Public Health and Healthcare

Abstract: This study compared white type 650 and wholemeal wheat breads containing two mineral–vitamin premixes, with or without dried sourdough. Twelve formulations contained 0 or approximately 0.10% premix relative to flour. In the farinograph data, Premix 2 increased dough stability from 5:55 to 15:00 min in white flour and from 1:56 to 9:42 min in wholemeal flour. Premix-only bread volumes were 355–360 versus 370 cm³/100 g for the white control and 305–308 versus 310 cm³/100 g for the wholemeal control. Across all 12 breads, the tabulated zinc and selenium concentrations ranged from 0.155 to 0.851 mg/100 g and 0.369 to 9.457 µg/100 g; vitamin D and E ranged from 0.10 to 8.40 µg/100 g and 0.06 to 4.42 mg/100 g, respectively. All comparisons are descriptive; no estimates of baking retention or nutrient bioavailability were made.

Abstract: Background and Aims: Proper sagittal alignment and postural control are important for functional independence. This exploratory cross-sectional study evaluated sagittal vertical alignment (SVA) in individuals with axial spondyloarthritis (iwaxSpA) and examined its associations with plantar-pressure-derived postural sway parameters and handgrip strength (HGS). Methods: Twenty-one iwaxSpA and 20 controls underwent whole-spine lateral radiography for SVA measurement, baropodometric assessment, and HGS testing. Results: An SVA ≥50 mm was observed in 9/21 (42.8%) iwaxSpA and 4/20 (20.0%) controls. Median SVA was higher in iwaxSpA than in controls (31 [16–53] vs. 26.5 [9.50–36.7] mm), but the between-group comparison was not statistically significant after correction for multiple testing (adjusted p=0.802). No baropodometric parameter or mean HGS differed significantly between groups after multiplicity correction. Within the iwaxSpA group, SVA showed nominal positive correlations with age (ρ=0.511, unadjusted p=0.017) and maximal mediolateral displacement (ρ=0.452, unadjusted p=0.039), but neither association remained statistically significant after Benjamini–Hochberg adjustment (adjusted p=0.356 and p=0.395, respectively). Conclusions: Although iwSpA exhibit worse postural assessment and balance control values ​​than controls—when measured via spinal radiography and baropodometry, respectively—there are no significant differences after adjusting for multiple comparisons. In iwSpA, the associations between postural assessment (via spinal radiography) and baropodometric parameters or HGS are weak and non-significant. Larger, adequately characterized studies with prespecified outcomes and adjustment for relevant confounders are needed.

Abstract: Background and Objectives: Diabetes mellitus (Type 2 diabetes) is a significant and rapidly growing global healthcare challenge and a leading cause of severe complications, including cardiovascular disease (CVD), chronic kidney disease and other conditions. In Latvia more than 103 000 individuals have been registered in the Latvian Diabetes Patient Register, of whom 90% had type 2 diabetes. Since early diagnosis can reduce complication risk, considerable effort has been devoted to the development of numerous CVD risk prediction tools using traditional statistics as well as data science-based methods. This article augments these efforts with predictive models built specifically for Latvia’s diabetes patient population. Materials and Methods: Models used anonymized diabetes patient data stored at Latvia’s Center for Disease Prevention and Control containing routinely collected information on patients’ utilization of publicly funded healthcare services. No clinical data were included. In keeping with best practices in model development, 96 302 available patient records were randomly partitioned into a 70% training data portion and 30% for out-of-sample validation. We tested three modeling methodologies – logistic regression, Random Forests, and XGBoost. Results: The binary dependent variable was defined as the occurrence of an ischemic heart disease hospitalization during 2023 or 2024. The predictor variables were limited to data from the prior two year period, 2021-2022. The three model types all produced similar fit to the data – area under the Receiver Operating Curve (ROC) of 0.70-0.71 in the validation data, which is comparable to results obtained in other studies, including SCORE2. Prediction reliability, as measured by the Brier Score, was 0.08. Conclusions: We find ischemic heart disease hospitalization risk prediction models based on routinely collected Latvian health care utilization data to be feasible. Our model identified in the anonymized data set of 103 000 individuals a group of 8 000 – 10 000 diabetes patients with an elevated (40%-45%) risk of experiencing an ischemic heart disease-related hospitalization over the next two years. We suggest future prospective studies to evaluate whether integrating the model into primary care leads to earlier interventions and a reduction in preventable ischemic heart disease hospitalizations.

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/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: Hypertension remains a major cause of cardiovascular morbidity and mortality among older adults, yet achieving adequate blood pressure control remains a significant chal-lenge. Pharmacists and community health workers (CHWs) may provide complementary clinical and community-based support for medication management and hypertension self-management. This review aimed to characterize pharmacist-led and CHW-supported interventions relevant to hypertension and blood pressure outcomes. PubMed, Scopus, and CINAHL were searched for peer-reviewed studies published from 2015 to 2026. Nine publications were included, comprising seven original primary studies and two study protocols. Across the included studies, pharmacists contributed medication therapy management, medication optimization, clinical monitoring, and home blood pressure monitoring support, while CHWs provided health education, self-management support, healthcare navigation, and connections to community resources. Collaborative models demonstrated improvements in selected blood pressure, medication-related, and self-management outcomes; however, intervention components and outcomes varied con-siderably. Few studies specifically focused on older adults, highlighting an important ev-idence gap. Pharmacist-CHW collaborative interventions varied in design and outcomes, and did not consistently result in improved clinical outcomes . Based on the findings of the review, this article describes a framework that provides a structured approach to coor-dinated hypertension management.

Abstract: Biologic therapies are highly efficacious for pediatric atopic dermatitis (AD) and psori-asis (PsO); however, their expanding use has led to increased reports of phenotype switching—a paradoxical condition where biologics induce new-onset im-mune-mediated dermatoses. To address clinical uncertainty regarding these complex reactions, this review evaluates real-world case reports, case series, and observational studies of pediatric AD and PsO patients who developed phenotypic switching during biologic therapy. Dupilumab is the most frequently implicated agent, commonly in-ducing psoriasiform, pustular, or palmoplantar eruptions in AD patients via a compen-satory shift from Th2- to Th17-predominant immunity. Conversely, phenotype switch-ing from IL-12/23 and TNF-α inhibitors remains rare in pediatric dermatology. For se-vere, refractory cases or AD-PsO overlaps, Janus kinase (JAK) inhibitors demonstrate significant rescue efficacy, provided appropriate baseline and ongoing laboratory mon-itoring is maintained. Pediatric patients experiencing biologic-induced phenotype switching can be successfully managed in clinical practice through early recognition and the implementation of the practical, evidence-based treatment algorithm proposed in this review.

Abstract: Background/Objectives: Rehabilitation in active rheumatoid arthritis (RA) remains challenging, particularly regarding the dosing of physical agent modalities during in-flammatory activity. We evaluated changes in clinical disease activity, inflammatory markers, and Power Doppler (PD) activity in patients with RA undergoing individual-ized multimodal rehabilitation. Methods: In this retrospective longitudinal study, 29 patients with RA were assessed at baseline and after 8 weeks. The program comprised 10 supervised sessions of individualized electrotherapy and therapeutic exercise over 2 weeks, followed by 6 weeks of home-based exercise. Background disease-modifying an-tirheumatic therapy was unchanged; 16 patients received ESR-guided methylpredni-solone. Outcomes included DAS28-ESR and its components, C-reactive protein (CRP), and patient-level PD grade across a standardized joint set. Results: DAS28-ESR de-creased from 6.05 ± 0.87 to 4.03 ± 0.82, with significant reductions in all its components and in CRP (all p < 0.001). PD grade decreased from 2.38 ± 0.62 to 1.69 ± 0.66 (p < 0.001); 18 patients (62.1%) improved and none worsened. Changes in DAS28-ESR and PD grade were not correlated (ρ = 0.181, p = 0.348). In the 13 patients without gluco-corticoids, DAS28-ESR decreased from 5.22 to 3.41 (p < 0.001) and PD grade from 2.38 to 1.77 (p = 0.016). Conclusions: Improvements across clinical, laboratory, and ultra-sound domains were observed during individualized rehabilitation delivered along-side pharmacological treatment, while the magnitude of clinical and ultrasound changes was not significantly correlated. Because of the uncontrolled design and con-comitant glucocorticoid and NSAID therapy, the contribution of rehabilitation cannot be isolated; controlled studies of dose-adapted rehabilitation in active RA, prescribed by the rehabilitation physician in collaboration with the rheumatologist, are warranted.

Abstract: Background: Human papillomavirus (HPV) vaccination is a major strategy for cervical cancer prevention, but uptake may be affected by misinformation, sociocultural concerns, and distrust. Pakistan’s 2025 national HPV vaccine rollout provided an opportunity to explore how parents experienced and interpreted this new intervention. Methods: A phenomenological qualitative study explored parental experiences in Islamabad and Rawalpindi through 16 in-depth interviews conducted in Urdu during September and October 2025. Data were transcribed, translated, coded using NVivo-supported procedures, and analysed thematically using Braun and Clarke’s reflexive approach. Interpretation integrated the Socio-Ecological Model and WHO health-system building blocks. Results: Parents initially described fear, uncertainty, infertility concerns, misinformation, moral concerns, and distrust of institutions. Islamabad participants reported greater exposure to digital information and misinformation and sought formal evidence and professional reassurance. Rawalpindi participants relied more strongly on interpersonal reassurance from Lady Health Workers, teachers, relatives, and other parents. Across settings, confidence increased when concerns were acknowledged, information was communicated clearly, vaccination appeared safe, and trusted community members endorsed the intervention. Conclusion: HPV vaccine confidence is relational and context-dependent. Successful implementation requires transparent communication, trained frontline workers, community engagement, rapid misinformation response, and visible institutional accountability.

Abstract: Many countries have adopted integrated primary care (IPC) models to combat prevalent mental and behavioural health issues from a biopsychosocial approach. However, its application is not universal and team-based perspectives on its implementation alongside psychologists are scarce. This research employs mixed methods to examine the novel integration of psychologists into a primary care clinic in Canada, where public access to doctoral-level psychologists is limited. Team members in a primary care clinic (N = 8) cross-sectionally reported on IPC attitudes (Mdn = 4.95, IQR = 0.78) and interest levels (Mdn = 5.25, IQR = 1.74) on a 6-point Likert scale, as well as readiness for change in consultation and practice management (Mdn = 4.00, IQR = 0.63) and intervention and knowledge (Mdn = 4.00, IQR = 0.44) on a 5-point Likert scale. Thematic analysis (N = 7) described benefits as: the ability to address the great demand for psychologists in primary care, feasibility through teamwork, improved individualized primary care, and better access. Perceived challenges were minor clinic-level constraints and policy and model-level barriers. This small-sample analysis demonstrates the feasibility of IPC and calls for policy reform to enable sustainable funding of doctoral-trained mental health specialists in primary care.

Abstract: Rationale: The population-level impact of malaria vaccines introduced through routine health systems depends on whether reductions in malaria burden occur consistently across implementation settings. However, facility-level variation in malaria trends following vaccine introduction remains poorly characterised. Evaluating heterogeneous responses after R21/Matrix-M roll-out is necessary to determine whether observed changes reflect a uniform programme effect or are driven by local epidemiological and health system factors. Objectives: To characterise the pattern, consistency, and correlates of change in facility-recorded malaria prevalence among children aged 5-11 months following R21/Matrix-M malaria vaccine roll-out in Ogbia Local Government Area, Bayelsa State, Nigeria. Methods: A retrospective facility-based observational analysis was conducted using routinely collected malaria and immunization records from nine primary healthcare facilities across four clans in Ogbia LGA. Facility-level malaria prevalence before and after vaccine roll-out was compared using prevalence ratios (PRs) with 95% confidence intervals. Heterogeneity was assessed using Cochran’s Q and I² statistics. Additional analyses examined clan-level differences, association between catchment population size and prevalence change, regression-to-the-mean effects, vaccine coverage associations, and facility-specific excess malaria episodes. Results: Across the nine facilities, malaria prevalence increased from 3.12% before roll-out to 6.30% after roll-out, corresponding to a pooled prevalence ratio of 2.02 (95% CI: 1.66-2.45; χ²=53.18; p<0.001). Facility-level changes were heterogeneous, with PRs ranging from 0.40 (95% CI: 0.08-2.04) to 12.00 (95% CI: 1.57-91.75). Significant between-facility heterogeneity was observed (Cochran’s Q=27.97, df=8, p<0.001; I²=71.4%; τ²=0.254). At clan level, prevalence increases differed significantly (Q=19.18, df=3, p<0.001; I²=84.4%), with Abureni showing the largest increase (PR=2.90; 95% CI: 2.03-4.14). Catchment population size was not significantly associated with prevalence change (Spearman ρ=0.650; p=0.058). Baseline prevalence did not predict subsequent change (Spearman ρ=0.117; p=0.765). Neither first-dose vaccine coverage (ρ=0.200; p=0.606) nor third-dose coverage (ρ=-0.05; p=0.910) was associated with prevalence change. Ogbia Central PHC, Otuogidi PHC, and Anyama PHC contributed 80.7% of the total excess malaria episodes observed after roll-out. Conclusion: Malaria prevalence increased after R21/Matrix-M roll-out, but the magnitude of change was highly heterogeneous across facilities and clans. The absence of associations with vaccine dose coverage, catchment population size, and baseline prevalence suggests that the observed variation was unlikely to be explained by vaccination coverage patterns alone. Thus, routine malaria vaccine monitoring should incorporate facility-level surveillance to identify local drivers of divergent malaria trends and guide targeted programme responses. The findings demonstrate that malaria vaccine implementation outcomes can vary substantially within the same geographical area. Identifying facility-specific contributors to changing malaria burden is essential for translating vaccine introduction into measurable public health impact.

Abstract: Importance: Hearing loss is a multifactorial sensory impairment associated with communication difficulties, cognitive impairment, and emotional impacts in all ages. There are occupational risk factors for noise-induced hearing loss among healthcare workers, and this may present with negative professional outcomes. Assessing the baseline hearing of healthcare workers in their early medical education is a necessary step to inform screening measures and provide timely interventions and preventative strategies. Objective: To determine whether extended headphone use contributes to premature hearing loss among medical students and to explore the potential of simple questionnaires, self-reported health information (SRHI), and phone-reported health information (PRHI) as preliminary screening tools for hearing loss in this population. Design, Setting, Participants: A cross-sectional study was conducted among medical students. Eligibility criteria for enrollment included being over 18 years old and having no previous chronic or acute ear pathology. Participants completed a self-administered questionnaire assessing demographics, SRHI, PRHI, and hearing-related habits. Audiometry measured air conduction hearing thresholds across 1, 2, 4, and 8 kHz, reported as pure-tone audiometry (PTA). The study took place from August 2023 to March 2024. Retrospective control group data was sourced from a national database. Primary Outcomes and Measures: The primary outcome was the hearing threshold measured by PTA. Secondary outcomes included associations between hearing thresholds and factors such as headphone use (via PRHI), migraines, exposure to loud sounds, tinnitus, age, gender, and ethnicity.Results: The study included 50 medical students. The average ambient testing noise level was 41.66 dB. Daily moderate headphone use, whether in-ear or over-ear, did not significantly affect hearing outcomes (in-ear: p=0.633; over-ear: p=0.901). Self-reported migraines, weekly exposure to loud sounds, and tinnitus were not significantly associated with hearing test results (p=0.837, p=0.37, p=0.661, respectively). Age did not impact hearing (p=0.919), but gender was a significant factor, with females exhibiting slightly poorer hearing than males (p=0.0199). Finally, PRHI included headphone and environmental audio levels. Headphone audio levels proved no correlation with hearing threshold (Pearson’s correlation coefficient: -0.0311, p =0.847, n = 41), nor did environmental audio levels (Pearson’s correlation coefficient: -0.450, P-value: 0.0920, n=16).Conclusions and Relevance: The findings of the study suggest that there is no significant association between the modality, duration, or sound level of headphone usage and the baseline hearing levels, as measured at a single point in time, among medical students recruited from the study site. Our investigation utilized simple questionnaires, self-reported health information (SRHI), and phone-reported health information (PRHI) as preliminary screening tools for hearing loss within this population. While this study provides valuable insights, its findings are limited by the small cohort, absence of a concurrent control group, and reliance on a single-measure design. This study does support the use of audiometry, SRHI, and PRHI as valuable methods to screen healthcare students for hearing loss. Future research with larger, more diverse samples and more rigorous methodologies would be beneficial to validate and extend these findings.

Abstract: Cancer now ranks among the leading causes of death in Kenya, with approximately 35,867 new cases and 22,888 deaths annually, and outcomes remain constrained less by the availability of therapy than by the diagnostic pathway that must precede it. A national pathology workforce numbering in the low hundreds serves a population exceeding fifty million, and delayed or absent tissue diagnosis drives late presentation across the five malignancies that account for most of the national burden. Artificial intelligence offers a mechanism to extend interpretive capacity in a system where human expertise cannot be scaled at the rate the disease burden demands. This communication sets out a prioritized research agenda spanning smartphone-assisted visual inspection of the cervix, breast ultrasound classification and histopathological grading, morphological and immunophenotypic triage of hematolymphoid neoplasms, radiomic triage of thoracic and hepatic disease, and AI-assisted radiotherapy contouring. We present a six-stage methodological pipeline covering stakeholder engagement, local dataset curation, transfer learning, validation, usability assessment, and data governance, together with a tiered adoption framework matched to laboratory capability and the workforce competencies required for safe clinical supervision of these systems. The agenda is directed at early-career investigators and is transferable to comparable low- and middle-income settings.

Abstract: Rationale: The successful deployment of malaria vaccines requires not only achieving initial vaccine uptake but also ensuring completion of the recommended multi-dose schedule. However, evidence on real-world implementation performance and retention patterns of the R21/Matrix-M malaria vaccine in rural African healthcare settings remains limited. Understanding where attrition occurs across the vaccination cascade is essential for designing targeted strategies that maximize vaccine impact. Objective: This study evaluated uptake, retention, geographic variation, and implementation bottlenecks affecting completion of the four-dose R21/Matrix-M malaria vaccine schedule among children aged 5-11 months in rural Niger Delta healthcare facilities. Methods: A retrospective programme evaluation was conducted using aggregated vaccination records from nine primary healthcare facilities. The analysis assessed dose-specific coverage, facility- and community-level disparities, retention across vaccination transitions, and the relative contribution of implementation failure points. Coverage was calculated using the registered eligible catchment population (n = 4,714), while retention and dropout analyses quantified losses throughout the vaccination cascade. Results: Among 4,714 eligible children, 2,487 initiated vaccination, achieving 52.8% Dose 1 coverage. Retention declined to 72.1% after Dose 2 (1,794 children), 57.8% after Dose 3 (1,437 children), and 0.9% after Dose 4 (23 children). Facility-level Dose 1 uptake ranged from 12.8% to 87.4%, whereas no facility exceeded 2.0% booster completion. Geographic disparities were observed, with Oloibiri and Anyama clans demonstrating higher initiation coverage (75.6% and 71.2%, respectively) compared with Abureni (18.3%). The largest implementation failure occurred between Dose 3 and Dose 4, accounting for 1,414 losses (57.4% of post-initiation dropout). Conclusion: R21/Matrix-M vaccine implementation achieved moderate initial reach but experienced severe failure in maintaining children through schedule completion. The dominant programme constraint was inadequate retention rather than vaccine initiation alone. Recommendation: Malaria vaccine programmes should incorporate longitudinal tracking systems, caregiver reminder platforms, community health worker follow-up, and integration with routine immunization services to improve completion rates. These findings show that vaccine availability does not guarantee population protection; sustainable malaria control requires implementation systems that can convert early vaccine access into complete vaccination coverage.

Abstract: Introduction Guyana has one of the highest cervical cancer mortality rates in the Americas, and a national HPV DNA testing voucher programme substantially expanded screening in 2024–25. How that expansion is experienced in remote Indigenous communities, and what shapes prevention there, is poorly described. We compared how Indigenous women in two hinterland regions account for cervical cancer, screening, traditional medicine and care-seeking. Methods Comparative qualitative study using framework analysis of semi-structured interviews with 294 Indigenous women: 137 from 39 communities in Region 1 (Barima-Waini) and 157 from 41 communities in Region 9 (Upper Takutu-Upper Essequibo). The 41-item schedule covered eight domains, from knowledge and awareness to cost. Coding was deductive at domain level with inductive sub-coding of open-text responses, and framework matrices supported within- and cross-region comparison. Because the interviews were structured and answers were often brief, we do not claim thematic saturation. Results Reported screening differed sharply between regions (Region 1, 29.9%; Region 9, 72.6%), but women's explanations located the difference in services rather than in willingness. Region 1 women described screening as unavailable, irregular or unreachable; Region 9 women more often described missing an outreach visit that had taken place. Language was a structural barrier in Region 1, where 86.8% of women who spoke only an Indigenous language named it as an obstacle and only 5.3% had been screened. Knowledge and screening came apart in both directions: women were screened during outreach without prior knowledge, and women with knowledge went unscreened where no service existed. Traditional medicine was learned from mothers, grandmothers and elders rather than from specialist healers, and was used alongside biomedical care. Few women told clinicians about it (Region 1, 12.4%; Region 9, 31.2%), though many asked for plain explanations of ingredients, interactions and side effects. Fear that a neighbour working in the health post would talk, and fear of referral to Georgetown, shaped care-seeking. Conclusion In these communities, cervical cancer prevention depends less on educating women than on putting an acceptable service within reach, in a language women use, with confidentiality they can believe. Traditional medicine is better treated as a subject for routine, non-judgemental clinical enquiry than as competition.

Abstract: Background: Physical inactivity contributes substantially to morbidity, disability and premature mortality in older adults. However, physical activity counselling in primary care does not necessarily translate into structured, individualized exercise prescription. PREFIS-AP evaluates a standardized Exercise Prescription Program embedded in routine primary care for adults aged ≥65 years. Methods: PREFIS-AP is a pragmatic, parallel-group randomized controlled trial including 210 participants allocated 1:1 to an individualized exercise prescription program or usual care. The primary outcome is change in functional exercise capacity measured by the Six-Minute Walk Test (6MWT). Secondary outcomes include physical activity, health-related quality of life, muscle strength and lower-limb function, anthropometric measures, rectus femoris morphology assessed by point-of-care ultrasound, medication burden and safety. Analyses will follow the intention-to-treat principle, estimating between-group effects adjusted for baseline values. Discussion: PREFIS-AP will evaluate a reproducible model for integrating structured exercise prescription into routine primary care. Key strengths include electronic health record integration, standardized decision algorithms, individualized multicomponent exercise, objective functional and ultrasound assessment, and intervention-fidelity procedures. Limitations include its single rural setting, participation of an exercise professional, lack of participant and clinician blinding, and 12-week follow-up. If effective, the model could support scalable implementation of exercise prescription in primary care.

Abstract: Background/Objectives. Mobile phone-based vaccination interventions, including SMS reminders, voice calls and tracking applications, have repeatedly shown effectiveness in controlled settings across sub-Saharan Africa. Many nevertheless stop operating once project funding ends and do not become part of the routine health systems they were intended to strengthen. This study aimed to develop a preliminary evidence-informed conceptual framework explaining the multilevel conditions required to embed mobile vaccination interventions within routine immunization systems in sub-Saharan Africa. Methods. A systematic evidence synthesis was undertaken to inform framework development. Six scientific databases (PubMed/MEDLINE, CINAHL, EMBASE, Epistemonikos, Web of Science and Global Health) were searched for studies published between January 2014 and April 2024. Selection followed the PRISMA 2020 statement, methodological quality was appraised with the Mixed Methods Appraisal Tool (MMAT, 2018 version), and implementation conditions were synthesized thematically through an iterative framework-development process. Results. Eighteen of 913 identified records were included. Four interdependent domains formed the preliminary Mobile Vaccination Embedding (MOVE) framework: user readiness (acceptability, trust and digital literacy among caregivers and providers); technological reliability (network coverage, electricity access and device sustainability); organizational integration (staff training, workflow adaptation and health worker adherence); and system governance (policy frameworks, multisectoral partnerships, financing and integration into national Expanded Programme on Immunization structures). Together, these domains describe the conditions shaping progression from adoption to institutionalization. Conclusions. The primary contribution of this study is the preliminary evidence-informed MOVE framework, which shifts attention from whether mobile vaccination interventions are effective to whether health systems possess the capacity to embed and sustain them. The framework requires prospective refinement, empirical testing and validation across diverse health-system contexts.

Abstract: Background/Objectives: Paediatric oral health during primary school years profoundly impacts systemic development and psychosocial wellbeing, with parental health habits heavily dictating whether care follows a preventive or a reactive pathway. The aim of this study was to evaluate parent-reported oral health status, oral hygiene habits, and dietary patterns in primary schoolchildren, as well as parental awareness regarding the impact of oral health on children’s overall wellbeing across preventive and reactive care pathways. Methods: A cross-sectional study was conducted, administering an online questionnaire to 1889 parents of primary schoolchildren, which evaluated the parent’s knowledge, behaviors and attitudes regarding the oral health and diet of their children. Results: Parent-perceived child oral and gum health was overall favorable, with girls (p<0.01) and children of parents with higher educational background (p<0.001) receiving higher ratings. While toothbrushing with fluoridated toothpaste was widely reported, fluoride usage and dental flossing remained heavily stratified by socio-demographic factors (p<0.001). The consumption of fruits, sweet bakeries and cariogenic snacks was frequent and soft drink intake demonstrated an age-dependent increase (p=0.001). Dental pain was rarely reported; increased pain frequency was correlated with poorer parent-perceived oral health ratings and cariogenic diets (p<0.001). Child dental visits were predominantly low or reactive, with non-attendance and pain-triggered visits significantly linked to rural residence, lower parental academic attainment, poor brushing frequency and cariogenic diets, which affected the children’s quality of life (p<0.001). Conclusions: Schoolchildren’s oral healthcare remains largely reactive, with dental pain serving as the primary trigger for dental service utilization, despite generally favorable parental perceptions.

Abstract: Background: Early childhood caries (ECC) remains a major public health concern and is influenced by interactions among children, environmental, and dental care factors. Purpose: This study aimed to determine the prevalence of dental caries and identify factors associated with dental caries among preschool children in Nakhon Si Thammarat Province. Methods: A cross-sectional correlational study was conducted among 435 preschool children aged 3–5 years and their primary caregivers in Nakhon Si Thammarat Province, Thailand. Data were collected using oral health examinations and structured questionnaires completed by caregivers. The questionnaires assessed demographic characteristics, caregivers' oral health attitudes and practices, and access to and utilization of dental services. Data was analyzed using descriptive statistics, chi-square tests, and binary logistic regression. Results: The prevalence of dental caries was 52.6%, and 55.6% of children had poor oral hygiene. The factors associated with dental caries included bottle-feeding, frequency and duration of toothbrushing, having a toothbrushing assistant at home, caregiver education level, attitude, caregivers’ oral health care behaviors for children, and visiting the dentist for toothaches, check-ups, and fluoride application (p < 0.01). Binary logistic regression confirmed that caregivers' oral health care practices were most strongly associated with dental caries. Children whose caregivers had low-to-moderate oral health care practices were 7.11 times more likely to have dental caries than those whose caregivers had high oral health care practices (AOR = 7.11; 95% CI: 4.11-12.32; p<0.001). And factors associated with dental caries included caregiver education below a bachelor's degree (AOR = 2.64; 95% CI: 1.64-4.23; p < 0.001), toothbrushing once daily (AOR = 2.20; 95% CI: 1.07-4.52; p < 0.05), and never/sometimes visiting a dentist only when experiencing toothache (AOR = 2.26; 95% CI: 1.36-3.74; p < 0.01). Conclusions: Dental caries remains highly prevalent among preschool children in southern Thailand. Caregiver oral health care was a strong predictor of dental caries. Oral health promotion programs should strengthen caregivers' practical skills in oral health care and encourage regular preventive dental care by collaborating among families and primary healthcare providers.