Public Health and Healthcare

Abstract: Background and Objectives: Vitamin D deficiency is a pervasive public health issue in high-latitude regions, yet large-scale population data for the Baltic states remain sparse. This study aimed to determine the prevalence of vitamin D status and identify its primary determinants within a primary care setting in Lithuania. Materials and Methods: We conducted a retrospective cross-sectional analysis of serum 25-hydroxyvitamin D [25(OH)D] concentrations from 14,330 unique patients (aged 1–101 years) collected during 2025 at a major clinic in Vilnius. Vitamin D status was categorized according to the Central and Eastern European Expert Consensus thresholds. Results: The overall median 25(OH)D concentration was 68.3 nmol/L (Mean: 74.7 nmol/L; SD: 35.1), placing the population average in the "insufficiency" range (50–75 nmol/L). Seasonality emerged as the most significant predictor of deficiency; multivariable logistic regression showed a maximal risk reduction in September (OR 0.33; 95% CI: 0.27–0.41) and August (OR 0.34) compared to January, while June and November provided no significant protection. Age-specific analysis revealed a non-linear "U-shaped" distribution: children aged 0–6 years had the highest levels (mean ~100 nmol/L), likely due to rickets prophylaxis, whereas adolescents (12–18 years) exhibited the highest vulnerability, with approximately 80% suffering from deficiency or insufficiency. Males faced a 13.9% higher likelihood of deficiency than females (OR 1.14; p = 0.0036), potentially due to lower rates of elective supplementation. Conclusions: These findings suggest that current supplementation strategies successfully protect infants but fail to sustain adequacy through adolescence and adulthood, particularly during the "vitamin D winter." Targeted public health interventions for adolescents and year-round monitoring are recommended to mitigate the high prevalence of suboptimal vitamin D status in Lithuania.

Abstract: Background: COVID-19 manifested with a wide range of clinical symptoms, including asymptomatic or mild illness and life-threatening respiratory failure. We hypothesized that elevated predictors during intensive care unit (ICU) stays would independently predict mortality and the subsequent development of post-COVID-19 condition (PCC). Methods: In this retrospective cohort study, we evaluated the clinical and laboratory determinants of mortality using hospital records in severe COVID-19 patients in conjunction with their PCC in survivors by self-reported survey. This research was conducted at XX University Hospital, and adult patients with laboratory-confirmed SARS-CoV-2 infection by RT-PCR assay who required ICU admission for respiratory failure or hemodynamic instability were included. Biomarkers were monitored throughout ICU stay to evaluate dynamic changes and their association with mortality. Survivors were followed from ICU discharge to assess readmissions, vaccination status, and post-COVID-19 condition, including fatigue, sleep disturbance, physical exhaustion, concentration problems, and memory impairment. Post-ICU mortality and hospitalization due to cardiovascular, respiratory, neurological, or other complications were recorded. Results: A total of 273 critically ill patients were included, of whom 112 survived and 161 died during ICU stay. Non-survivors were older and had lower mean arterial pressure. Intubation was more frequent among non-survivors, and APACHE II scores were significantly higher in this group. Hospitalizations due to cardiovascular, respiratory, and neurological complications were particularly associated with increased hazard of death (HRs ≥2, p-values < 0.05). Patients who died after ICU discharge (31.5%) had higher rates of fatigue, physical exhaustion, and memory impairment, suggesting a strong correlation between biomarker derangements during ICU stay and PCC. Conclusions: The present study was specifically designed to address this critical gap by evaluating whether biomarker trajectories during ICU follow-up not only predict in-hospital mortality but also serve as early determinants of Post-COVID status in survivors.

Abstract: Objectives: To analyze the evolution of suicide rates among adolescents during the COVID-19 pandemic, examine the evidence regarding the relationship between bullying, cyberbullying, and suicidal behavior in adolescents during this period, and identify evidence-based prevention strategies. Methods: This study is a narrative literature review synthesizing current knowledge on adolescent suicide during the COVID-19 pandemic, was conducted following a structured search strategy across five databases (PubMed, CINAHL, PsycINFO, Embase, and Dialnet) for publications between 2020 and 2025, with quality appraisal using STROBE and SRQR guidelines. MeSH and DeCS keywords were used with Boolean operators. Inclusion criteria comprised peerreviewed articles investigating adolescent suicide during COVID19, including quantitative, qualitative, mixedmethods studies, and relevant systematic reviews. Results: Twentysix articles were selected for analysis, representing studies from 10 countries across four continents. The evidence demonstrates that the COVID19 pandemic significantly impacted adolescent mental health, with increased rates of depression (5–7% increase), anxiety, and suicidal ideation, particularly among females and vulnerable populations. Key risk factors identified included social isolation, excessive social media use, preexisting mental health conditions, LGBTQ+ identity, and low socioeconomic status. While traditional bullying decreased during school closures (78.2% reduction), cyberbullying increased dramatically (264.4% increase). Protective factors included family support, access to mental health services, and structured school environments. Conclusions: The evidence from this review indicates that the COVID19 pandemic created a significant mental health crisis among adolescents, with increased suicide risk across most countries studied. The shift from traditional bullying to cyberbullying represents a critical emerging threat. Evidencebased prevention strategies identified include universal screening in schools and primary care, telehealth mental health services, social emotional learning programs, family based interventions, and community support systems. A multitiered prevention approach (universal, selective, and indicated) is essential. The persistent shortage of mental health professionals and lack of comprehensive national prevention plans remain critical barriers. Future research should focus on longterm pandemic effects and evaluation of prevention program effectiveness in postpandemic contexts.

Abstract: Background: Influenza vaccination uptake among healthcare professionals remains subop-timal despite their key role in influencing public vaccination behavior. This study investi-gated motivational and behavioral determinants of influenza vaccination uptake and ad-vocacy among primary healthcare professionals in Greece. Methods: A cross-sectional study was conducted among 304 physicians and pharmacists using an anonymous online questionnaire. Vaccination uptake (2023–2024 season and annual) and motivational and advocacy constructs were assessed using the validated MoVac-flu and MovAd scales. Factor structure was evaluated using confirmatory and ex-ploratory factor analyses. Multivariable logistic regression models were applied to identify predictors of vaccination uptake. Results: The study sample consisted of 304 healthcare professionals of whom 61.2% were physicians and 38.8% were pharmacists. Most of the participants were female (52.6%) and aged 41-60 years (57.6%). Influenza vaccination uptake was 77.6% for the 2023–2024 sea-son and 75.3% for annual vaccination. A two- and a four-factor structure was found for the MoVac-flu (F1: Vax Self-Care, F2: Vax Awareness) and MoVAd (F1: Vax Communica-tion, F2: Vax Influence, F3: Vax Confidence, F4: Vax Choice) scales, respectively. Both scales demonstrated high internal consistency (Cronbach’s alpha coefficient > 0.87). Mo-tivation toward influenza vaccination and vaccination advocacy were high among the participants. Vaccinated participants had higher motivation and advocacy scores than non-vaccinated ones. In multivariable analyses, higher scores on Vax Self-Care (aOR = 3.22, 95% CI: 2.08-4.96, p < 0.001) and Vax Communication (aOR = 1.64, 95% CI: 1.14-2.34, p = 0.007) subscales, demonstrating enhanced motivation and advocacy, respectively, as well as male sex (aOR = 2.35, 95% CI: 1.14-4.83, p = 0.020) were associated with higher odds of annual vaccination. Higher scores on the Vax Self-Care subscale (aOR = 3.66, 95% CI: 2.33-5.77, p < 0.001) were also found to be associated with higher odds of 2023–2024 vaccination uptake, as well as living with vulnerable individuals (aOR = 2.95, 95% CI: 1.18-7.38, p = 0.020) Conclusions: Influenza vaccination uptake among primary healthcare professionals in Greece was relatively high; however, it was strongly driven by intrinsic motivational fac-tors, particularly the perceived personal and public health benefits of vaccination. Com-munication-related competencies also independently contributed to vaccination behavior, highlighting the link between professional practice and personal uptake. In contrast, con-textual factors, such as cohabitation with vulnerable individuals, appeared to exert a more situational and less consistent influence. These findings suggest that interventions focus-ing on strengthening intrinsic motivation and communication skills may lead to more sustained improvements in both vaccination uptake and advocacy among healthcare professionals.

Abstract: The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Although parents should play a critical role in preventing GD, how parenting styles help prevent adolescent GD remains understudied. This study assessed the association of parenting styles with adolescent GD in junior high school boys in Tokyo, Japan. Data were collected in 2024 via web-based, self-administered questionnaires from 300 parents. Suspected adolescent GD was assessed using a validated parent report measure (i.e., the Gaming Disorder Scale for Parents). Parenting styles were measured using the Parenting Scale, comprising two dimensions: Overreactivity and Laxness. The mean factor scores of Overreactivity and Laxness were compared between the suspected and non-suspected GD groups by t-test. Logistic regression analysis assessed the association of Overreactivity and Laxness with suspected GD, controlling for covariates. The mean factor score of Overreactivity was significantly higher in the suspected GD than in the non-suspected group, whereas Laxness was not. Logistic regression analysis identified parental Overreactivity as an independent predictor of suspected GD (adjusted odds ratio: 1.75, 95% CI: 1.24 to 2.49). This study showed that overreactive parenting is independently and significantly associated with an increased risk of adolescent GD, suggesting the importance of psychological support for parents.

Abstract: The Omicron variant of SARS CoV-2 is associated with milder symptoms and lower hospitalization and mortality rates than Delta variants, although the impact of Omicron on immunocompromised patients, especially Solid Organ Transplant (SOT) recipients, is still unclear. This study compares the hospitalization rate and outcomes between immunocompromised, immunocompetent, and SOT patients during the Delta and Omicron periods. We included adult patients who tested positive for SARS-CoV-2 on PCR or nasopharyngeal antigen test between June 26, 2021 to September 8, 2022, at our institution. 12,401 COVID-19 patients were included, of which 11,055 were immunocompetent, and 1,346 were immuno-compromised (375 SOT recipients). Throughout the Delta and Omicron outbreaks, immunocompromised patients exhibited higher comorbidities and 30-day hospitalizations, but rates of mechanical ventilation and ICU-level care were like immunocompetent patients. During the Omicron wave, immunocompromised patients had higher unadjusted relative risk estimates (RR=2.37, 95% CI 1.96-2.87, p< 0.05) than Delta (RR=1.58, 95% CI 1.24-2.01, p< 0.05) with higher adjusted relative risk for hospitalization in Omicron (RR=1.50, 95% CI 1.10-2.03, p=0.01). Analyses show increased hospitalization risk in immunocompromised during the Omicron wave compared to the Delta wave with no significant difference in hospitalization outcomes. The relative risk of hospitalization for SOT patients was higher in both waves.

Abstract: Background: Healthcare systems are organized around traditional levels of care (primary, secondary, tertiary), activated only when a patient enters the formal system. Translational medicine typically moves from bench to bedside. Here we propose a reverse translational step: patient-led self-management as a pre-clinical level of care – LINE ZERO. Objective: To introduce and test LINE ZERO – self-management, prevention, and self-care – as an extension of the traditional care model. Methods: An 11-month longitudinal self-experiment (n=1) in a 55-65 year old man with adjustment disorder. Interventions included breathing exercises, light therapy, music therapy, gentle stretching, moderate dietary changes, and self-monitoring of blood pressure, deep sleep, and blood glucose. Results: Deep sleep increased 3-fold (p < 0.001). Blood pressure stabilized. Glycemic variability decreased after an acute stress-related peak. A subsequent work stress episode caused a 30% drop in deep sleep, followed by rapid recovery within 48 hours. Conclusion: LINE ZERO extends the traditional care model by adding a pre-clinical self-management space. It aligns with Future Medicine (predictive, preventive, personalized, participatory) and represents a reverse translational contribution – from patient observation to a conceptual framework applicable to health systems.

Abstract: Intimate partner violence-related brain injury is the most recent condition in a 150-year arc in which biological brain injury has been misattributed to psychological or moral causes before formal clinical recognition emerged. Earlier conditions in this pattern were each marked by decades of recognition lag before formal diagnostic frameworks emerged. In each prior case, that lag was driven by limits in available diagnostic technology. Intimate partner violence-related brain injury is the first condition in which diagnostic technology, including computed tomography, magnetic resonance imaging, diffusion tensor imaging, and neurocognitive assessment, has been continuously available throughout the recognition gap. The review identifies three structural barriers that sustain this recognition gap: a diagnostic barrier that leaves the injury without formal criteria, an administrative coding barrier that leaves it absent from ICD architecture, and a population surveillance barrier that leaves it indistinguishable from broader assault categories. Each barrier reinforces the others, limiting visibility, resource allocation, and access to care. Across these conditions, recognition lag has reflected an institutional imperative that has shaped which injured populations became clinically legible. Recent neuroimaging and cognitive studies make the biological imperative explicit. A cognitive entrapment framework reframes the reduced capacity to engage the cognitive and material resources leaving requires as injury-driven rather than as ambivalence or motivational deficit. The framework explains mechanistically why brain injury disrupts the multistep planning that leaving demands. Intimate partner violence-related brain injury is not only underdiagnosed but structurally underserved; correcting the mechanisms of recognition failure is necessary for access to treatment and rehabilitation.

Abstract: Diabetes mellitus (DM) is increasing worldwide and places a substantial burden on health systems through its complications. Background/Objectives: To identify factors associated with DM-related complications in adults receiving primary care in Rio Branco, Acre, western Brazilian Amazon. Methods: Population-based cross-sectional study in 30 Family Health Strategy (FHS) units; 324 participants, weighted to represent 2,245 adults with DM. Five binary outcomes were analyzed: self-reported stroke, electrocardiographic (ECG) abnormalities, microangiopathy, chronic nephropathy, and any complication. Associations were estimated by Poisson regression with robust variance. Results: About 72% of participants had at least one complication. Any complication was independently associated with male sex (PR = 1.23), age ≥ 60 years (PR = 1.25), hypertension (PR = 1.34), illiteracy (PR = 1.18) and ≤ 3 medical appointments in the previous 12 months (PR = 1.46). Distinct factors emerged for each individual outcome. Conclusions: DM complications were highly prevalent and driven by multifactorial determinants, supporting risk stratification, early detection and targeted interventions in primary care.

Abstract: Sanitation knowledge, attitudes, and practices (KAP) among primary school learners can aid in disease prevention through sanitation as well as in improving learner academic achievement. Despite this, evidence regarding sanitation KAP among rural South African primary school learners is inadequate. In this study, sanitation KAP among grade 6 learners in Sekhukhune District, Limpopo Province, were investigated. The study adopted a quantitative cross-sectional design among 249 learners chosen randomly from nine primary schools. Data were collected utilizing a structured questionnaire which was pre-tested prior to the study. Analysis was performed using SPSS version 29 with the help of the Pearson chi-square test at a significance level of 5%. Of the total sample size, 59.0% exhibited adequate knowledge about sanitation (≥80% correct answers). Nonetheless, 41% held erroneous views regarding hand washing that it was enough for hands to look clean even without the use of soap, while only 41.0% used soap always after defecating. Open defecation was noted by 12.4% of the learners, where non-functional toilets accounted for 73% of these cases. Over half (45.8%) of the respondents were embarrassed about using school toilets. Knowledge about ill effects of poor hygiene on one's health correlated significantly with the age of learners.

Abstract: Background and Objectives: Chronic diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) remain a major source of morbidity, healthcare utilization, and limb loss, despite adherence to established standards of care protocols and the widespread availability of advanced wound technologies. Many advanced modalities only target isolated aspects of wound healing and fail to address the complex, interdependent pathophysiology of chronic wounds, particularly tissue hypoxia, edema, impaired microcirculation, and persistent inflammation. Cyclical Pressurized Topical Wound Oxygen (TWO2) therapy is a home‑based, multimodal intervention that combines humidified topical oxygen delivery with cyclical non‑contact compression to address these core drivers simultaneously. Materials and Methods: This review synthesizes mechanistic rationale and evidence from randomized controlled trials, long-term venous ulcer studies, and real-world comparative effectiveness analyses. Emphasis is placed on the large cohort study by Yellin et al., which directly compared TWO2 with other advanced modalities including negative pressure wound therapy (NPWT), skin substitutes, and growth factor therapies. Results: Across these studies, TWO2 therapy is consistently associated with improved healing durability, reduced recurrence, and substantial reductions in hospitalization and amputation rates compared with both standard care and advanced wound therapies. Conclusions: The convergence of randomized and real‑world evidence supports TWO2 therapy as a clinically meaningful and mechanism‑driven adjunctive treatment option for patients with chronic, high‑risk lower‑extremity wounds.

Abstract: Self-check-in via digital technology is becoming increasingly prevalent to streamline workflows and improve primary care efficiency, including kiosks, eCheck-in via portals, mobile check-in apps, and pre-appointment questionnaires. This scoping review examines the value-creation potential of digital self-check-in tools by assessing the quality of intake data generated with these tools and their reuse. Following the Joanna Briggs Institute guidelines for conducting scoping reviews and the PRISMA-ScR reporting criteria, searches were conducted across the CINAHL, PubMed, and Google Scholar databases to identify English-language peer-reviewed studies published between 2021 and 2026. In total, 488 studies were identified; 361 were assessed based on titles and abstracts after duplicate removal, 65 were reviewed in full text, and 15 studies were included in the final review and graded using the Johns Hopkins Nursing Evidence-Based Practice (JHEBP) levels and quality ratings. Most of the evidence was level III with a B quality rating. Findings showed that the portal and pre-visit questionnaire approaches provided the most reliable support for data structuring, visit preparation, and communication between the patient and the clinician. In turn, improvements in workflow efficiency, reduced patient congestion, increased throughput, and minimized front-desk burden could be achieved primarily through studies focused on kiosks and registration processes. Across the study, the strongest evidence supports operational and informational value rather than return on investment (ROI). The main barriers to the effective implementation of the interventions included access inequity, workflow integration, staff training, and bad data quality. Overall, digital self-check-in tools create value in primary care when patient-generated intake data are timely, complete, structured, and reusable across downstream clinical and administrative workflows. However, stronger evidence is still needed regarding measurable economic return.

Abstract: Breast cancer constitutes one of the oncological diagnoses with the greatest impact on women’s lives, with consequences that extend beyond active treatment into a survi-vorship period marked by profound transformations in identity, relationships, and well-being. This study aimed to explore the impacts that breast cancer produces on the everyday lives of survivor women in the municipality of Villarrica, La Araucanía Region. A qualitative methodology with a phenomenological orientation was employed, based on discourse analysis of three focus groups with breast cancer survivor women. The analysis identified five categories: impact on everyday life and work, management of uncertainty and fear, transformation of self-care and life priorities, support networks and community, and barriers to accessing the healthcare system. The findings demon-strate the coexistence of posttraumatic growth and persistent psychological distress, together with structural inequities that limit access to comprehensive care during the survivorship period. It is concluded that cancer survivorship demands public policy responses that are continuous, multilevel, and integrative of a gender perspective, ar-ticulating individual, family, and community interventions from primary healthcare.

Abstract: Background/Objectives: Handgrip strength is a widely used indicator of physical function that is associated with various health outcomes of older adults. However, the relationship between lifestyle factors and handgrip strength, as well as the age-associated relationship between them, remains insufficiently understood. This study examined age-adjusted associations between multiple lifestyle factors and handgrip strength among older women. Methods: During this cross-sectional study of 2,206 older women, handgrip strength was categorized into low, middle, and high tertiles. Lifestyle factors such as dietary status, exercise frequency, sleep quality, social interaction, and outing frequency were assessed using a questionnaire. Group differences were evaluated using an analysis of variance and chi-square tests. An analysis of covariance was performed to examine associations between lifestyle factors and handgrip strength after adjusting for age. Results: Participants in the high handgrip strength tertile were younger and more likely to report favorable lifestyle behaviors. After adjusting for age, dietary status (p = 0.024), social interaction (p = 0.001), and outing frequency (p = 0.017) remained significantly associated with handgrip strength. In contrast, sleep quality (p = 0.073) and exercise frequency (p=0.060) were not significantly associated with handgrip strength after age adjustment. A clear dose–response relationship was observed between lifestyle scores and handgrip strength. Conclusions: Among older women, dietary status, social interaction, and outing frequency were independently associated with handgrip strength, even after accounting for age. These findings suggest that multidimensional lifestyle factors, particularly those related to nutrition and social engagement, may contribute to maintaining physical function in older adults.

Abstract: Affected persons supporting substance-dependent individuals during COVID-19 needed innovative communication strategies to facilitate their well-being in a scenario of limited access to physical services. This study explored the lived experiences of affected persons assisting substance-dependent individuals during COVID-19 to highlight the perceived benefits of a support framework that could sustain practices beyond the pandemic. This descriptive phenomenological study examined how affected persons developed a sense of coherence while supporting individuals with substance-use disorders, emphasizing health promotion practices. Health promotion is rooted in social support, which enhances subjective well-being. The study drew on Antonovsky’s Sense of Coherence theory, focusing on factors that enable individuals to remain healthy despite stressors. A heterogeneous purposive convenience sample of 26 participants was used, with data saturation achieved. Telephonic interviews lasting up to 45 minutes were conducted using a pretested schedule, followed by open coding. Findings indicate that practical support and resource exchange foster a global life orientation, enabling individuals to perceive their environment as understandable, manageable, and meaningful while addressing substance use. Key factors included social support networks, family bonds, self-care, identity, and relationships. Participants reported positive experiences and sustained actions promoting health, often driven by caregiving, personal growth, and future aspirations.

Abstract: Aim. This study aimed to evaluate the impact of cone-beam computed tomography (CBCT) on preoperative surgical decision-making and risk assessment for mandibular third molar (MM3) extractions in cases identified as high-risk by orthopantomograph (OPG). Materials and Methods. This prospective clinical study utilized the purposive sampling method, recruting50 MM3s from 33 patients (mean age 24.24 ± 6.77 years). Samples were categorized into five distinct radiographic groups based on the proximity of roots to the inferior alveolar canal (IAC) on OPG. The methodology involved a comparative 3D analysis to determine neurovascular contact, spatial orientation, and the presence of cortical border. Surgical strategies, specifically the necessity for coronectomy or the lingual split technique, were reassessed following 3D evaluation. Postoperative neurosensory outcomes were recorded. Statistical analysis was performed using the Fisher-Freeman-Halton and Kruskal-Wallis tests. Results. CBCT identified direct IAC contact in 74% of the cases. In 18% of the cases initially deemed high-risk by OPG, CBCT revealed a safe distance, thereby altering the surgical approach. Tooth angulation (P = 0.012) and Pell and Gregory classification (P = 0.0024) were significant predictors of contact. Temporary neurosensory disturbances occured in 4% (n = 2) of the sample, specifically in cases where CBCT had confirmed loss of canal cortication. Conclusion. In accordance with the study aim, CBCT provides essential 3D data that refines surgical planning in nearly one-fifth of high-risk cases. The findings justify selective CBCT use, guided by the ALADA principle, to minimize iatrogenic injury.

Abstract: This scoping review examined how external clinical notes are obtained and used before scheduled primary care visits in high-income countries, with attention to continuity of care, workflow integration, value, healthcare delivery, policy, and risk. Within the health data ecosystem, the value of external clinical data depends not only on exchange capability but also on whether information is timely, easy to find, and usable in practice. Guided by Arksey and O’Malley, Joanna Briggs Institute guidance, and PRISMA-ScR, the review searched PubMed, CINAHL, and Google Scholar for English-language, peer-reviewed studies published from 2021 to 2026. Of 330 records identified, 15 studies were included and assigned Johns Hopkins evidence levels and quality ratings. The evidence base was dominated by Level III studies, indicating stronger support for conclusions about workflow barriers, usability, and care coordination than for causal or economic effects. Three patterns emerged: technical exchange alone did not ensure continuity of care, workflow integration shaped whether external information was useful, and the literature described clinical and operational value more clearly than direct financial return. Using the Sittig and Singh sociotechnical model, the review shows that value is produced or lost across infrastructure, clinical content, interface design, people, workflow, organizational conditions, external rules, and monitoring. Overall, external clinical notes function as high-value data only when they are available before the visit, routed appropriately, and usable within the routine primary care workflow. Future research should use stronger workflow-specific measures and assess cost implications and return on investment more consistently.

Abstract: Emergency contraception (EC) is a time-sensitive pharmacy service in which consistent, patient-centred counselling is important but can be challenging to deliver in routine practice. This prospective implementation study evaluated the feasibility, real-world use, and patient experience of a digital counselling support tool integrating patient self-reporting with structured, evidence-based support for pharmacist-led EC consultations. All EC consultations using the tool in 10 Swiss community pharmacies were analysed descriptively (n = 3,428), alongside a voluntary anonymous post-consultation survey (n = 148). Median total consultation duration was 11:32 min, including 4:27 min of direct pharmacist counselling, indicating partial transfer of assessment to the digital pre-consultation phase. Ulipristal acetate was dispensed in 71% and levonorgestrel in 26% of consultations. Prior to counselling, 80% of patients reported uncertainty regarding the optimal active ingredient, underscoring the relevance of pharmacist involvement. Survey respondents rated the tool as easy to use (97%), discreet (99%), and trustworthy (98%); 85% preferred it over standard paper-based procedures. These findings demonstrate high feasibility and patient acceptance, supporting the integration of a digital tool into routine EC services while enabling consistent, evidence-based counselling without compromising interpersonal interaction.

Abstract: Background: HIV-infected children (CLHIV) are known to have impaired seroconversion or waning immunity following seroconversion against measles. This may result in measles infection, morbidity and mortality among CLHIV and is also a challenge to measles elimination. Objectives: To compare measles seroprevalence between vaccinated CLHIV and HIV-exposed uninfected children (HEU). The null hypothesis (H₀) was that the difference in proportions for measles seroconversion between CLHIV and HEU is not statistically significant. Materials and Methods: An unmatched case-control study was conducted among 35 CLHIV and 28 HEU aged 18 months to 8 years, attending the Paediatric Centre of Excellence in HIV care (PCOE) at Medical College, Kolkata, between 2022-2024. Participants provided demographic and treatment details; venous blood sample was collected and tested using an ELISA kit to detect measles IgG. We measured outcome as distribution of measles IgG titre and odds ratio (OR) for seroconversion with 95% confidence interval (CI). Results: Groups were similar by sex, weight and duration since last measles vaccine, but differed in age. There were 50% of HEU and 33.7% of CLHIV who had seroconverted, with Measles IgG antibody ≥ 275 IU/L. The overall seroconversion rate was 41%; the difference in proportion did not reachstatistical significance (χ² = 1.7; p = 0.18). However, antibody distributions according to serostatus were significantly different by the Mann-Whitney U test (p = 0.04).Conclusion: Null hypothesis could not be rejected; a combination of vaccine failures and waning immunity possibly resulted in low seroconversion. This indicates existing pockets of vulnerability which could hinder measles elimination.

Abstract: Objective: This perspective piece examines the role of Large Language Models (LLMs) in healthcare, arguing that despite significant investment, these models have had only a limited impact. Moreover, we argue that LLMs must replicate key phases of clinical healthcare delivery to be a force multiplier, a necessary condition to address the global burden of disease. Discussion: We argue that LLMs lack the metacognitive capacity for ranked, dynamic reasoning. This is evidenced by clinically dangerous fabrications and an inability to perform unless complete information is provided. We extend clinical critiques with a statistical argument and a simulation exercise demonstrating that LLM-based diagnosis is not merely impractical but structurally incapable of converging on correct diagnoses in realistic clinical settings. Conclusion: Unless LLMs can independently collect patient history and triage, eliminate differential diagnoses, provide a treatment plan, and generate encounter notes, these models will have limited gains in efficiency relative to cognitive AI and structured reasoning approaches that are capable of functioning autonomously at each stage of the clinical workflow.