Public Health and Healthcare

Abstract:

Background/Objectives: Type 2 diabetes mellitus (T2DM) requires sustained self-management between clinical encounters, yet structured behavioural support is not consistently available in routine community and primary-care settings. We evaluated whether adding a structured community-based Behaviour Change Communication (BCC) programme to usual care improved glycaemic control, cardiometabolic outcomes, and self-management behaviours among adults with T2DM in South India. Methods: In this parallel-group randomized controlled trial, 256 adults with physician-diagnosed T2DM in Kanyakumari District, Tamil Nadu, were allocated 1:1 to six months of structured BCC plus usual care (n = 128) or usual care alone (n = 128). The primary outcome was six-month glycated haemoglobin (HbA1c). Secondary outcomes included fasting blood glucose (FBG), body mass index (BMI), waist ratio, low-density lipoprotein cholesterol (LDL-C), and diabetes-related behaviours. The trial was prospectively registered (CTRI/2019/09/021122). Results: All 256 randomized participants completed six-month assessment. Mean HbA1c changed from 10.01 ± 2.38% to 8.71 ± 1.30% in the intervention group and from 9.84 ± 2.41% to 9.80 ± 2.14% in the control group. The unadjusted six-month between-group difference was −1.09 percentage points (95% CI −1.52 to −0.66; p < 0.001). In the baseline-adjusted analysis, the HbA1c treatment effect was β = −1.203 (95% CI −1.358 to −1.049; p < 0.001). FBG, BMI, waist-to-hip ratio, and LDL-C were also lower in the intervention group at follow-up. Self-reported dietary adherence, fruit and vegetable intake, physical activity, and favourable tobacco- and alcohol-related behaviours improved markedly in the intervention arm, whereas the control group did not show significant improvement comparable to the intervention group. Conclusions: Structured community-based BCC improved glycaemic and cardiometabolic outcomes and supported diabetes self-management over six months. The findings support BCC as a potentially useful component of community-oriented chronic-care delivery. Longer-term implementation, fidelity, resource, and economic outcomes require prospective evaluation.

Abstract: Background:Patients with chronic critical illness (CCI), particularly those requiring tracheostomy and prolonged respiratory support, often experience fragmented care during the transition from intensive care to rehabilitation and subsequently to the home setting. Caregiver preparedness, airway safety, and timely access to professional support remain major challenges after hospital discharge.Practice Description:We developed and implemented a respiratory therapist (RT)–led three-stage longitudinal care model integrating the intensive care unit (ICU), rehabilitation ward, and home. The model extends RT involvement beyond conventional ICU-based respiratory management to include transitional care and longitudinal home support. In the ICU, RTs participate in protocol-based mechanical ventilation management, airway clearance, bedside bronchoscopy, weaning assessment, and tracheostomy management, while initiating structured caregiver education. During rehabilitation, RTs provide scheduled bedside follow-up, reassess airway status, support respiratory rehabilitation, and reinforce caregiver competency. After discharge, RTs maintain longitudinal contact with patients and families through structured communication, caregiver education, emergency preparedness, home visits when appropriate, coordination of community resources, rapid hospital referral, and interdisciplinary referral.Preliminary Experience:The model has been implemented in our department for 5 years and has included 126 patients with tracheostomy and CCI. During this period, the RT team performed 336 rehabilitation-ward follow-up encounters, and 379 home or remote follow-up encounters. Descriptive observations suggested that the model was feasible and was associated with favorable signals regarding airway safety, caregiver confidence, continuity of communication, and access to medical support. However, these observations were not derived from a controlled comparative study and should not be interpreted as evidence of causal effectiveness.Conclusions:An RT-led longitudinal care model integrating ICU, rehabilitation, and home-based support may provide a feasible framework for addressing fragmented care among patients with tracheostomy and CCI. Its potentially distinctive features include continuity of RT involvement across care settings, structured caregiver competency training, emergency preparedness, rapid escalation pathways, and interdisciplinary coordination:Prospective multicenter studies are warranted to evaluate its effects on clinical outcomes, caregiver burden, healthcare utilization, and patient-reported outcomes.

Abstract:

Schistosomiasis and hookworm affect hundreds of millions, particularly in low-resource settings where coinfections contribute to substantial morbidity and severe clinical outcomes. We developed a portable duplex CRISPR assay for simultaneous detection of Necator americanus and Schistosoma mansoni. Building on our established S. mansoni CRISPR-Cas13 assay, we designed a CRISPR-Cas12 assay for N. americanus combining recombinase polymerase amplification (RPA) with Cas12 detection. Analytical sensitivity was assessed using serially diluted DNA from third-stage larvae, and specificity was evaluated using DNA from multiple helminth species. The N. americanus Cas12 and S. mansoni Cas13 assays were integrated into a duplex format following optimisation of Cas12/Cas13 detection conditions. Fluorescence was measured using a portable multichannel reader. Diagnostic performance was evaluated in 208 stool-derived DNA samples from Uganda using qPCR as the reference method. The N. americanus Cas12 assay had a detection limit of 0.1 pg/µL and showed no cross-reactivity with the other helminth species tested. In duplex format, N. americanus detection achieved 91.4% sensitivity and 100% specificity, whereas S. mansoni detection achieved 99.1% sensitivity and 99.0% specificity. This portable duplex RPA-CRISPR platform enables sensitive, highly specific simultaneous detection of N. americanus and S. mansoni, supporting integrated surveillance of helminth coinfections in resource-limited settings.

Abstract: This review assesses the influence of ADRB2 (beta-2 adrenergic receptor) gene polymorphisms on athletic performance and physiological function in humans. The literature was analysed for associations with results in cyclic endurance and speed-strength sports and for effects on the cardiovascular, respiratory and metabolic systems. The GG genotype of ADRB2 is associated with the body mass index of female rhythmic gymnasts and is positively related to successful performance in competition. The Arg16Gly variant influences the cardiovascular and respiratory systems and the expression of endurance in athletes. ADRB2 (rs1042713) has been linked to insulin resistance and to increased fat content in the central part of the body in non-athletes; carriers of the Gln/Gln genotype have less body fat than those with the Gln/Glu and Glu/Glu genotypes (rs1042714) (p = 0.050 and p = 0.009, respectively). The polymorphisms rs1042718 and rs1042719 are associated with longevity in men (A-C haplotype: OR = 1.49, p = 0.0007), and the GG genotype of rs1042714 increases the risk of myocardial infarction 3.3-fold (p = 0.021), indicating an indirect link between ADRB2 and life expectancy mediated by cardiovascular disease. The Arg16Gly and Gln27Glu polymorphisms are also associated with an increased risk of respiratory pathology. The data obtained across studies are highly contradictory, which may be due to differences in the populations studied, study design, ethnicity, measurement scales, nutrition and sample size. At present, the ADRB2 gene may be considered a candidate marker for talent identification in sport and for the assessment of the risk of certain diseases and injuries, although the available evidence remains inconsistent.

Abstract: Background: The aim of this review is to present the current possibilities for using low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) in musculoskeletal rehabilitation programs for knee osteoarthritis (KOA). Methods: A narrative review of the scientific literature published in PubMed, Scopus, Web of Science, Cochrane CENTRAL and Google Scholar was conducted. Scientific articles containing information regarding the application of LLLT and/or HILT for musculoskeletal rehabilitation in KOA were searched. This review included observational studies, randomized controlled trials, systematic reviews, and meta-analyses. Results: Data were found indicating a high degree of disability due to degenerative musculoskeletal conditions. This requires the optimization of osteoarthritis management strategies. Evidence of varying levels of significance was identified regarding the benefits of LLLT and/or HILT in reducing osteoarthritis symptoms. However, at this stage, no firm recommendations have been made regarding the inclusion of LLLT and/or HILT in musculoskeletal rehabilitation programs. Conclusions: The use of LLLT and/or HILT therapeutic lasers in musculoskeletal rehabilitation programs may have a positive effect on osteoarthritis by improving tissue trophism and pain reduction, as well as improving range of motion and functional activity, and may also help to reduce the use of pharmacological agents. However, there is no strong recommendations were found for the inclusion of LLLT and/or HILT in osteoarthritis management programs. Therefore, it is necessary to standardize laser therapy protocols and to conduct higher-quality scientific studies in the future that can be easily transformed from a scientifically based achievement into a real applied therapeutic option in clinical practice.

Abstract: Background: Excessive sugar consumption is a major contributor to chronic diseases including obesity, type 2 diabetes, dental caries, and mental health disorders. International evidence highlights the need to integrate nutrition and lifestyle education into nursing curricula. In Albania, where non-communicable diseases are rising, nursing education and clinical practice must adapt to address these challenges. Aim: This scoping review aimed to map recent evidence on sugar consumption, health outcomes, and policy interventions, and to explore how these can be integrated into nursing education and practice in Albania. Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, six databases (PubMed, Embase, CINAHL, ERIC, Academic Search Premier, PsycINFO) were searched for studies published between January 2021 and June 2026. Inclusion criteria were peer-reviewed articles in English addressing sugar consumption, health outcomes, or policy frameworks relevant to nursing education. Data extraction was performed using a structured template and analyzed through inductive thematic analysis. Results: Three dimensions emerged: ● Contextual: System-level interventions such as taxation, labeling, and public health campaigns support healthier choices. ● Social: Cultural norms, family practices, and peer influences shape sugar consumption, requiring community-based interventions. ● Individual: Sugar intake is linked to chronic disease, dental health, and mental well-being, highlighting the need for counseling and behavioral support. Rising rates of obesity and diabetes at QSUT underscore the urgency of integrating these dimensions into nursing curricula. Conclusion: Sugar consumption poses a multidimensional challenge requiring contextual, social, and individual responses. Nursing education at University Aldent should incorporate policy literacy, community engagement, and counseling skills. Collaboration between QSUT, academic institutions, and public health authorities is essential to strengthen Albania’s response to sugar-related diseases.

Abstract: Self-medication is influenced by socioeconomic and structural factors and is frequently used as a coping strategy in resource-constrained settings. In Mozambique, weaknesses in the public healthcare system and unrestricted access to medicines contribute to self-management of illness. This study aimed to analyse the sociocultural, economic, and structural factors influencing self-medication as a strategy for accessing biomedical treatment in the low-lying area of Xai-Xai City, Mozambique. A qualitative cross-sectional study was conducted during the first half of 2025 in six urban and peri-urban neighbourhoods (Bairro A, Bairro B, Bairro 1, Bairro 2, Bairro 12, and Fenicelene) located in the low-lying area of Xai-Xai City, Gaza Province, Mozambique. Purposive sampling was used to recruit 36 key community informants, including neighbourhood secretaries, block leaders, and traditional healers, distributed across the six neighbourhoods. Data were collected through six focus group discussions and analysed using thematic content analysis with MAXQDA software. A total of 36 community informants participated. Most were aged 36–65 years (72.2%), female (61.1%), and had completed primary education (47.2%). Informal workers constituted the largest occupational group (66.7%). Regarding community roles, block leaders predominated (66.7%). Qualitative analysis revealed that self-medication was perceived as a pragmatic response to difficulties in accessing healthcare services. Key factors included the desire for autonomy in managing familiar symptoms, previous therapeutic experience, recommendations from family members, neighbours, and pharmacy workers, and the use of medicinal plants. These practices were facilitated by long waiting times, medicine stock-outs, shortages of healthcare professionals, transportation costs, and loss of daily income. Although participants acknowledged the risks associated with self-medication, including adverse drug reactions, drug–drug interactions, and the potential masking of serious illnesses, they considered self-medication to be a necessary practice under certain circumstances. Self-medication in the low-lying area of Xai-Xai City appears to be strongly associated with structural, economic, and sociocultural barriers to healthcare access. Intervention strategies should combine improvements in the availability and accessibility of healthcare services with community-based health education and enhanced regulation and oversight of medicine dispensing.

Abstract: Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for glycemic control and now widely used for weight management, affect appetite, satiety, gastrointestinal function, and body weight in ways that may support or complicate eating disorder (ED) recovery. This review examines emerging evidence on GLP-1 RA use across ED presentations and considers implications for recovery-oriented care. Methods: We conducted a narrative synthesis of peer-reviewed research, review articles, and relevant clinical guidance addressing GLP-1 RA mechanisms, ED psychopathology and treatment, and recovery-related clinical and psychosocial considerations. Results: Evidence is most developed for binge-eating disorder (BED), but remains preliminary and inconsistent. Some observational findings suggest reductions in binge eating symptoms, whereas a placebo-controlled trial found greater weight loss without a significant between-group difference in binge-eating episodes. Evidence for bulimia nervosa, anorexia nervosa, atypical anorexia nervosa, and other specified feeding or eating disorder presentations is sparse. For restrictive and purging presentations, appetite suppression, early satiety, delayed gastric emptying, and gastrointestinal adverse effects may reinforce restriction, complicate symptom monitoring, or interfere with nutritional rehabilitation. Conclusions: GLP-1 RAs are not established treatments for ED psychopathology, and changes in weight, metabolic health, or selected symptoms should not be equated with multidimensional ED recovery. When these medications are prescribed for appropriate medical indications or investigated as adjunctive treatments, ED screening, informed consent, multidisciplinary monitoring, and assessment of psychological, nutritional, behavioral, and functional outcomes are warranted.

Abstract: Background: Stroke prediction using machine learning is crucial for early detection, enabling timely interventions to reduce mortality and long-term disability. Our study aimed to find the best scaling method and classifier for stroke prediction. Methods: We applied three scaling techniques to the datasets: standardization, minmax, and robust scaling. For each scaling method, we employed eight classifiers: Gaussian Naïve Bayes, Decision Tree, Support Vector Machine, Logistic Regression, Random Forest, K-Nearest Neighbors, Extreme Gradient Boosting (XGBoost), and Bagging Method. We used performance metrics such as accuracy, F1 score, recall, and precision to evaluate the model's performance. 10-fold cross-validation was conducted, and accuracy, precision, recall, and F1 score were assessed to determine the most robust classifier for the dataset. All analyses were performed using Python. Results: Across all the scaling techniques, XGBoost delivered remarkable performance. For standardization, min-max, and robust scaling, XGBoost achieved accuracies of 95.44%, 95.56%, and 95.39%, respectively. The Bagging and Random Forest Classifier also demonstrated strong accuracy across various scaling methods. Despite no statistical difference among the scaling methods, min-max scaling demonstrated a slight performance improvement. Under min-max scaling, the Bagging Classifier reached an accuracy of 93.32%, whereas the Random Forest Classifier attained an accuracy of 94.53%. Decision Tree 90.73%, SVM 83.70%, Logistic Regression 83.35%, and K-NN 88.02%. Conclusion: XGBoost achieved the highest accuracy, while min-max scaling enhanced the performance of all classifiers. These results highlight the importance of scaling and the effectiveness of XGBoost for stroke prediction.

Abstract: Survival analysis has been widely used to understand the etiology of chronic diseases. However, traditional survival analysis models only a single endpoint, whereas the development of chronic diseases is a multi-state process. In this review, we examine the connections among logistic regression, the Cox model, competing risk models, and multi-state models in estimating hazards and survival risks, with findings summarized in three aspects. First, logistic regression and the Cox model are connected. The conditional likelihood of a conditional logistic regression stratified by risk set is equivalent to the partial likelihood used by the Cox model. The survival risks can be derived from the Cox model using the Breslow estimator. Alternatively, pooled logistic regression can be used to estimate risk within small time interval that approximate discrete-time hazard, with survival risks estimated using the Kaplan-Meier (K-M) estimator. Survival risk estimated from the Cox model is more accurate, whereas discrete-time hazard is more flexible for creating complex statistics (such as counterfactual survival risks in causal inference) and provides an approach for integrating machine learning into survival analysis. Second, for nonparametric estimation of survival risks from hazards, the cumulative incidence functions (CIFs) used in competing risks and the Aalen-Johansen (A-J) estimator used in multi-state process are extensions of the K-M estimator used in single disease endpoint. Third, the cause-specific Cox model and the Markov Cox model are extensions of the Cox model to competing risk and multi-state settings, respectively. Correspondingly, multinomial pooled logistic regression and a discrete-time split-state framework extend pooled logistic regression to competing risk and multi-state settings. Our paper can serve as a tutorial to illustrate the connections between survival analysis and multi-state modeling. We anticipate that multi-state models will play an increasingly important role in understanding chronic disease dynamics and advancing precision prevention and prediction.

Abstract: The aim of the present study is to analyse the relationship between sociodemographic variables and the perception of obstetric violence in Spain. A cross-sectional study was carried out through an online questionnaire. A descriptive analysis of all variables was performed followed by a bivariate analysis using the Chi-Squared test. Finally, all statisti-cally significant variables were included in a multivariate binary logistic regression mod-el. Data were processed and graphs created using Jamovi 2.3.28 software. Statistical sig-nificance was set at p< 0.05. A total of 6060 women were included in the study. Some 33.5% (n=1578) referred to having experienced obstetric violence or not being aware of it. Variables that showed a statistically significant relationship with obstetric violence were (p< 0.05): aged between 18 and 25 years, being a student, being of Romani ethnicity, being treated in public health, and labour being completed with urgent caesarean section or in-strumental delivery. The binary logistic regression model proved significant (X2=314; p< 0.001), with high sensitivity (0.970), an AUC=0.647 and a Nagelkerke pseudo-R2 deter-mination of 0.079. Young women face higher obstetric violence, influenced by occupation and ethnicity, reflecting socioeconomic and cultural care impacts. Improving obstetric practices is crucial for women's autonomy and respectful childbirth care.

Abstract: Several studies have established a link between outdoor air quality and cardiovascular disease (CVD), with air pollution causing millions of premature deaths annually according to the WHO. However, a similar link has not been clearly established for indoor air quality (IAQ), despite the fact that people spend much of their time indoors. In this prospective observational study, we monitored IAQ parameters for several weeks in the homes of 49 patients referred for coronary CT angiography (CCTA) at two outpatient cardiology clinics in Amsterdam and compared them with their CCTA results. The monitored IAQ parameters were PM_2.5, PM₁₀ (particulate matter), and CO₂, while the CCTA outcomes included CAD-RADS scoring, coronary calcium quantification, vessel involvement, and the presence of obstructive disease. Patients were recruited from two Amsterdam neighborhoods with contrasting socioeconomic profiles, Amsterdam Zuid (n = 24) and Amsterdam Nieuw-West (n = 25). We found no strong systematic difference in indoor air quality between the two recruitment sites, but observed substantial within-neighborhood variability, suggesting that household-level factors may play an important role in indoor air quality. In this cohort, we found no significant association between residential indoor PM levels and CAD or obstructive CAD.

Abstract: Background/Objectives: Ultra-processed food (UPF) consumption has increased worldwide, but evidence regarding its dietary and health associations among preschool children in East Asia remains limited. This study examined the associations of UPF intake with nutrient intake, anthropometric status, dental caries, and constipation-related symptoms among preschool children in Taiwan. Methods: This cross-sectional study included 822 children aged 2–6 years recruited from 82 kindergartens in Taipei, Taiwan. Habitual dietary intake was assessed using a 107-item semi-quantitative food frequency questionnaire, and foods were classified using an adapted NOVA-based framework. Participants were categorized into quartiles according to the percentage of total energy intake derived from UPFs. Anthropometric data were available for 777 children and dental examination data for 746 children. Six constipation-related symptoms derived from the Rome IV criteria were assessed based on parental reports of symptoms during the previous 3 months. Differences across UPF quartiles were examined using chi-square tests and one-way analysis of variance. Multivariable regression models were used to evaluate associations of UPF intake and specific food groups with dental caries and constipation-related symptoms. Results: UPFs contributed a mean of 15.12% of total energy intake. Higher UPF intake was associated with lower intakes of dietary fiber, protein, potassium, calcium, magnesium, zinc, phosphorus, retinol equivalents, vitamin B1, vitamin B2, vitamin B6, vitamin B12, and vitamin C, and with higher intakes of total fat, saturated fatty acids, and sodium. No significant differences in height percentile, weight percentile, or anthropometric status were observed across UPF quartiles. Among the 746 children with dental examination data, dental caries experience (defined as the presence of at least one decayed or filled tooth) increased from 12.8% in Q1 to 31.2% in Q4 (p < 0.001). After adjustment for age group, sex, total energy intake, and frequency of home cooking, children in Q4 had a higher prevalence of dental caries than those in Q1 (aPR = 2.270, 95% CI: 1.480–3.480; p < 0.001; p for trend < 0.001). Higher UPF intake was also associated with greater constipation-related symptom scores. Compared with Q1, constipation-related symptom scores were 0.900 points higher in Q4 (β = 0.900, 95% CI: 0.330–1.470; p = 0.002). After additional adjustment for dietary fiber intake, this association was attenuated but remained significant (β = 0.680, 95% CI: 0.110–1.260; p = 0.019). In mutually adjusted food-group analyses, higher fruit intake was associated with lower constipation-related symptom scores (β = −0.219, 95% CI: −0.353 to −0.086; p = 0.001), whereas higher biscuit/snack intake was associated with higher constipation-related symptom scores (β = 1.193, 95% CI: 0.441–1.946; p = 0.002). Higher vegetable intake was associated with a lower prevalence of dental caries (aPR = 0.810, 95% CI: 0.660–0.990; p = 0.038). Conclusions: Higher UPF intake among Taiwanese preschool children was associated with an unfavorable nutrient profile, higher dental caries prevalence, and more frequent constipation-related symptoms, but not with differences in anthropometric status. The attenuation of the UPF–constipation association after adjustment for dietary fiber suggests that lower fiber intake may partly contribute to this association. These findings support dietary guidance that emphasizes reducing UPF consumption and promoting minimally processed, nutrient-dense foods, particularly fruits, vegetables, and other fiber-rich foods, during early childhood.

Abstract: Background: Oral frailty is a multidimensional condition associated with physical frailty, malnutrition, and adverse health outcomes in older adults. Although the Oral Frailty 5-item checklist (OF-5) is useful for screening, its binary classification may not capture the heterogeneous patterns of oral functional decline. The Oral Frailty 20-item Checklist (OF-20) was designed to provide a more detailed, domain-specific characterization of oral frailty while complementing, rather than replacing, the existing screening tool.Methods: This cross-sectional study included 297 older outpatients (138 men and 159 women; mean age, 77.5 ± 7.5 years) attending internal medicine clinics in Japan. The OF-20 comprises five domains: speech and social communication; dentition and masticatory function; eating and swallowing; nutritional status, appetite, and general condition; and oral dryness and oral hygiene. Associations between domain scores and demographic characteristics, physical function, laboratory parameters, and comorbidities were examined, with analyses stratified by sex.Results: Based on the conventional OF-5 criterion (score ≥2), 117 participants (39.4%) were classified as having oral frailty. However, OF-20 scores varied substantially among these participants, indicating heterogeneity not captured by the binary OF-5 classification. Higher scores in several domains were associated with older age, lower body weight, reduced grip strength, lower hemoglobin levels, and impaired renal function. The nutritional status, appetite, and general condition domain was associated with lower body weight in both sexes. The eating and swallowing domain was also associated with malignancy and respiratory disease, particularly among women.Conclusions: The OF-20 provides an exploratory, multidimensional profile of oral and systemic vulnerability that may complement the simple screening approach of the OF-5. These findings suggest that oral frailty may comprise heterogeneous patterns of vulnerability. Further studies are needed to develop the OF-20 into a screening tool that comprehensively evaluates frailty and oral frailty.

Abstract: Background: This study characterized HBV and HIV molecular profiles and drug resistance mutations in South Kivu, DRC. Methods: A cross-sectional study included 3,421 participants aged 18–70 years. Serological testing was performed using ELISA, and viral loads (VL) were quantified by GeneXpert. Molecular analyses involved 132 HBV-positive and 383 HIV-positive samples. Nucleic acids were extracted using QIAamp® MiniElute®. HBV genotyping was performed by PCR, and HIV-1 sequencing using the Viroseq® system. Results: HBV prevalence was 7.4% and >8% in high-risk groups (PLHIV, sex workers, survivors of sexual violence). HBV VL was low in 76.3% and high in 23.7%. Genotype A predominated (87.1%), mainly subgenotype A1 (93.4%), followed by genotype E (12.9%). HIV prevalence was 3.5%, highest among women aged 26–45 years. Among ART patients, 60.7% had undetectable VL. HIV subtypes A1 (38.1%) and C (27.4%) were most frequent, with CRFs (CRF11_cpx: 6.5%; CRF26_A5U: 3.1%). Drug resistance was detected in 23.3% of ART-naïve and 70.0% of treated patients, with predominant NNRTI resistance followed by NRTI (52.5%) and PI (15.6%). Integrase-associated polymorphisms were found in 4.2%. key mutations were M184I/V (96.8%) and K103N (74.1%). Conclusion: HBV and HIV show substantial prevalence, marked genetic diversity, and significant drug resistance in South Kivu.

Abstract: Background: There continues to be a growing number of systematic reviews with variable methodological quality. Using a systematic review to inform decision making relies on the quality of methods used to synthesize evidence. Tools that have been developed, such as AMSTAR 2, aim to assess the methodological quality and validity of systematic reviews of healthcare interventions. As this task takes time, use of large language models (LLMs) may help expedite the process. Objectives: We aim to test the ability of two LLMs, Claude Opus 5 and ChatGPT 5.5, to perform AMSTAR 2 assessments on a set of systematic reviews and to compare the accuracy to standard methods using human reviewers. As a secondary objective, we aim to explore the temporal consistency of the AMSTAR 2 assessments from each LLM over time (baseline and one month later).Methods: Our study sample includes open-access systematic reviews of interventions in pediatric populations. Our primary outcome is accuracy of each LLM’s AMSTAR 2 assessments as compared to a human reviewer process as the reference standard. Accuracy will be calculated as the total number of assessments of AMSTAR 2 items that correctly match the human reviewer team. Two humans will independently perform AMSTAR 2 assessments and come to consensus through discussion, or involvement with a third senior reviewer when required. A randomly selected subset of the systematic reviews will be used for the secondary objective exploring temporal consistency of the same LLM model versions over time. Results: AMSTAR 2 assessments will be performed on all 45 systematic reviews by each LLM and two human reviewers. Accuracy of the LLMs versus the human reference standard will be recorded for each AMSTAR 2 item. We will also identify whether there are common discrepancies for specific AMSTAR 2 items, and possible reasons (e.g., items requiring methodological judgement, vague methods reported in the systematic reviews, etc.). The temporal consistency for each model over time will be summarized narratively with descriptive statistics.Conclusion: Evaluating the methodological quality of systematic reviews with LLMs has the potential to more efficiently respond to the needs of decision-makers, by offsetting time spent performing AMSTAR 2 assessments, while maintaining accuracy. Our study will provide evidence to support or reject the use of LLMs to replace human reviewers in this process based on the accuracy of assessments, as well as whether responses are consistent over time. We will also identify AMSTAR 2 items that appear consistently problematic, where decision rules or adequate prompts are needed.

Abstract: Assessing municipal implementation of the Convention on the Rights of Persons with Disabilities (CRPD) requires instruments that capture the perspectives of those involved in or affected by local governance. Developed for this purpose, the PICI-Q was evaluated in this cross-sectional study among 400 Italian stakeholders. Participants were randomly divided into two subsamples (n = 200 each) for exploratory and confirmatory factor analyses. Ordinal reliability and associations with external variables were also assessed. The findings yielded a provisional 19-item, three-factor solution comprising Institutional Support, Accessibility and Inclusion, and Protection from Discrimination. The correlated three-factor model was retained provisionally, although fit varied across indices and In-stitutional Support substantially overlapped with Accessibility and Inclusion. Internal consistency was good (ordinal alpha = .802–.898). Higher PICI-Q scores showed associa-tions with fewer depressive symptoms and better physical and mental health-related quality of life, with small correlations. Exploratory comparisons of observed scores in-dicated higher ratings among participants with administrative roles. Although these findings provide preliminary psychometric evidence regarding PICI-Q reliability, fac-torial structure, and selected aspects of construct validity in participating municipalities, further research should examine factor distinctiveness, temporal stability, responsiveness, measurement invariance, and cross-cultural validity before PICI-Q can be recommended for policy evaluation or longitudinal monitoring.

Abstract: Background. Multiple sclerosis (MS) is a chronic neurological disease in which physical disability, psychological stress, impaired self-management, and reduced self-efficacy may interact over time. Peer education based on Pender’s Health Promotion Model (PHPM) has been investigated as a strategy for improving quality of life, stress management, and self-efficacy in patients with MS. Classical statistical analyses, however, normally represent observed outcomes by precise numerical summaries and consequently provide limited mathematical language for distinguishing measurement variability from genuine indeterminacy, incomplete information, or conflicting evidence. Objective. The objective of this paper is to develop a neutrosophic framework for representing and analysing clinical outcomes associated with peer education based on Pender’s Health Promotion Model. The framework is applied as a secondary mathematical interpretation of a previously published randomized controlled trial involving 90 patients with multiple sclerosis. Methods. A single-valued neutrosophic representation is developed in which each clinical outcome is characterized by a truth-membership component, an indeterminacy component, and a falsity-membership component. Neutrosophic representations are constructed for quality of life, stress management, and self-efficacy. We introduce neutrosophic change vectors, intervention-effect indices, an indeterminacy-adjusted health-promotion index, and sensitivity procedures. The published summary statistics are retained as the empirical basis; no individual patient-level observations are fabricated. Results. The published clinical study reported significant improvements in quality of life, stress management, and self-efficacy in the intervention group immediately after the educational intervention and at three-month follow-up, whereas corresponding changes in the control group were not statistically significant. The proposed neutrosophic framework preserves these observed directions while explicitly representing uncertainty surrounding the reported aggregate evidence. The resulting formulation makes it possible to distinguish a strong direction of observed change from the degree to which the available evidence remains indeterminate. Conclusions. Neutrosophic modelling provides a flexible mathematical language for clinical education research in which measurements may contain variability, incomplete information, contextual uncertainty, or heterogeneous patient responses. The framework should be regarded as a methodological extension and not as a replacement for conventional randomized-trial statistics. A definitive patient-level neutrosophic reanalysis requires access to the original individual-level dataset.

Abstract: Background/Objectives: Multi-dose packaging services aim to simplify complex drug regimens; however, national evaluations of user experience in Saudi Arabia remain limited. This study evaluated patient satisfaction and self-reported medication adherence among active Ez-Pill users across the nationwide network of Nahdi Medical Company in Saudi Arabia. Methods: A national, cross-sectional study was conducted from February to July 2026 utilizing a bilingual online survey administered to a convenience sample of active service users across 14 cities. Two separate multivariable linear regression models were performed to identify demographic, operational, and clinical predictors of self-reported adherence and satisfaction scores. Results: Of 498 distributed surveys, 443 completed responses were analyzed (89.0% response rate; mean age: 53.22 ± 12.36 years; 78.30% male; 43.12% taking ≥ 6 medications). The composite satisfaction score reached 4.55 ± 0.77 out of 5.00, and the self-reported adherence and dosing confidence score reached 4.53 ± 0.79. Service longevity exceeding 1 year was a significant independent positive predictor of both self-reported adherence (B = 0.276, p = .030) and satisfaction (B = 0.278, p = .013). Conclusions: Among surveyed active users, the Ez-Pill compliance aid is associated with high levels of overall satisfaction, self-reported adherence, regimen clarity, and dosing confidence. Given the cross-sectional design and reliance on self-reported data, future longitudinal studies utilizing objective adherence metrics are warranted to confirm clinical effectiveness.

Abstract: Lean-oriented redesign is widely used to improve hospital flow and productivity, but the capabilities nurses need to implement and sustain change remain poorly defined. This critical narrative review integrates empirical evidence concerning nursing capability, organizational conditions, implementation, sustainment, and performance. Nursing-specific instruments assess perceived Lean implementation or service leanness, but none validates nursing improvement capability as an adaptive individual and collective capacity. The most credible candidate manifestations are practical knowledge and judgement, collective problem-solving, learning, professional agency, and enacted improvement leadership. Staffing, protected time, decision authority, data access, and infrastructure shape whether these capabilities can be expressed but are not equivalent measures of capability. Operational process improvements are reported most often, yet causal attribution is weak. Evidence for reallocated bedside time, net economic value, workforce benefit, patient safety, environmental benefit, and long-term sustainment remains limited or inconsistent. Evaluations should measure capability, context, implementation, sustainment, benefits, and harms separately and prospectively.