Public Health and Healthcare

Abstract: Natural mineral water (NMW) represents a heterogeneous hydrochemical exposure whose metabolic effects may depend on its complete mineral and physicochemical profile. This critical review evaluates human evidence on NMW consumption in relation to glucose regulation and metabolic pathways relevant to type 2 diabetes mellitus (T2DM), while distinguishing clinical findings from mechanistic plausibility. Controlled studies have not demonstrated a consistent glucose-lowering effect: oral glucose tolerance and postprandial glucose responses were generally unchanged, while longer-term reductions in fasting glucose were not clearly attributable to water composition. Conversely, selected studies identified potentially relevant intermediate responses, including altered postprandial insulin dynamics, reduced glycoalbumin, changes in oxidative status, gastrointestinal and microbiota-related variables, and favourable intestinal, inflammatory, and liver-related outcomes in metabolic dysfunction-associated steatotic liver disease. Human studies also establish mineral water as a bioavailable source of magnesium and calcium, although bioavailability does not imply metabolic efficacy. Interpretation remains limited by small samples, heterogeneous hydrochemical profiles, short interventions, and comparator design. We propose a hydrochemical–phenotypic framework in which metabolic responses may depend on water composition, dose, exposure duration, and host phenotype. Current evidence does not support NMW as a treatment for T2DM but identifies specific metabolic pathways warranting rigorous clinical investigation.

Abstract: Rationale. Evidence-based medicine (EBM) and health technology assessment (HTA) rest on a positivist epistemology in which value is treated as objective, measurable and generalisable across populations. This framing struggles to represent how individual patients construct the meaning and value of health states. Aims and Objectives. To analyse the epistemological tension between positivist and constructivist approaches to evidence, value and decision-making in EBM and HTA, and to examine its consequences for clinical practice and reimbursement. Method. Conceptual analysis. A philosophical account of positivism and constructivism was combined with six illustrative clinical vignettes drawn from clinical practice and selected to make the tension visible, and each vignette was mapped onto the methodological rules that govern HTA. Results. Across the vignettes, valid positivist endpoints (survival, relapse rates, quality-adjusted life years) systematically diverged from what individual patients valued (dignity, identity, meaning, cultural belonging). Utility weights, surrogate endpoints and cost-effectiveness rules could not represent this constructed value; and HTA, in turn, shapes clinical practice through reimbursement, service availability and opposable guidance. Modern HTA increasingly incorporates patient involvement, patient-reported outcomes, discrete choice experiments, deliberative processes and multi-criteria decision analysis, but these remain structurally secondary to population-level quantitative evidence. Conclusion. Positivism and constructivism are complementary rather than opposed. A more pluralist HTA — one that makes preference heterogeneity, experienced utility and the underlying facts, norms and values explicit — would be more, not less, evidence-based, and would widen the room clinicians have to practise person-centred care. The vignettes are pedagogical illustrations, not empirical evidence.

Abstract: General practitioners (GPs) are central to smoking cessation; however, their own smoking may influence cessation-related perceptions and practices. This study examined Australian GPs’ perceptions of smoking cessation support, implementation of the 5As model, and associations with their smoking status. A cross-sectional online survey of Australian GPs used a questionnaire primarily based on the Global Health Professional Survey, with items adapted from a previous Australian study. Uni-variate and multivariable logistic regression analyses examined associations between perceptions, 5As implementation, smoking status, and sociodemographic charac-teristics. Among 178 participants, 57% were male, 92% were migrants, and 7.3% were daily smokers. Compared with never smokers, current smokers were more likely to agree that GPs who smoke are less likely to advise patients to quit (AOR=4.02, 95% CI:1.20–13.45), and less likely to view GPs as role models (AOR=0.13, 95% CI:0.03–0.48) or believe GP advice promotes quitting (AOR=0.11, 95% CI:0.01–0.88). Current smokers were less familiar with the 5As than ex-smokers (AOR=0.12, 95% CI:0.02–0.65). Four-fifths reported no cessation-counselling training. Barriers were patient resistance, limited consultation time, and lack of reimbursement. GPs’ smoking status was associated with cessation-related perceptions and practices. Targeted training and system-level support may strengthen smoking cessation care in Australian primary care.

Abstract: In May 2026, the Democratic Republic of the Congo declared an outbreak of Bundibugyo virus disease (BVD) caused by Bundibugyo ebolavirus (BDBV), for which no licensed vaccine or antiviral treatment was available. We analysed the epidemic trajectory through 14 July 2026 and developed conditional six-month projections. Aggregated data from official INSP/COUSP Situation Reports (14 May–14 July 2026), supplemented by WHO and UN reports, were used to describe cases, deaths, case-fatality ratios (CFRs), and geographic spread. Log-linear models estimated phase-specific growth rates and doubling times; logistic, Gompertz, and constant-incidence scenarios were used for projections, with model comparison, Bayesian sensitivity analysis, deterministic sensitivity bounds, CFR confidence intervals, and rolling-origin validation. Confirmed cases increased from 8 to 2,073, with 796 deaths (national CFR, 38.4%), while affected health zones increased from 3 to 45 across five provinces. Doubling time increased from 8.9 to 19.5 and 25.1 days, representing a 64.1% reduction in growth rate. Ituri accounted for 89.9% of cases, while North Kivu had a CFR of 58.7%. Six-month projections ranged from 2,624 cases under rapid containment to 3,942 under continued deceleration and 10,839 with persistent recent incidence. Although proportional growth slowed, transmission and geographic expansion remained active. The divergence between modelling approaches and systematic under-prediction in temporal validation indicate substantial forecast uncertainty; projections should therefore be interpreted as conditional planning scenarios rather than deterministic forecasts.

Abstract: Background: The transition from milk feeding to complementary foods during the first 1000 days is a critical period for child nutrition, growth, and oral health. This study explored Cook Islands Māori parents’ and caregivers’ experiences of transitioning infants from milk to complementary foods, with a focus on their knowledge, practices, and contextual influences, using Bronfenbrenner’s Ecological Systems Theory. Methods: An interpretive-descriptive approach was employed, using kōrero, a culturally grounded qualitative method of storytelling and shared dialogue. Fifty parents and caregivers of children aged under six years in the Cook Islands participated in face-to-face interviews conducted between September and December 2023. Data were thematically analysed following Braun and Clarke’s framework and mapped across the micro, meso, exo, macro, and chronosystem levels of the Bronfenbrenner Ecological System Theory (EST). Results: Complementary feeding commonly commenced before six months of age, and was shaped by interacting influences across family, health system, cultural, environmental, and societal contexts. Perceptions of infant hunger, concerns about insufficient milk intake, and strong family influence, particularly from grandparents, contributed to early introduction of complementary foods. Conclusion: Complementary feeding during the first 1000 days in the Cook Islands is shaped by interconnected nutritional, familial, cultural, health-system, and environmental influences. The transition from milk to solid foods is influenced by nutritional, cultural, and environmental factors. In the Cook Islands, culturally responsive and family-centred approaches are important for promoting healthy nutrition and oral health during the first 1000 days.

Abstract: Background/Objectives. Respiratory syncytial virus (RSV) is an important cause of acute lower respiratory infection in infants. Panama introduced the bivalent prefusion F vaccine (RSVpreF) for administration between 32.0 and 36.6 weeks of gestation in July 2025. In this tropical setting, respiratory viruses are detected throughout the year, with RSV activity increasing during the rainy season. We characterized self-reported maternal and neonatal events and outcomes to generate early post-introduction real-world safety evidence from Central America. Methods. This retrospective descriptive observational study included women aged 18 years or older vaccinated with RSVpreF between 32.0 and 36.6 weeks of gestation from July through December 2025 and recruited from January through July 2026. Structured telephone, virtual, or in-person interviews were used. We calculated absolute and relative frequencies and 95% Wilson confidence intervals (CIs). Results. Of 225 questionnaires obtained, 200 were eligible for analysis. Mean maternal age was 28.1 years (SD 6.4). At least one reaction was reported by 55.5% of participants, mainly local; injection-site pain was most frequent (48.0%). At least one obstetric condition was reported by 17.5%, including hypertensive disorders of pregnancy (12.0%). Preterm birth occurred in 2.0% and low birth weight in 2.5%. No fetal or neonatal deaths, thrombocytopenia, paralysis, facial paralysis, or Guillain–Barré syndrome were reported. Jaundice was the most frequent neonatal morbidity (20.0%). Conclusions. In this cohort, self-reported reactogenicity was mainly local, and no unexpected cluster of events was apparent. Participant selection, retrospective self-report, absence of an unvaccinated comparator, and sample size limit risk estimation and detection of uncommon events. The findings provide early active-pharmacovigilance evidence from Central America and support continued surveillance with clinically verified maternal and neonatal outcomes.

Abstract: Introduction: Noma is a severe gangrenous orofacial disease affecting malnourished children aged 2–6 years in extreme poverty, with 85–90% mortality if untreated. Recently classified as a Neglected Tropical Disease, it is managed mainly with empirical broad-spectrum antibiotics. Antimicrobial resistance (AMR) threatens to undermine treatment, yet AMR remains largely absent from Noma research and policy. This review examines AMR prevalence and drivers in Noma, identifies knowledge and policy gaps, and proposes recommendations.Methods: We reviewed literature on Noma microbiology and documented AMR, plus WHO NTD and AMR policy documents. Community and health system factors and surveillance capacity in Noma-endemic regions, primarily Sub-Saharan Africa, were synthesized.Results: Noma lesions show marked dysbiosis with frequent detection of Fusobacterium necrophorum, Prevotella spp., Staphylococcus aureus, Pseudomonas aeruginosa, and a novel “Treponema sp. A”. A 25-year retrospective analysis found that >92% of patients presented late, requiring prolonged antibiotics. Direct AMR data are scarce. Case reports documented MDR-Escherichia coli in Afghanistan(2012), Vancomycin-resistant Enterococci in South Korea(2022), ESBL E. coli in Mali(2021), Serratia marcescens (Ticarcilline, amoxicillin, and sulfamethoxazole-trimethoprim) and Pseudomonas aeruginosa (Rifampicin) in Chad (2014); and Pseudomonas aeruginosa (penicillins, carbapenems, aminoglycosides, sulfamethoxazole-trimethoprim, and nitrofurantoin) in Italy (2015). A recent metagenomic study reported high β-lactam and metronidazole resistance determinants, especially in Prevotella spp. Drivers include empirical broad-spectrum antibiotic use, self-medication, irrational prescribing, and weak diagnostics, with only a small share of laboratories across 14 SSA countries performing routine bacteriology and susceptibility testing. Policy gaps persist: WHO NTD and AMR strategies are siloed, anaerobes are excluded from GLASS surveillance, and Noma guidelines lack AMR triggers. Conclusion: AMR risks reversing gains in Noma control, and treatment centers may become AMR amplification sites without stewardship. Given limited microbiology data, we recommend adding AMR indicators to WHO and national Noma strategies, integrating anaerobic AMR surveillance at sentinel sites, generating Noma-specific antibiograms, and mandating antimicrobial stewardship in Noma programs. Mainstreaming AMR in Noma research and policy is essential to preserve therapeutic options.

Abstract: Background: The burden of chronic diseases is increasing across Africa, while many health systems continue to face challenges in delivering sustained, long-term care. Although diagnosis and treatment remain essential, chronic disease management extends well beyond the clinical encounter and requires ongoing medication adherence, self-management, monitoring, dietary and lifestyle support, and timely follow-up. Problem: Chronic disease services in many low-resource settings remain organised around episodic clinical encounters, creating a gap between treatment received within health facilities and the day-to-day management required outside them. Patients spend much of their time managing their conditions at home and within their communities, where access to structured follow-up and support may be limited. Community pharmacies, family and social networks, and mobile communication increasingly help patients navigate this gap, but these mechanisms often operate without systematic integration into formal care. Argument: This paper conceptualises this space between clinical encounters as the “missing middle” in chronic disease care. We argue that improving long-term outcomes requires greater attention to the systems that connect clinical encounters with patients’ everyday experiences of managing chronic conditions. The paper proposes a community-integrated digital continuity framework that brings together community-based support, digital communication, patient education, monitoring, medication adherence support, and care coordination as complementary components of longitudinal chronic disease management. Implications: Addressing the missing middle requires health systems to move beyond a predominantly encounter-based approach toward models that provide structured support across the full course of chronic illness. Integrating community actors and accessible digital communication into routine care may offer a practical pathway for strengthening continuity, particularly in settings where health-system resources are constrained. The framework provides a basis for further implementation research and evaluation of community-integrated approaches to chronic disease continuity in African health systems.

Abstract: Background/Objectives: Maternal immunization is a public health priority within Panama's Expanded Programme on Immunization (EPI), yet coverage among pregnant women remains below target and little local evidence is available on perceptions and practices among women engaged in antenatal care. We aimed to describe vaccination-related perceptions, attitudes and practices in an urban, predominantly private-care sample and to explore factors associated with acceptance. Methods: We conducted a cross-sectional study in 204 pregnant women aged ≥18 years, recruited by convenience sampling and surveyed with an anonymous, self-administered questionnaire. Vaccine acceptance was defined as having received or intending to receive at least one recommended vaccine during the current pregnancy. Participant characteristics were summarized descriptively; bivariate analyses and multivariable Poisson regression with robust variance estimated adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Acceptance was 93.1% (190/204). Most participants had higher education (88.2%) and private antenatal care (77.9%); all reported antenatal care. Healthcare professionals were the main information source (92.6%) and most trusted source (98.0%). A vaccination recommendation was reported by 84.3% of participants; 96.5% of reported recommendations came from healthcare professionals. Influenza was most frequently received (56.9%), RSV most frequently planned (51.5%), and COVID-19 most frequently refused (47.1%). Recommendation was associated with acceptance (adjusted PR 1.22; 95% CI 1.02–1.45; p = 0.029), but may reflect broader access to high-quality care. Conclusions: In this selected urban sample, acceptance was high among women engaged in antenatal care. The findings cannot characterize national acceptance; improving coverage likely requires equitable access to antenatal care, evidence-based counseling, recommendations, and vaccination opportunities.

Abstract: Background: This paper documents implementation lessons from a trial evaluating locally sourced food vouchers and cash transfers for the management of moderate acute malnutrition (MAM) among children aged 6–59 months and pregnant and breastfeeding women in Ethiopia. Methods: Lessons were synthesized from program documentation, routine monitoring data, supportive supervision reports, field observations, and complementary studies conducted throughout the trial. Results: Implementation experience demonstrated that market-based nutrition approaches can be integrated into routine health systems with systematic program preparation, market feasibility assessments, digital and financial systems, and continuous implementation support. Locally sourced food vouchers enabled households to access a defined nutritious food basket while adapting to local food availability, although maintaining program quality required market monitoring, retailer engagement, and compliance with basket specifications. Cash transfers provided greater household choice and purchasing flexibility but were influenced by market conditions, price fluctuations, household preferences, and intra-household decision-making. Implementation encountered several operational bottlenecks, including frontline health worker workload and turnover, digital system delays, cash and voucher card supply challenges, retailer non-compliance, financial service provider payment issues, and household-level barriers such as long travel distances and intra-household food sharing. Adaptive management approaches were used throughout implementation, including refresher training and supportive supervision for Health Extension Workers (HEWs), strengthened coordination with digital and financial service providers, improved supply planning, enhanced retailer monitoring through local market support groups, and targeted nutrition counseling to support appropriate use of interventions. Conclusions: Overall, the trial demonstrated that market and digitally enabled nutrition interventions are feasible alternatives for MAM management when supported by strong implementation systems. Successful scale-up requires investment in frontline workforce capacity, reliable digital and logistical support systems, effective market governance, and social and behavior change approaches that address household realities, including food access, storage capacity, and intra-household decision-making.

Abstract: Background: Infantile dilated cardiomyopathy (DCM) is uncommon but carries substantial mortality, particularly when accompanied by neurological, ocular, or metabolic abnormalities. Long-Olsen-Distelmaier syndrome is a rare mTORopathy caused by heterozygous gain-of-function variants in RRAGC and may include cortical malformations, congenital cataracts, mineral disturbances, and early-onset DCM. Case Summary: We describe a term male infant born to consanguineous parents who developed hypocalcemia with hyperphosphatemia, bilateral frontoparietal polymicrogyria, bilateral congenital lamellar cataracts, and small patent ductus arteriosus and ventricular septal defect with initially preserved biventricular function. Consequently, clinical whole-exome sequencing was requested. At 53 days of age, he presented with poor feeding, lethargy, cardiogenic shock, severe lactic acidosis, and hyperkalemia during a rhinovirus/enterovirus-positive respiratory illness. Echocardiography demonstrated newly developed severe DCM, marked left ventricular dilatation, and an ejection fraction of 27%. Despite multi-agent inotropic support and intensive care, ventricular function did not recover, and he died at approximately two months of age. Whole-exome sequencing identified a heterozygous RRAGC NM_022157.4:c.343T>C, p.(Trp115Arg) variant. The diagnostic laboratory classified the variant as likely pathogenic, and an independent manuscript-level ACMG/AMP reassessment was concordant. The multisystem phenotype was also highly consistent with the reported syndrome. Conclusion: This case broadens the clinical and geographic spectrum of RRAGC-related Long-Olsen-Distelmaier syndrome and documents rapid progression from preserved neonatal ventricular function to fatal infantile DCM. Moreover, respiratory viral detection should be interpreted cautiously because myocardial infection or myocarditis was not established. Early exome-based testing should be considered in infants with cardiomyopathy and multi-system abnormalities.

Abstract: This study explored how rural children cluster in physical activity (PA) profiles and their psychological differences, to inform tailoring PA interventions to different types of children. The primary objective was to identify PA-based profiles, and the secondary objective was to examine the differences in basic psychological needs across profiles. A 1-year exploratory prospective cohort study was conducted with 83 6th-8th grade students from an under-resourced rural middle school. The sport-based PA intervention was implemented by college students in an undergraduate service-learning course. PA was assessed using Axivity AX3 accelerometers, and included light, moderate, vigorous, and total PA minutes/week. Psychological measures included the Basic Psychological Needs Satisfaction and Frustration. K-cluster analysis identified PA profiles based on light, moderate, and vigorous PA levels (minutes/week). Multivariate analysis of variance (MANOVA) assessed profile differences based on (a) needs satisfaction, (b) needs frustration, (c) autonomy, (d) competence, (e) relatedness. Three PA profiles emerged: a Low activity (n=21), Medium activity (n=22), and High activity cluster (n=5). These clusters differed significantly in PA levels (p<0.001).  Children differ based on their PA profiles. As such, interventions may be well served to consider tailoring PA interventions to different types of children, based on PA and/or psychological profile differences.

Abstract: Background/Objectives: The increasing incidence of mild cognitive impairment and dementia in older adults are crucial for cognitive impairment. This study aimed to examine the relationships between anthropometric status, dietary diversity, dietary quality, and cognitive performance in older adults. Methods: This single-center cross-sectional study included 117 older adults. Anthropometric measurements were performed. Dietary Diversity Score (DDS), Healthy Eating Index-2020 (HEI-2020), 24-hour dietary recall and Montreal Cognitive Assessment (MoCA) were used. We used hierarchical multiple linear regression analysis. Results: 53.0% of the participants were in the group of possible mild cognitive impairment (MCI). Participants in the probable MCI group had a higher body mass index (BMI) compared to those with normal cogni-tive performance (32.67 ± 5.78 and 29.54 ± 3.39 kg/m²; p < 0.001) and a higher prevalence of obesity (62.9% and 41.8%; p = 0.027). The final regression model explained 23.6% of the variance in MoCA scores (R² = 0.236; adjusted R² = 0.194; p < 0.001). More years of edu-cation were associated with higher MoCA scores (B = 0.795, β = 0.375, p < 0.001), while higher BMI was associated with lower MoCA scores (B = −0.282, β = −0.225, p = 0.016). Conclusions: Higher BMI was found to be associated with lower cognitive performance in older adults. However, DDS and HEI-2020 scores were not associated with cognitive performance. Longitudinal studies including repeated nutritional assessments are needed to clarify the direction and temporal pattern of these relationships.

Abstract: Introduction: Clinical Associates were introduced into South Africa's district health system to strengthen healthcare delivery through task sharing, particularly in underserved rural settings. Their effectiveness depends on appropriate supervision by medical practitioners. However, the workforce shortages that necessitate task sharing may simultaneously constrain clinicians' capacity to provide effective supervision. This study explored how pressures within rural health systems shape the supervision of Clinical Associates in district hospitals. Methods: A qualitative descriptive study was conducted among eight medical practitioners supervising Clinical Associates in rural district hospitals in the O.R Tambo District, Eastern Cape, South Africa. Participants were recruited through hospital management and professional networks. Semi-structured interviews were conducted online in English, audio-recorded with informed consent, transcribed verbatim, and thematically analysed using Braun and Clarke's six-phase approach. The Contextual, Operational, Analytical, Transformational, and Synthesis (COATS) framework informed data collection and provided a deductive analytical lens, complemented by inductive coding to identify emerging themes. Results: Clinical Associate supervision occurred within resource-constrained facilities characterized by workforce shortages, high patient volumes, broad service demands, and limited supervisory capacity. Supervising clinicians described balancing supervisory responsibilities alongside demanding clinical, administrative, and governance roles. Consequently, supervision was predominantly informal, reactive, and accessibility-based rather than continuously direct or structured. Experienced Clinical Associates frequently managed routine clinical care independently and sought medical support when faced with diagnostic uncertainty or cases requiring escalation. This pragmatic supervision model enhanced service delivery but relied heavily on trust, professional judgment, supervisor accessibility, and Clinical Associates' ability to recognize their own limitations. Conclusion: The realities of rural health systems intrinsically shape Clinical Associate supervision. Supervision models based on assumptions of adequate staffing and continuous medical oversight are unlikely to be sustainable in resource-constrained district hospitals. Policies should support context-responsive supervision by combining accessible clinical support with structured escalation pathways, periodic case review, developmental feedback, and clinical governance mechanisms to strengthen patient safety, workforce sustainability, and quality of care.

Abstract: The aim of our study is to retrospectively examine the frequency of rotavirus and adenovirus in acute gastroenteritis cases, their distribution according to age, season, and gender, and to investigate the epidemiological impact of COVID-19. We conducted a single-center, retrospective, observational cohort study over a four-year period. A total of 46.459 stool samples with a preliminary diagnosis of acute gastroenteritis from our hospital's wards and outpatient clinics were included in the study. Rotavirus and adenovirus antigens in stool samples were investigated using qualitative immunochromatographic diagnostic tests, and patient records were retrospectively evaluated. The distribution of antigen positivity according to seasons, patient ages, and genders was statistically evaluated using Pearson chi-square analysis. Rotavirus antigen was found in 10.7% of patients with gastroenteritis. 76.8% of rotavirus positive samples were taken from children aged 0-5 years, with the highest antigen positivity rate of 14.5% observed in children aged 13-24 months. Adenovirus antigen was detected in 3.2% of patients. Adenovirus positivity was highest in children aged 2-4 years (4.1%). There was no statistically significant difference between genders in terms of rotavirus and adenovirus prevalence. In our region, rotavirus and enteric adenoviruses, especially among pediatric gastroenteritis cases, maintain their importance as a significant public health problem. It has been observed that rotavirus gastroenteritis increases in winter and spring, while adenovirus gastroenteritis increases in spring and summer. In 2020, positivity rates were found to be very low, which has been interpreted as a result of the peak period of the COVID-19 pandemic.

Abstract: Diagnosing tuberculous pleural effusion (TPE) is challenging, particularly when lung parenchyma appears normal on imaging and sputum smears are negative. This study evaluates the diagnostic utility of medical thoracoscopy in such cases. We conducted a retrospective review of nine patients with exudative pleural effusions and radiographically normal lungs who underwent semi-rigid medical thoracoscopy. Data on demographics, thoracoscopic findings, histopathology, and microbiology (including induced sputum and pleural fluid cultures) were analyzed. The cohort had a mean age of 42 years, with fever (89%) and chest pain (78%) being the most common symptoms. All patients had lymphocytic exudates with elevated adenosine deaminase (ADA). Thoracoscopy revealed characteristic abnormalities, including sago-like nodules and adhesions, in the majority of cases, and provided histological evaluation supporting the diagnosis of tuberculosis in 89% (8/9) of patients. Notably, while all acid-fast bacilli sputum smears were negative, 56% of patients eventually grew M. tuberculosis on induced sputum culture despite the absence of lung parenchymal abnormalities. Medical thoracoscopy is a safe and highly effective diagnostic tool for TPE, providing rapid histological confirmation when non-invasive workup fails. The findings also suggest that patients with normal lung imaging may still harbor active, sputum culture-positive pulmonary tuberculosis, necessitating robust infection-control measures.

Abstract: Background/Objectives Remote patient monitoring (RPM) has expanded the capacity of peritoneal dialysis (PD) programs to supervise home-based therapy; however, its full clinical value may be limited when patient-generated data remain disconnected from electronic medical records (EMRs). This study evaluated the implementation and impact of integrating the Sharesource RPM platform with the Versia EMR system in routine PD care. Methods This multicenter real-world implementation study was conducted between November 2024 and February 2025 across three dialysis centers in Colombia. The integration enabled automated transfer of home treatment-related information from Sharesource to Versia and supported population health management through interactive dashboards. Workflow efficiency was assessed using a before-and-after time and motion analysis, and user experience was evaluated through structured surveys administered 12 weeks after implementation. Analyses were descriptive. Results The integration was successfully implemented across the participating centers, achieving complete data concordance and operational stability. During follow-up of 287 patients, 501 patient-clinic communications, 159 preemptive evaluations, and 122 prescription modifications were recorded, reflecting proactive identification and management of clinical issues. Nursing consultation time decreased from 34 to 26 minutes per patient, and nephrologist time from 31 to 25 minutes per patient. Surveys showed high acceptance, supporting proactive clinical decision-making, and greater workflow efficiency. Conclusions Real-world implementation of an interoperable RPM-EMR ecosystem in PD care was feasible, operationally stable, and associated with improved workflow efficiency and proactive population health management. By transforming fragmented patient-generated data into actionable clinical insights, this digital ecosystem can support more efficient, data-driven, and proactive models of chronic kidney disease care.

Abstract: Background: Obstetric haemorrhage remains one of the leading causes of maternal mortality worldwide and continues to contribute substantially to severe maternal morbidity in low-resource settings. However, limited data exist on the outcomes of women requiring specialized critical care for severe obstetric haemorrhage in Ghana. This study aimed to describe the clinical characteristics, outcomes, and predictors of mortality among women admitted with severe obstetric haemorrhage to the main intensive care unit (ICU) of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods: A retrospective cohort study was conducted among women admitted with severe obstetric haemorrhage to KATH’s main ICU. Data on demographic characteristics, clinical parameters, critical care interventions, and hospital outcomes were extracted from patient records. Women were categorized as survivors or non-survivors. Univariable and multivariable logistic regression analyses were performed to identify factors associated with ICU mortality. Results: Among 344 obstetric admissions to KATH’s main ICU, 79 women were admitted with severe obstetric haemorrhage and were included in the study. Postpartum haemorrhage was the most common haemorrhage subtype (32, 40.5%), followed by abruptio placentae (18, 22.8%) and uterine rupture (12, 15.2%). Overall, 44 women died during admission, resulting in an ICU mortality rate of 55.7%. Women who died had significantly lower admission Glasgow Coma Scale (GCS) scores, lower diastolic blood pressure, shorter hospital stays, and were more likely to require mechanical ventilation than survivors. In multivariable logistic regression analysis, admission GCS score was independently associated with mortality (adjusted odds ratio [aOR] = 0.78, 95% confidence interval [CI]: 0.66–0.89; p = 0.001). Mechanical ventilation and vasopressor support were not independently associated with mortality after adjustment. Conclusion: Severe obstetric haemorrhage was associated with a high mortality rate among women admitted to a general intensive care unit in Ghana. Postpartum haemorrhage was the most common haemorrhage subtype, and admission GCS score was an independent predictor of mortality. Early recognition of clinical deterioration, prompt referral, and timely access to specialized critical care services may help improve maternal outcomes among women with severe obstetric haemorrhage.

Abstract: Background/Objectives: Cognitive stimulation and cognitive training are used as non-pharmacological approaches to support people living with Alzheimer’s disease, but Alzheimer-specific evidence is dispersed across heterogeneous intervention formats. This scoping review mapped structured cognitive stimulation and training interventions evaluated in people with mild-to-moderate Alzheimer’s disease and summarized the cognitive, emotional, functional, and follow-up outcomes reported. Methods: The review was conducted using the Joanna Briggs Institute methodology and reported according to PRISMA-ScR. PubMed, SciELO, PEDro, LILACS, and Google Scholar were searched on 24 February 2025 for studies published between January 2015 and 24 February 2025 in English, Portuguese, or Spanish. Intervention studies were eligible. Two reviewers independently screened records and charted data, with disagreements resolved by a third reviewer. Results: Of 352 records identified, five studies involving 245 participants were included. Interventions comprised virtual-reality cognitive stimulation, conventional cognitive training, group reminiscence therapy, a multicomponent music–reminiscence–reality-orientation intervention, and computerized cognitive training. Technology-based interventions reported improvements in global cognition or selected memory, language, attention, and executive outcomes. Conventional cognitive training improved initiative and temporarily stabilized memory. Reminiscence-based interventions primarily improved depressive and neuropsychiatric symptoms. Where longer follow-up was available, benefits diminished over time. Conclusions: The mapped evidence suggests that structured cognitive stimulation and training may produce short-term, outcome-specific benefits in mild-to-moderate Alzheimer’s disease. However, the small number of heterogeneous studies, variable outcome measures, and limited long-term evidence preclude firm conclusions regarding comparative effectiveness. More rigorous and adequately powered studies are needed.

Abstract: Background/Objectives: Obstetric spinal anaesthesia practice changes with evidence, drug availability, and quality-improvement priorities, but longitudinal African data remain limited. This study described temporal changes in spinal anaesthesia practice for caesarean delivery in Windhoek, Namibia, and examined associated postoperative re-covery outcomes. Methods: We conducted a retrospective time-trend analysis of 400 routinely collected anaesthesia records for caesarean deliveries from 2017 to 2025. Calendar time was grouped as 2017-2019, 2020, 2021, and 2022-2025. Practice variables included intrathecal regimen, vasopressor type, spinal needle gauge, documented spinal level, infusion time, and spinal attempts. Outcomes included pain, headache, nausea, shortness of breath, blood pressure drop, backache, symptom count, and motor recovery grade. Results: Anaesthesia practice changed substantially. Phenylephrine use increased from 0.0% in 2017-2019 to 70.6% in 2020, 96.8% in 2021, and 100.0% in 2022-2025. Use of 27G spinal needles increased from 0.0% in 2017-2020 to 95.2% in 2021 and 76.3% in 2022-2025. Any postoperative symptom was documented in 74.5% of records, predominantly backache. After adjustment for age, body mass index, and intrathecal regimen, calendar period remained associated with postoperative symptom burden. Conclusions: Obstetric spinal anaesthesia practice evolved in this Windhoek cohort, with substantial changes in vasopressor selection, spinal needle gauge, spinal level, and in-fusion time. Routine anaesthesia data can support local quality-improvement protocols for haemodynamic management and patient-centred recovery after caesarean spinal an-aesthesia.