practice of opportunistic cervical cancer screening and health education, and the barriers and facilitators experienced by health workers practicing in antenatal and postnatal clinics in Ogun State, Nigeria. Methods: This is a qualitative cross-sectional study. In-depth interviews were conducted among 43 health workers—doctors, nurses and community health extension workers, working in antenatal and postnatal clinics in public primary, secondary and tertiary health facilities. Data analysis was done using thematic analysis. Results: Health education on cervical cancer prevention was not done in most health facilities. Where cervical cancer health education was practiced, it was done mostly prior to family planning provision, and sometimes at antenatal, postnatal/infant immunization clinics. Facilities for cervical cancer screening was not available in most of the health facilities and patients had to travel long distances to tertiary facilities to have a Pap smear done. Barriers to cervical cancer screening and health education include, high cost of screening, manpower shortage, fear of positive result among patients, poor awareness among patients, and religious and cultural beliefs. The major facilitators to screening and health education mentioned were passion for their work and the desire that no woman should die from preventable cancers. Conclusion: Government should ensure adequate staffing of health facilities, health worker training, adequacy of reagents and equipment for screening, accessibility of screening centers and make screening free/more affordable. Awareness activities and community mobilization for cervical cancer screening is needed. It is recommended that health facilities include cervical cancer health education into routine antenatal and postnatal clinic activities, and screening at post-natal clinics.

Abstract: Long Covid is now regarded as a chronic disease that follows from an acute infection of SARS-CoV-2. Patients themselves were at the forefront of developing the scientific understanding of the disease, which was followed up by government related health institutions. This analysis describes how the patient led research initiated the development of the institutions’ “case definitions” of long Covid and which of these definitions is the more suited to providing a set of “diagnostic criteria” for long Covid.

Abstract: Background: Gastric cancer (GC) is a major public health issue and a leading cause of cancer-related mortality in Ecuador. Despite national cancer control efforts, the burden remains high, with variations by gender and age. This study aimed to quantify the burden of GC in Ecuador from 2010 to 2021 using Disability-Adjusted Life Years (DALYs), providing insights for public health strategies. Methods: A cross-sectional study was conducted using hospital discharge and mortality data from the National Institute of Statistics and Census (INEC). The study included all Ecuadorian individuals diagnosed with GC (ICD-10: C16) from 2010 to 2021. The burden of disease was estimated using DALYs, which combine Years of Life Lost (YLL) and Years Lived with Disability (YLD). Data were stratified by gender and age groups. Analyses were performed using Microsoft Excel and the DALY calculator in R v4.2.1. Results: Between 2010 and 2021, GC accounted for 802,135 DALYs in Ecuador, with an annual average of 66,845 DALYs. Males accounted for 57.2% of the total burden. The highest impact was observed in individuals aged 65–69 years. A progressive increase in disease burden was identified, particularly among older age groups. Conclusions: The findings highlight the need for targeted interventions, including early detection programs, risk reduction strategies, and improved healthcare access. Strengthening public health policies is crucial to mitigating the rising burden of GC in Ecuador.

Abstract: Coffee is considered as one of the most commonly consumed beverages in the world. Understanding the impact of coffee on human health is of considerable interest. Fluoride is an essential inorganic element that mineralizes hard tooth tissues and increases their resistance to caries. Fluoride is found in many daily beverages, including coffee. Research shows that high fluoride intake can lead to dental issues in both adults and children fluorosis. The arabic coffee has been the most widely consumed cultural beverage , but to date, there is a lack of literature on the fluoride concentration in Arabic coffee. This study aimed to evaluate fluoride levels in various coffee beverages across different regions, as well as to analyze the dietary fluoride intake from Arabic coffee intake.8 samples were considered from each category of 5 regions for testing a total of 40 samples were recorded. Each sample was examined using an ion chromatography system (ExStik® FL700 Fluoride Meter, USA), and the dietary intake and risk assessment were calculated using the equations concerning the 7mg recommended by the European Food Safety Authority (EFSA). Analysis of variance (ANOVA) was employed to assess the significance of study parameters among the groups. Additionally, post hoc analysis was conducted if the ANOVA test values were significant. The mean concentrations of fluoride were highest in the eastern followed by the northern and the least in the southern region.

Abstract: Abstract: Background: Although screening for early signs of autism spectrum disorder (ASD) using the Modified Checklist for Autism in Toddlers (M-CHAT) has been recommended by the Brazilian Ministry of Health since 2017, the feasibility of this intervention and its effects in primary care have not been sufficiently investigated. Objectives: (1) to assess the level of knowledge and practices of nursing professionals’ caregivers in Brazilian primary health care regarding ASD, (2) to evaluate the feasibility of incorporating the M-CHAT into the vaccination childcare routine, and (3) evaluate the frequency of children with possible early signs of ASD using the M-CHAT. Methods: This is an observational, cross-sectional study conducted in a medium-sized city in southeastern Brazil. A total of 97 nurses from 21 health facilities participated. The professionals answered a questionnaire on knowledge and practices regarding ASD, attended a training on early signs of ASD and for the use of M-CHAT. Finally, they administered the M-CHAT to 267 parents of children aged 16 to 57 months in primary care settings. Results: Insufficient knowledge of ASD was identified among the nursing professionals evaluated. Approximately 80% agreed that the training was satisfactory, and 88% agreed that they felt competent to use the M-CHAT, 74% agreed with the benefits of using the M-CHAT to detect early signs of ASD in public health settings. However, 91% of the professionals reported that incorporating the M-CHAT into the day care routine overloaded their work, and less than 50% agreed that the instrument should continue to be used in the day care routine. Sixty-seven (25.09%) children screened positive for possible early signs of ASD by M-CHAT. Conclusion: The insufficient level of knowledge on ASD found among nursing professionals suggests gaps in Brazilian academic and professional training in this area. Although most participants recognized the importance of early detection of signs of ASD in primary care settings, the implementation of the M-CHAT in the routine primary care settings was not well accepted for most participants due to work overload, which indicates the need for public health policies to offer working conditions that minimize the overload of professionals, maintaining early screening interventions for ASD in Brazilian primary care institutions.

Abstract: Background: Sexual dysfunction is prevalent in the Australian population, affecting over half of men regardless of age and sexual identity. It can have significant impacts on men's physical health, mental well-being, and quality of life if left untreated. The present study aimed to examine sexual dysfunction trends and factors associated with sexual help seeking behaviour among a cohort of Australian men. Methods: Four waves of longitudinal data from the Australian Longitudinal Study on Male Health (Ten to Men) were used in the analysis. We included adult men aged 18 years and above who had engaged in vaginal, oral, or anal sex. Our analysis included a total sample size of 12,737 (wave 1), 8,933 (wave 2), 6,991 (wave 3), and 5,804 (wave 4) men. Logistic regression was undertaken to identify factors associated with sexual help seeking behaviour. Results: Across the data waves, there was a significant rise in the prevalence of men experiencing at least one form of sexual difficulty, increasing from 54.1% (95% CI: 52.7, 62.5) in 2013/14 to 64.7% (95% CI: 62.8, 66.7) in 2022. The increase in prevalence of sexual difficulties was most pronounced among men from culturally and linguistically diverse (CALD) backgrounds which increased from 42.8% (95% CI: 38.1, 47.5) in 2013/14 to 61.5% (95% CI: 55.6, 67.1) in 2022. Around 17.6% of men sought assistance for their sexual health concerns in 2022, with no significant change over the study period. Number of sexual difficulties, age, sexual identity, relationship status, conformity to masculine norms, depression, and number of financial hardships were factors significantly associated with sexual health seeking behaviour.Conclusions: Despite the burden of sexual dysfunction increasing among Australian men, few have sought assistance, suggesting a significant level of unmet sexual health need. This underscores the necessity for co-designed sexual health services, informed by an intersectional approach, to better engage men from a range of communities and meet their distinct sexual health needs and preferences.

Abstract: People who are trans and gender diverse are underserved by the healthcare system; one way to improve healthcare access is with peer healthcare navigators. We piloted two trans peer health navigators from April 2021 to March 2022 in a small Canadian province. The purpose of the study was to explore how trans peer navigators experienced their work and work environment through reflective journalling. The navigators journalled roughly weekly. They were encouraged to interrogate their own biases, and to think about what was omitted from conversations with others. Each journal was treated as a qualitative case study, anonymized and analyzed thematically using Interpretive Phenomenological Analysis. Six themes emerged: Expected work, Unexpected work, Teamwork, Lived experience, Challenges and Systemic factors. These themes were complexly interwoven with a network of subthemes that frequently fell under multiple main themes and were highly emotionally charged, many both positively and negatively. The importance of navigators being transgender themselves was highlighted. The rewards came from being able to provide meaningful help to people in their community and the challenges came from not being respected by other healthcare providers and systemic barriers that prevented them from helping clients. The navigators successfully adapted their services to bridge some systemic barriers. This research has implications for improving the experience of being a navigator and improving trans navigator services for clients.

Abstract: Background/Objectives: Suicide is a deliberate act of ending one's life, often driven by suffering perceived as insurmountable. Suicidal thoughts serve as warning signs that require urgent intervention. Some individuals leave farewell messages in the form of letters or other media, revealing their psychological state. This study aims to analyze a suicide note from a forensic and psychological perspective to enhance the under-standing of suicidal crises. Methods: We present a forensic case involving a civil serv-ant who was dismissed after a workplace accident that led to neurological complica-tions. Forced to return to work despite his physical incapacity, he experienced a pro-found sense of injustice. The forensic examination included an autopsy, toxicological analysis, and psychological interpretation of the suicide note. Family interviews were conducted to assess prior distress signals. Results: The forensic analysis of the suicide note revealed intense psychological distress and a deep sense of injustice regarding his situation. After the failure of his legal proceedings, his despair worsened. His family reported previous suicidal warning signs that had been overlooked. The autopsy con-firmed the cause of death as hanging, with no evidence of external intervention. Con-clusions: This case highlights the importance of recognizing distress signals during a suicidal crisis—a reversible period if appropriate interventions are implemented. It underscores the medico-legal relevance of suicide notes in forensic investigations and emphasizes the necessity of integrating mental health strategies to strengthen suicide prevention efforts.

Abstract: In dental clinics the risk of airborne infection is relevant. Microbiological air monitoring is a useful tool for evaluating the effectiveness of preventive measures and identifying at-risk situations. Active and passive sampling can be used to assess microbial air contamina-tion; however, optimal sampling methods and reference threshold values have not been established. Passive sampling has been standardized by the Index of Microbial Air con-tamination (IMA). This study aimed to review the use of the IMA standard for air quality assessment in dental clinics proposing IMA threshold values based on a meta-analysis. Scopus, PubMed, and Web of Science were analyzed for articles published until April 30, 2024, citing “Pasquarella C., et al., The index of microbial air contamination. J Hosp Infect 2000”. After applying the inclusion criteria, nine studies were considered. The mean IMA values before, during, and after dental procedures ranged from 2.4 to 38.3, 19 to 53.3, and 13 to 20, respectively. Seven studies were included in the meta-analysis, which had mean IMA values of 15.4, 33, and 16.7, respectively. Due to the ease of use, low cost, and com-parability of results, the IMA standard is recommended for the routine monitoring of mi-crobial air contamination.

Abstract: Mental Health disorders have a high prevalence in Latin America (LATAM), with an estimated 6.7% of the population suffering from anxiety and 4% from depression. Digital Mental Health Interventions (DMHIs) have been implemented to address these issues. However, there has yet to be a clear picture of these interventions in the region. This scoping review aims to analyze DMHIs characteristics and the barriers and facilitators for their implementation in five LATAM countries (Brazil, Chile, Colombia, Mexico, and Peru). To achieve this goal, four databases (PubMed, APA PsycNet, Scielo, and LILACS) were searched using relevant search terms in English, Spanish, and Portuguese. A total of 484 references were identified and narrowed down to 15 articles included in the final analysis. The studies mostly consisted of RCTs and mixed-methods studies. Most of the DMHIs were designed for individuals, with a focus on targeted communication and personal health tracking. Interventions targeting healthcare professionals were less common, primarily focusing on decisional support. The most prominent barriers to the successful implementation of DMHIs included insufficient healthcare professional training (40%) and resistance from clinicians and organizational culture (40%), while common facilitators included easy access to the interventions (46.7%) and increased training and support for clinical teams (46.7%). Positive outcomes were reported in terms of both effectiveness (33.3%), with many interventions showing results equal to or better than traditional methods (33.3%), and patient satisfaction (33.3%).

Abstract: Background: Sputum culture and smear conversion are key indicators of treatment response in drug-resistant tuberculosis (DR-TB). This study aimed to assess sputum conversion dynamics among DR-TB patients and identify factors influencing conversion rates. Methods: This retrospective cohort study analyzed medical records of DR-TB patients treated between 2018 and 2020 in the Eastern Cape Province, South Africa. Kaplan-Meier curves, Spearman correlation, and logistic regression models were used to assess time-to-sputum conversion and its predictors. Results: Among the 88% of patients who achieved sputum conversion, the median time ranged from 29 to 59 days. Patients on short treatment regimens converted significantly faster than those on long regimens (p = 7.55 × 10⁻¹⁵), with 90% of short-regimen patients achieving favorable outcomes compared to 52% in the long regimen group (p = 0.0000040). Spearman correlation revealed a weak but significant positive association between comorbidities and conversion time (r = 0.041, p = 0.041). HIV-positive patients had a slower conversion rate than HIV-negative patients, but this association was not statistically significant (χ² = 0.426, p = 0.514). Logistic regression identified older age as a predictor of favorable outcomes (coefficient = 0.039, p = 0.045), while regimen type and HIV status did not show significant predictive power. Conclusions: Shorter treatment regimens significantly improve sputum conversion rates and treatment outcomes. The findings support optimizing DR-TB treatment through personalized regimens based on patient health status and drug resistance patterns. This study provides evidence to enhance TB control efforts in high-burden regions, with implications for global treatment strategies.