Public Health and Healthcare

Abstract: Aedes aegypti, the primary vector of dengue, chikungunya, Zika, and yellow fever viruses, is widely distributed globally and has become a major public health concern. This study assessed the density, spatiotemporal distribution, and breeding habitat characteristics of Ae. aegypti in Dar es Salaam, Tanzania. A two-year longitudinal survey was conducted in Ilala, Kinondoni, and Temeke districts. Immature and adult mosquitoes were sampled using larval dipping, Prokopack aspiration, ovitraps, and BG-Sentinel traps in four wards per district, 20 households per ward and all other potential breeding habitats in a selected ward. 220,947 mosquitoes were collected, and 8,496 (3.8%) were Ae. aegypti. Temeke district had significantly higher Ae. aegypti density than the other districts (IRR=2.13, 95%CI:1.75–2.59;p<0.001), accounting for approximately 50% of all specimens collected. Mosquito density was nearly twice as high during the wet season as during the dry season (IRR=1.85, 95%CI:1.54–2.05;p<0.001). The highest Container Index (CI), House Index (HI) and Breteau Index (BI) of 14%, 3.4% and 11.9 respectively were recorded in Kinondoni district. Water storage containers exhibited the highest larval positivity rate. Aedes aegypti is widely distributed across Dar es Salaam. Water storage containers likely sustain year-round populations and represent important targets for surveillance and vector control interventions.

Abstract: Background. Antimicrobial resistance (AMR) poses a significant global health challenge, threatening the effectiveness of life-saving antimicrobial therapies, and requires a multifaceted approach for its mitigation. Methods. This article explores the One Health (OH) framework as a comprehensive strategy that integrates human, animal, and environmental health to combat AMR. Key aspects of antimicrobial stewardship across various sectors are analyzed, including hospital-based interventions, community initiatives, and veterinary practices. Environmental contributors, including antibiotic water and soil contamination, are addressed through mitigation strategies, such as advanced waste management technologies and sustainable agricultural practices. Wildlife's role in transmitting resistance is discussed, emphasizing the need for conservation efforts and environmental monitoring. This paper also reviews global success stories and collaborative programs, in Africa, Europe, and North America, illustrating the importance of integrated surveillance and policy harmonization. Results. Challenges to implementing the OH strategy, including regulatory discrepancies, communication barriers, and cultural resistance, are acknowledged. However, opportunities for progress, such as global partnerships, interdisciplinary education, and innovation, offer hope for mitigating AMR. The role of technological innovations, such as artificial intelligence, advanced data analysis, and cutting-edge antibiotic research, is explored, alongside the importance of vaccines in preventing infections with resistant pathogens. Conclusions. By fostering collaboration, promoting sustainable practices, and leveraging advanced technologies, the OH framework provides a pathway to address AMR and safeguard public, animal, and environmental health for future generations.

Abstract: Background: MpMRI-integrated risk calculators have been developed to improve individualized prediction of clinically significant prostate cancer (csPCa) before biopsy. Although these models have demonstrated good predictive performance in previous validation studies, their performance and clinical utility may vary across patient populations and diagnostic pathways. This study externally validated the mpMRI-based prostate cancer risk calculators developed by Radtke et al. (Radtke-RC) and Alberts et al. (Alberts-RC) in a contemporary pre-biopsy mpMRI population and directly compared both models within the same patient population. Methods: We retrospectively included patients undergoing pre-biopsy mpMRI followed by combined MRI-targeted and systematic prostate biopsy. Predicted probabilities of clinically significant prostate cancer (csPCa; ISUP Grade Group ≥ 2) were calculated using the Radtke and Alberts MRI-integrated risk calculators. Discrimination was assessed using receiver operating characteristic analysis and compared using DeLong’s test. Clinical utility was evaluated using decision curve analysis across a range of threshold probabilities, with thresholds of 12%, 20%, and 30% used for descriptive interpretation of net benefit and potential reductions in unnecessary biopsies. Results: Of 171 screened patients, 164 were eligible for validation of the Radtke-RC, including 62 (37.8%) with csPCa. Complete data for both calculators were available in 114 patients, of whom 41 (36.0%) had csPCa. In the head-to-head cohort, discrimination was acceptable for both calculators (AUC 0.785 for Radtke-RC vs. 0.767 for Alberts-RC; DeLong p=0.318). Decision curve analysis demonstrated threshold-dependent clinical utility. The Radtke-RC provided greater net benefit than biopsy-all from approximately 9% to 69%, whereas the Alberts-RC provided greater net benefit from approximately 18% to 56%. At 12%, incremental benefit over biopsy-all was marginal for the Radtke-RC and absent for the Alberts-RC. At 20%, the Radtke-RC and Alberts-RC reduced unnecessary biopsies by 7.9 and 4.4 per 100 patients, respectively, corresponding to numbers needed to assess of approximately 13 and 23 to avoid one unnecessary biopsy. At 30%, the corresponding reductions were 12.9 and 10.8 per 100 patients, with numbers needed to assess of approximately 8 and 9, respectively. Conclusions: Both the Radtke and Alberts MRI-integrated risk calculators demonstrated acceptable and comparable discrimination for csPCa, with neither model showing a clear overall advantage. Clinical utility was strongly threshold-dependent, with limited incremental benefit over biopsy-all at low thresholds but increasing potential to reduce unnecessary biopsies at higher thresholds. These findings suggest that the principal value of MRI-integrated risk calculators in an already MRI-selected population lies in supporting individualized biopsy decisions. Threshold selection should therefore reflect the clinical trade-off between avoiding unnecessary biopsy and minimizing missed csPCa. Further prospective multicentre validation is warranted to define clinically appropriate thresholds.

Abstract: This study adapted and evaluated the construct validity of the Levenson Self-Report Psychopathy (LRSP) scale among Mexican school-attending adolescents, addressing the limited research on emotional processing difficulties, antisocial behavior, and long-term psychosocial adjustment in this population. A cross-sectional sample of 1010 adolescents aged 14 to 19 years from both urban and rural educational institutions. Exploratory factor analysis and structural equation modeling were used to assess the factorial structure and measurement invariance by sex. Results indicated a two-factor structure, representing primary and secondary psychopathic traits, with satisfactory fit indices (CFI = 0.960, RMSEA = 0.045), acceptable reliability (α Ordinal = 0.838 and 0.673), discriminant validity (MSV = 0.019, ASV = 0.000), and convergent validity, particularly for the first dimension (CR = 0.83). Invariance analyses confirmed configural, metric, and scalar equivalence between male and female participants. A significant difference in latent means by sex was observed, with girls scoring higher than boys on the secondary psychopathic traits after establishing scalar invariance. The adapted LSRP for Mexican adolescents demonstrates robust psychometric properties and constitutes a valuable instrument for examining personality characteristics associated with psychosocial risk, as well as for guiding the development of preventive strategies and early interventions in educational and community contexts.

Abstract: Objectives: Classification of heart failure (HF) by left ventricular ejection fraction and aetiology captures only part of the clinical heterogeneity of the syndrome. We aimed to derive data-driven phenotypes in an unselected cohort of hospitalised HF patients and to assess whether phenotype membership was associated with the cumulative incidence of recurrent HF rehospitalisation once death was modelled as a competing risk. Methods: We retrospectively analysed 1,318 consecutive adults hospitalised with HF in the Cardiology Department of Elias University Emergency Hospital, Bucharest, between 2018 and 2022. Minimum-Redundancy-Maximum-Relevance selection retained 15 non-redundant variables, which were projected into two dimensions by t-distributed Stochastic Neighbour Embedding and clustered with HDBSCAN. The endpoint was multiple HF rehospitalisation (MHR, ≥3 admissions). Results: Five phenotypes emerged (n = 176, 211, 252, 498 and 181) with moderate internal separation (silhouette 0.498; Davies–Bouldin 0.747) and a significant association with MHR (χ² p < 0.0001; Cramér’s V 0.17). The proportion of patients with MHR rose across phenotypes, from 5.1% in Cluster 1 to 24.9% in Cluster 5. The phenotypes were separated principally by documented pulmonary hypertension, loop-diuretic requirement and vitamin K antagonist therapy, with secondary gradients in age, renal function, valvular findings and congestion burden. Cluster 5, characterised by universal vitamin K antagonist use and the highest prevalence of aortic regurgitation, chronic kidney disease and thromboembolic disease, carried the highest readmission burden; Cluster 1, the youngest phenotype and free of loop-diuretic requirement, carried the lowest. Cumulative incidence curves for MHR diverged progressively across phenotypes throughout follow-up. Conclusions: Unsupervised phenotyping of an unselected hospitalised HF population identified five subgroups with a graded burden of recurrent rehospitalisation after formal accounting for competing mortality. This approach isolated different risk phenotypes that conventional classification would obscure, supporting prospective validation.

Abstract: In the context of the climate crisis, individuals’ psychological resources, such as climate hope and a sense of connection with nature, are significant for adopting pro-environmental behaviors and at the same time also important for mental health. In this study, we present a model describing the relationships under investigation, concurrently considering sociodemographic variables (age, gender, and religiosity) to gain a more detailed understanding of the predictors of pro-environmental intentions. The study involved 620 participants aged between 18 and 74 (M = 31.95; SD = 13.55), who completed an online set of standardized questionnaires measuring climate hope, connection with nature, mental well-being, symptoms of depression and anxiety, and pro-climate behavioral intentions. The hypotheses were tested using correlation analyses and multiple linear regression. Climate hope (r = .38, p < .001) and connection with nature (r = .33, p < .001) showed positive correlations with pro-environmental behaviors. Both variables were also associated with higher psychological well-being. Hierarchical multiple regression revealed the significance of these variables and selected socio-demographic variables for pro-environmental behavior. Climate hope and a connection with nature are key factors in fostering care for the environment and one’s own mental wellbeing.

Abstract: Soccer is one of the most widely practiced and studied sports worldwide. The increasing professionalization of women’s soccer has raised interest in bone health. This study aimed to analyze the mediating role of lean body mass in the association between muscle strength, jump height, and bone mineral density (BMD) in elite female soccer players. A cross-sectional study was conducted with 28 players from the Spanish national soccer team. Muscle strength was assessed using estimated 1RM in the deadlift, jump height through the countermovement jump (CMJ) test, and BMD using dual-energy X-ray absorptiometry (DXA). Lean body mass significantly mediated the association between muscle strength and BMD at the lumbar spine (B = 0.0020, 95% CI [0.0001–0.0049]), femoral neck (B = 0.0020, 95% CI [0.0003–0.0052]), and whole body (B = 0.0019, 95% CI [0.0005–0.0038]). These results suggest that muscle strength alone may not fully explain inter-individual differences in bone mass and that lean body mass may play an important role in this relationship Combining soccer practice with appropriate strength training may contribute to optimizing bone health, preventing injuries and fractures, and reducing future age-related bone loss. Longitudinal studies are needed to confirm these findings.

Abstract: The computational literature on Digital Patients combines heterogeneous data, models, software, infrastructure, and intended outputs. A catalogue of these parts is not evidence that they form an operational or credible pipeline. We examined computational-construction and credibility fields in a shared cohort of 61 reviews. Input, model-family, standards, computing, and output categories were counted non-exclusively at review level. Scripted classifications were manually verified against the full-text articles. Validation, reproducibility, prospective-evidence, and maturity totals were withheld when a semantic audit showed that defined rules counted negation, future recommendations, adjacent systems, or unrelated meanings. Imaging appeared in 49 reviews, sensors or wearables in 43, electronic health records in 29, and omics in 24. Artificial intelligence or machine learning appeared in 50, mechanistic modeling in 38, and hybrid modeling in 33. DICOM, HL7, FHIR, and OMOP were named in 15, 14, 13, and 11 reviews, respectively, but mention did not demonstrate conformance or end-to-end semantic traceability. Only 11 source reviews reported a named appraisal of their included evidence. Focused reviews described synthetic-only tests, component-level validation, sparse sensitivity or uncertainty analysis, retrospective evaluation, and incomplete reproducibility. Readiness should be argued as a chain of linked claims: defined context of use, fit and traceable data, explicit update logic, verified software and models, identifiable calibration, decision-relevant validation and uncertainty, external evaluation when warranted, and controlled lifecycle change. The reviewed literature shows abundant components; it does not establish the prevalence of integrated, updating, closed-loop, or clinically ready Digital Patient systems.

Abstract: Digital representations of patients are discussed as digital twins, digital patients, virtual patients, and in silico patients, but labels do not disclose what a system represents, how it changes, or whether it is credible for use. We conducted a systematic overview of reviews (meta-review), with reporting guided by PRISMA 2020. Web of Science, PubMed, IEEE Xplore, and Google Scholar were searched for English-language structured reviews published from 2020 through October 2025, with supplementary reference-list and preprint searches. Two reviewers independently screened titles and abstracts for each record in CADIMA; one reviewer completed standardized extraction, and a second verified it; findings were synthesized descriptively. This focused terminology analysis used the resulting evidence map of 61 unique reviews and was specified after its assembly as a reporting amendment. We distinguish three concepts that must not imply one another: construct identity (the label), operational profile (what is represented and how it is configured), and credibility (evidence of fitness for a stated purpose). Four non-exclusive, non-ordered dimensions form the operational profile: represented subject and biological scale, patient specificity, temporality or update pattern, and the physical–digital information pathway. Digital twin was the primary term in 46 reviews (75.4%), but its reported configurations varied. Individual specificity appeared in 55 reviews, dynamic or continuous orientation in 53, bidirectional coupling in 26, explicitly static constructs in 15, and one-way coupling in 39. Twenty-five reviews co-reported individual specificity, dynamic or continuous orientation, and bidirectional coupling. We propose a six-question reporting grammar that targets operational profile in the first four questions, the intended decision in the fifth, and credibility evidence in the sixth question collectively providing a complete picture of the state of the digital patient framework.

Abstract: Digital Patient systems are being increasingly explored across a range of health care domains. However, it remains unclear whether their reported clinical reach matches the available evidence of implementation and clinical adoption. The purpose of this study was to distinguish the clinical reach claimed for Digital Patient systems from the available evidence and to clarify the organizational conditions needed for responsible adoption. We synthesized application, maturity, barrier, and future-priority fields from a shared meta-review of 61 reviews following PRISMA guidelines. Categories were non-exclusive and described what reviews discussed, not numbers of systems, deployments, patients, or benefits. The reviews spanned multiple health care domains and identified recurring functions, most frequently treatment planning, prediction or prognosis, and diagnosis. Reported barriers to clinical adoption included: Privacy/security/governance, ethical/legal/regulatory concerns, and computing/scalability, each reported in 51 reviews; interoperability in 49; workflow and data barriers in 40 each; and validation or reproducibility in 34. Prototype wording appeared in 43 reviews and operational wording in 19. Our findings suggest that successful adoption requires the satisfaction of four linked gates: establish purpose and accountability; demonstrate data integrity and semantic continuity; build an intended-use credibility and lifecycle case; and show workflow fit, safety, equity, and outcomes. Requirements should increase with the level of clinical influence and degree of potential consequences. This four-part framework is an implementation hypothesis rather than a validated maturity scale.

Abstract: Malnutrition in Nepal’s Eastern Terai is linked not only to food intake and health services but also to the resilience of local food systems, water and sanitation conditions, women’s access to resources, and climate-sensitive agricultural livelihoods. These interdependencies make nutrition programming relevant to planetary health, which considers human health together with the natural and social systems that sustain it. This mixed-methods evaluation examined an integrated Nutrition Education and Rehabilitation Program (NERP) and Linking Agriculture and Natural Resource Management towards Nutrition (LANN+) model implemented in Karjanha, Kalyanpur, and Siraha municipalities from 2021 to 2024. The final evaluation included a household survey of 365 participating households (Kalyanpur n=107, Karjanha n=78, Siraha n=180), six focus group discussions with 69 participants, 19 key informant interviews, document review, and a partner reflection workshop. Endline categorical outcomes were compared across municipalities using Pearson chi-square tests and Cramér’s V. Global Acute Malnutrition among children aged 6–59 months changed from 20.0% at baseline to 8.38% at final assessment. In the directly observed endline survey sample, Minimum Dietary Diversity for Women was 79.3% (242/305) and differed across municipalities (62.2% Kalyanpur, 74.5% Karjanha, 90.6% Siraha; χ²=29.30, p<0.001, V=0.310). Adequate nutrition actions also differed (52.5%, 58.3%, and 82.1%, respectively; χ²=13.35, p=0.001, V=0.300). The Sustainable Integrated Farming System criterion was met by 98.0% of eligible households in Kalyanpur, 96.9% in Karjanha, and 87.7% in Siraha (χ²=11.35, p=0.003, V=0.189), whereas the overall hygiene composite did not differ significantly (p=0.161). Qualitative findings indicated that nutrition gardens, diversified production, NERP/LANN+ learning, women’s economic participation, and municipal planning were perceived as mutually reinforcing, while COVID-19 disruptions, procurement delays, seasonal water constraints, and weak routine water treatment limited implementation. The findings provide municipality-level evidence that integrated nutrition and food-system programming can connect dietary, agricultural, WASH, and governance pathways relevant to planetary health. However, because the evaluation was cross-sectional at endline and lacked a comparison group, the observed changes should not be interpreted as causal effects.

Abstract: Background: Pleural effusion is a frequent clinical problem that is the result of several underlying disorders such as heart failure, infections, and malignancy. Ultrasound (US) is considered a gold standard in the identification of pleural effusion, with the chest X-ray (CXR) being extensively used. Nevertheless, the comprehensive diagnostic performance of CXR in the post-thoracentesis resolutions of pleural effusion is underresearched. Aim: The aim of this study is to assess the diagnostic accuracy of chest X-ray (CXR) in detecting the resolution of pleural effusion after ultrasound-guided thoracentesis, with ultrasound (US) serving as the gold standard. The study also seeks to compare the performance of both imaging modalities in detecting residual pleural fluid post-thoracentesis. Methods: It was an observational cross-sectional study that was done in the Hayatabad Medical Complex, Peshawar, Pakistan. And 60 patients with pleural effusion that were undergoing ultrasound-guided thoracentesis were enrolled. Both the CXR and US were done before and after the procedure to determine the presence and resolution of pleural effusion. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CXR were calculated and compared with US results. Results: The researchers concluded that CXR was identified to have a sensitivity of 96, specificity of 100, PPV of 100, and NPV of 33%. Conversely, the US showed better performance in diagnostic accuracy of higher sensitivity and specificity when an incident residual pleural effusion was to be detected following thoracentesis. CXR was also less effective with regard to detecting small or residual fluid collections, especially in the posterior or basal pleura. Conclusion: The study concludes that ultrasound is as accurate compared to chest X-ray in measuring the outcome of pleural effusion after thoracocentesis. Because of its greater sensitivity and real-time imaging, ultrasound is regarded as the gold standard of post-thoracentesis care, especially where sensitive identification of small residual effusions is essential.

Abstract: Cancer fear and fatalism are believed to be associated with lower engagement with cancer prevention participation and/or screening practices among men of African descent worldwide. This is despite black men having a disproportionately higher incidence of prostate cancer (PCa) than any other racial group. The objective of the current study was to explore cancer fatalism among black PCa patients undergoing treatment at a tertiary academic hospital, Limpopo Province, South Africa. A total of twenty (20) black PCa patients, selected through a purposive sampling method, with ages ranging between 67 and 85 years (mean age = 76 yrs; SD = 5.3), participated in the study. The data were collected through in-depth, semi-structured, individual interviews and analysed using Interpretative Phenomenological Analysis (IPA). The results show that cancer fatalistic beliefs are prevalent among the participants in the study. The findings highlight a need to include cancer fatalistic beliefs in any initiatives to improve the uptake of life-saving cancer screening programmes in black communities. Future research may consider longitudinal assessment of fatalistic beliefs and its association with low participation in PCa prevention and/or screening programmes among black men.

Abstract: Background: Candida parapsilosis is an opportunistic yeast of increasing clinical importance, with fluconazole resistance rates rising globally and reaching concerning levels in clinical settings across several countries, including Colombia. However, the occurrence of antifungal-resistant Candida species in domestic water systems in the country remains largely unexplored. Methods: This cross-sectional study assessed the occurrence and antifungal susceptibility of Candida spp. in intradomiciliary water from 104 households in Villavicencio, Colombia, during two monitoring periods. Water samples were filtered, and yeast-like colonies were identified using MALDI-TOF mass spectrometry. Susceptibility to fluconazole, amphotericin B, and anidulafungin was determined using the CLSI broth microdilution method. The ERG11 gene was sequenced in the fluconazole-resistant isolate. Results: C. parapsilosis was recovered from 16 of 104 households (15.4%), yielding 22 isolates distributed across six communes. Most isolates (72.7%) were obtained from household water-storage tanks. One isolate was resistant to fluconazole (MIC = 8 µg/mL) and harbored a nonsynonymous R398I substitution in ERG11. Conclusions: To our knowledge, this is the first report of C. parapsilosis, including a fluconazole-resistant isolate carrying an ERG11 substitution, recovered from domestic water in Colombia. These findings suggest that household water-storage tanks may serve as environmental reservoirs for this opportunistic yeast. The implications for human exposure remain to be determined and highlight the need for integrated One Health surveillance.

Abstract: Platelets undergo significant morphological transformations during activation influenced by chemical compounds such as zinc and milrinone. Manual classification methods are subjective, time-consuming, and prone to error. This research aimed to apply and evaluate the efficacy of different pre-trained deep learning Convolution Neural Networks, used for automated binary (treated vs. untreated) and multiclass classification (control vs. zinc vs. milrinone vs. combination) of platelet morphological changes induced by these solvents, addressing the limitations of manual classification methods. A dataset of 176 microscopic platelet images from Hull York Medical School was processed, comprising control (n=43), zinc-treated (n=45), milrinone-treated (n=40), and combination treatment (n=48) samples. Ten pre-trained CNN architectures were evaluated across 166 individual training iterations for both binary and multiclass classification tasks. Progressive optimisation strategies included contrast-limited adaptive histogram equalisation (CLAHE) enhancement, selective layer unfreezing, cross-validation, and hyperparameter tuning. For binary classification, Xception achieved optimal balanced performance (81% accuracy, 76% precision, 74% recall) with proper inter-class discrimination, despite higher numerical metrics (91% accuracy) showing classification bias. For multiclass classification, InceptionV3 and Xception demonstrated superior effectiveness with 72% accuracy. This study demonstrated that Xception and InceptionV3 architectures effectively capture subtle morphological features distinguishing treated platelets, offering reproducible alternatives to subjective manual methods.

Abstract: Introduction: Paramedics are at high risk of musculoskeletal injuries associated with the physical demands of the role. Paramedic physical fitness is an important requirement to complete the essential daily tasks of the role and potentially reduce injury risk. However, it is unclear what the specific fitness requirements should be across many ambulance services and how to assess or prepare for them. Objective: This scoping review explored the existing evidence in relation to paramedic physical fitness and the physical fitness testing and standards required by ambulance services in Australia, New Zealand, South Africa, the United Kingdom (UK), Ireland and Canada for the paramedic role. Methods: A scoping review was conducted and reported following PRISMA-ScR guidelines. Electronic databases (MEDLINE, CINAHL, Scopus, ERIC, Emcare, Informit) and grey literature sources (organisational documents) were searched, with searches completed October 2025. Results: Paramedics are reported to have poorer general health when compared to the average population despite a physically demanding role. Sixty-six organisational documents were reviewed as part of this scoping review. Most ambulance services required candidates to complete some form of pre-employment physical fitness test. No ambulance service identified required regular, ongoing physical fitness testing for all its paramedics. Each pre-employment physical fitness test identified was unique in its format, with five of the eight sourced test protocol documents including a musculoskeletal assessment, six including a strength assessment, and five including a cardiovascular fitness assessment. Conclusion: By prioritising, supporting and accurately assessing the physical health and fitness of paramedics, organisations can enhance job performance readiness and potentially reduce injury rates or injury risk. The integration of evidence-based practices in physical fitness testing and training will be crucial in shaping the future of the paramedic profession.

Abstract: Objective: To determine the effects of exercise snacks on cognitive function and to examine whether intervention characteristics and cognitive domains moderate these effects. Design: Systematic review and meta-analysis. Data sources: Six electronic databases were searched from inception to May 2026 for randomised controlled trials (RCTs). Eligibility criteria: Randomised controlled trials of participants of any age evaluating exercise snacks and cognitive function were eligible. Results: This three-level meta-analysis included 25 randomised controlled trials and 152 effect sizes. Exercise snacks resulted in a significant small-to-moderate improvement in cognitive function (Hedges’ g = 0.24, 95% CI [0.10, 0.38], p < 0.001). Greater effects were observed in interventions lasting several weeks (g = 0.51) and those conducted in school or workplace settings (g = 0.61), with cognitive flexibility (g = 0.60) and inhibitory control (g = 0.28) showing the most pronounced improvements. Meta-regression identified exercise intensity (β = 0.263, p = 0.003) and inter-bout interval (β = 0.011, p = 0.035) as positive moderators. Funnel plots and trim-and-fill analysis indicated no significant publication bias (adjusted g = 0.27, 95% CI [0.21, 0.34]). Conclusions: Exercise snacks confer a significant yet modest benefit to cognitive function, with effects varying by intervention duration, setting, and cognitive domain. Benefits were most pronounced in multi-week interventions and school or workplace settings. Higher exercise intensity and longer inter-bout intervals were also associated with greater cognitive improvements. These findings provide an evidence-based basis for developing tailored cognitive enhancement programmes in school and workplace settings.

Abstract: Antenatal anxiety and depression are common and frequently comorbid, affecting maternal and offspring outcomes; however, their underlying biological correlates remain incompletely understood. This cross-sectional study examined whether peripheral levels of brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF) were associated with anxiety and depressive symptoms during late pregnancy. A total of 148 women with uncomplicated second and third-trimester pregnancies was assessed using the Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale. Serum BDNF levels were quantified by ELISA, whereas VEGF and EGF were measured using a multiplex bead-based immunoassay. Based on scale scores, participants were classified as controls, women with anxiety without depressive symptoms, or women with anxiety and depressive symptoms. In the between-group comparisons, women with clinically significant anxiety exhibited higher BDNF and EGF levels than controls, whereas differences in VEGF levels did not reach statistical significance. Regression analyses indicated that anxiety severity was positively associated with BDNF, VEGF, and EGF levels, whereas depressive symptom severity was negatively associated with BDNF levels. These findings suggest distinct associations of antenatal anxiety and depressive symptoms with circulating growth factors, particularly BDNF, and warrant further investigation of vascular–immune–neurotrophic pathways potentially involved in perinatal mental health.

Abstract: Objectives: This study evaluates whether cardiovascular (CV) parameters derived from noninvasive arterial pulse signals can reveal subject-specific characteristics in patients with atypical CV dynamics that may be obscured in group-level analyses. Methods: Seven special-case patients—including a heart transplant (HTx) recipient and individuals with bradycardia (low heart rate), low dicrotic notch (DN), and intermittent arterial pulse waveform (APW) variations—were analyzed across three visits over the cardiac rehabilitation period. Radial artery (RA) and carotid artery (CA) signals, acquired using microfabricated tactile sensors, were processed using a single-degree-of-freedom time–frequency (SDOF–TF) framework to extract multiple CV parameters. Results: The patients exhibited highly heterogeneous CV profiles. Subjects with low heart rate (HR) demonstrated blunted post-exercise responses. Subjects with low DN morphology exhibited elevated lower-order harmonic amplitudes. Patients with intermittent features showed cyclic variations in APW morphology at-rest and during post-exercise recovery. Across all cases, RA measurements generally provided more stable and interpretable individualized patterns across visits, whereas CA measurements were more susceptible to variability related to motion artifacts (MA) and sensor-artery interaction effects. Conclusions: The SDOF–TF framework successfully identifies individualized multi-parameter CV characteristics associated with diverse complex CV conditions of the seven cases. The findings support the potential value of individualized arterial pulse analysis for personalized CV monitoring and indicate that post-exercise assessment provides more distinctive characterization of CV dynamics than conventional at-rest analysis alone.

Abstract: Background Drug-resistant tuberculosis remains a public health challenge globally, yet research on elderly RR-TB patients is scarce. This study examines the epidemiological characteristics and treatment outcome factors among elderly RR-TB patients in China (2015–2024) to inform case detection, clinical management, and TB control amid population aging. Methods Data on elderly RR-TB patients registered in 31 provinces of China (excluding Hong Kong, Macao, and Taiwan) from 2015 to 2024 were obtained from the China Disease Control and Prevention Information System. Descriptive epidemiological methods were used to analyze demographic characteristics, and binary logistic regression was employed to identify factors influencing treatment outcomes. Results From 2015 to 2024, a total of 12,574 elderly patients with RR-TB were registered in China. Among them, 9,327 (74.18%) were male and 3,247 (25.82%) were female; 10,845 (86.25%) were Han ethnicity; 9,077 (72.19%) were aged 65-74 years; 9,961 (79.22%) were local residents; 7,619 (60.59%) were farmers; and 6,763 (53.79%) were Multidrug-resistant. Treatment success was achieved in 4,787 cases (47.82%), while unfavorable outcomes occurred in 7,787 cases (52.18%). From 2022 to 2024, the death proportion was higher than in previous years. The proportions of tuberculosis-related deaths were 6.60% (2022), 10.70% (2023), and 7.02% (2024), respectively, and the proportions of non-tuberculosis-related deaths were 19.79% (2022), 41.98% (2023), and 57.24% (2024), respectively.Regression analysis revealed that the following factors were risk factors for unfavorable treatment outcomes: age 75-84 years, age ≥85 years, intra-provincial migrant, MDR, central region, and western region; and the following factors were protective factors: female, non-farmer occupation and new patients. Conclusions Elderly RR-TB patients in China are predominantly male, farmers, and local residents. Those aged ≥85 years are a high-risk group. In the past two years, treatment success rates have declined due to increased non-tuberculosis deaths. Age ≥75 years, central region residence, and MDR-TB increase the risk of unfavorable treatment outcomes. Enhancing active case-finding in elderly and rural populations and standardizing TB care are needed to improve treatment success.