Public Health and Healthcare

Abstract: Acute diarrheal disease (ADD) caused by parasites and TB represent a significant public health burden worldwide and in Colombia, particularly affecting indigenous populations who are at high risk of contracting these diseases due to the social, environmental, and cultural conditions in which they live. Materials: Fifteen Wayuu indigenous communities in four areas of Manaure, in La Guajira, were subject to intervention; with prior informed consent, environmental samples and samples from individuals with clinical symptoms were collected. A total of 156 samples of human and animal feces, soil, and sediment from drinking water were analyzed for microscopic using the Kato–Katz and formalin–ether concentration techniques, 109 samples were analyzed by qPCR for the detection of helminths and 23 for metatranscriptomics targeting protozoan parasites and helminths. Additionally, 36 sputum samples from patients with respiratory symptoms were tested using Xpert/MTB Rif, and 37 milk samples were tested for M. bovis. Results: Among the samples tested for tuberculosis, a positivity rate of 8.3% was found, in all cases with sensitivity to rifampicin; M. bovis was not found in animal milk. Microscopic analysis of human samples revealed pathogenic parasites, the most common being Blastocystis spp. and the Entamoeba hystolitica/Entamoeba dispar complexeach with 38.8% (n=38), Giardia spp. with 19.4%, Hymenolepis nanaand Trichuris trichiura each with 5.1%. Commensal parasites were also identified as indicator of poor sanitary conditions. Co-infection with intestinal parasites was common in humans at 60.2%. In microscopic analysis of animals fecal samples, revealed a high incidence of Uncinaria spp. with 58.3%, amoebas 16.7% and Giardia 8.3%; this latter is also found in soil. Metatranscriptomics showed a high frequency of intestinal parasites in fecal samples (90.9%), with Blastocystis spp. being the most frequent (81.8%) with notable intra-species diversity, followed by Entamoeba histolytica (54.5%) and Giardia duodenalis (31.8%), and detected free-living amoebae in community water sources, highlighting potential health risks associated with exposure to untreated water in low-sanitation settings. Conclusions: The Wayuu communities studied show a significant burden of tuberculosis and intestinal parasitic infections, likely associated with poor sanitary conditions and environmental factors that facilitate their transmission. Although TB prevalence was moderate, with no evidence of rifampicin resistance or the circulation of M. bovis in milk, the high prevalence of intestinal parasites, including co-infections and their detection in humans, animals, and the environment suggest active transmission in the region. These findings highlight the need to implement comprehensive interventions in water, sanitation, and hygiene, along with surveillance and health education strategies with an intercultural approach, aimed at improving the conditions of these vulnerable populations.

Abstract: Background: The Toscana Virus is a little-known virus, present in Italy, transmitted by sandflies and associated with cases of meningitis and meningoencephalitis in humans. this study compared three statistical models (SARIMA, Poisson, and Negative Binomial) to forecast monthly Toscana virus (TOSV) cases in Italy for the period 2023–2024. Materials and Methods: data were extracted from the epidemiological bulletins of the Italian National Institute of Health for the period January 2016–December 2024. The 2016–2022 training set was used to estimate the models, while the 2023–2024 test set validated the predictions. Results: in the model comparison, SARIMA showed the best predictive ability, with the lowest MAE (3.46) and RMSE (5.05), demonstrating that seasonality and temporal de-pendence were well captured. The Poisson and Negative Binomial models, although use-ful, showed lower performance in terms of accuracy (higher RMSE). Conclusions: the results indicate that the SARIMA model is the best suited for forecasting monthly TOSV cases, but it is not perfect, highlighting the need for more complex ap-proaches that also integrate exogenous variables to improve forecast quality.

Abstract: Background:Chronic musculoskeletal pain is a common condition, for which pain self-management is recommended. Digital tools offer potential to support individuals with chronic pain, but it is unknown to what extent existing tools are responsive to the social context of Pakistanis living with chronic pain and are engaging for them. Objective: This study aimed to explore strategies to enhance engagement with digitally enabled pain self-management tools among people with chronic musculoskeletal pain.Methods: A mixed-methods sequential explanatory design was used. We first reviewed Android app store and published literature to identify content and engagement strategies incorporated in digital tools. Following this, we conducted a narrative study involving adults with chronic musculoskeletal pain to capture their lived experiences and requirements for pain self-management. Review findings were synthesised descriptively, qualitative data were analysed thematically, and overall findings were combined to generate design and content recommendations.Results: Literature and app reviews revealed that digital tools commonly included components related to patient education and physical or mental therapy. They often included engagement features such as personalization and reminders. Dietary advice and peer or social support were less commonly included in digital tools but were commonly discussed during group discussions by individuals living with chronic pain. Nineteen individuals with chronic pain participated in group discussions and described how their pain self-management practices were shaped by cultural beliefs and perceptions and digital health information. These factors also influenced their decision making related to treatment choices and adoption of non-pharmacological strategies. Although participants trusted healthcare professionals but expressed concerns about limited guidance on how to apply clinical advice in their daily lives. Moreover, they identified several requirements for pain self-management tools, including evidence based audio-visual content and incorporating aspects related to symptom monitoring, symptom relief and physical rehabilitation, psychological wellbeing, lifestyle management, social support, patient education. Conclusion:Existing pain self-management tools rarely address the social context of South Asians. While pain self-management is shaped by digital information and cultural beliefs and perceptions, participants valued evidence-based digital resources. Therefore, future research should focus on co-developing these resources to ensure they are clinically meaningful, culturally responsive, and supportive of patient-centred and equitable pain self-management.

Abstract: Objective: To characterize the structural fragility of installed health-service capacity in Barranquilla, Atlántico, Colombia, using absolute capacity, supply concentration, reserve or transitory capacity, and service-line clinical sensitivity as structural-risk dimensions. Methods: An ecological health-services study was conducted using a local installed-capacity dataset traceable to the Colombian Special Registry of Health Service Providers and SISPRO, together with two contextual World Bank series for Colombia: physicians per 1,000 population and premature mortality from noncommunicable diseases. Traceable data cleaning, functional normalization, separation of baseline versus transitory capacity when allowed by the source fields, and exploratory estimation of a relative structural fragility proxy index using a normalized Poisson-type transformation were performed. This index was interpreted exclusively as a comparative structural-fragility ranking and not as an observed probability of saturation. Results: The analytical capacity of the Barranquilla node included 5,397 installed capacity slots. Adult ICU accounted for 707 slots and neonatal ICU for 160. Reserve capacity was low in neonatal ICU (2.5%) and higher in adult ICU (32.2%). The largest service lines were adult general hospitalization, adult ICU, and pediatric general hospitalization, whereas the highest relative structural fragility was observed in low-scale and highly concentrated services, including burn care, acute mental health, and selected highly specialized lines. Conclusion: Barranquilla has a broad but markedly heterogeneous structural health-service capacity network. The critical pattern is not determined only by the absolute number of slots, but by the interaction between limited capacity, high concentration, low stable reserve, and clinical sensitivity. The evidence generated is structural and should not be interpreted as observed occupancy, real-time saturation, or operational collapse.

Abstract: Background/Objectives: Acute ischemic stroke (AIS) care depends on rapid, coordinated workflows. This study compared two real-world in-hospital stroke models—a neurohospitalist-led model and a stroke practitioner–led multidisciplinary model—in terms of time metrics, radiological outcomes, and 3-month clinical outcomes in patients undergoing reperfusion therapy. Methods: This retrospective, single-center cohort study evaluated patients across two sequential workflow periods. In the practitioner-led model, trained non-neurologist clinicians coordinated care with a stroke nurse under neurologist supervision. Time metrics included door-to-needle time (DNT) and door-to-puncture time (DPT). Clinical outcomes included intensive care unit (ICU) transfer and 3-month functional outcomes assessed by the modified Rankin Scale (mRS). Results: A total of 573 patients were included (284 neurohospitalist-led, 289 practitioner-led). Baseline NIHSS scores were similar between groups. The proportion achieving DNT <60 minutes was significantly higher in the practitioner-led period (74.0% vs. 52.5%, p<0.001), while mean DNT and DPT were comparable. Early radiological outcomes at 24 hours were similar between groups. ICU transfer rates were significantly lower in the practitioner-led period (17.6% vs. 28.2%, p=0.002). Three-month mRS outcomes did not differ significantly. Conclusions: A structured, practitioner-led multidisciplinary workflow was as safe and efficient as a neurohospitalist-led model. Improved adherence to DNT targets and reduced ICU transfers highlight the importance of system-level organization in optimizing AIS care.

Abstract: Endoscopic submucosal dissection (ESD) has revolutionized the management of superficial colorectal neoplasms, offering superior en bloc resection rates compared with conventional endoscopic mucosal resection (EMR). While ESD has been the standard of care in East Asian countries for over two decades, its adoption in Western countries has been considerably slower, hampered by the steep learning curve, prolonged procedural times, limited training infrastructure, and differences in disease epidemiology. However, recent years have witnessed a paradigm shift, with growing evidence from Western multicenter studies demonstrating outcomes that increasingly approach those reported from high-volume Eastern centers. The landmark RESECT-COLON randomized trial provided level-1 evidence supporting the superiority of ESD over piecemeal EMR for large colorectal polyps. Concurrently, novel training paradigms, technological innovations including traction-assisted devices and artificial intelligence (AI)-guided systems, and evolving societal guidelines from the American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE) are accelerating Western adoption. This state-of-the-art review comprehensively examines the current landscape of colorectal ESD in Western practice, highlighting the evolution of outcomes, training pathways, guideline recommendations, technological advances, and future directions. We provide a critical appraisal of the East–West outcome gap and discuss strategies to bridge this divide, positioning colorectal ESD as an increasingly viable first-line therapy for appropriate lesions in Western endoscopy centers.

Abstract: Background/Objectives: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when same-day physician or nurse practitioner appointments are unavailable. A meaningful proportion of emergency department visits involve conditions that could potentially be managed in primary care [1,2], and the Canadian Institute for Health Information reported that 15% of Canadian emergency department visits between April 2023 and March 2024 involved conditions that could potentially have been managed in primary care [3]. This article describes the Registered Nurse Prescriber-led Triage-Treatment-Continuity model developed at Cranston Ridge Medical Clinic in Calgary, Alberta, Canada. Methods: The manuscript is reported as a clinic-based practice innovation and service evaluation using aggregate, non-identifying operational service data. The model includes medical office assistant emergency recognition, RN prescriber-led structured triage, a traffic-light urgency classification system, a booking algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, and communication with the patient's primary care provider through the electronic medical record. No patient-identifiable information, patient-level chart review, interviews, surveys, biological samples, or experimental interventions were used. Under TCPS 2 Article 2.5, quality improvement and program evaluation activities conducted exclusively for assessment, management, or improvement purposes do not constitute research for that policy and do not fall within Research Ethics Board review [4]. Results: During a 12-month service evaluation period from April 2025 to April 2026, 5032 patient calls or encounters were managed through the RN prescriber-led pathway. These encounters are interpreted as internal urgent and semi-urgent primary care capacity and potential diversion, not as confirmed emergency department avoidance. Conclusions: The model reframes triage as an integrated primary care intervention rather than a passive sorting process. Further ethics-approved research is required to evaluate patient-level outcomes, safety events, comparative effectiveness, confirmed health-system utilization effects, and cost-effectiveness.

Abstract: Background: Seasonal influenza prevention in young adults is influenced by access, trust, and vaccine information exposure, but local evidence linking vaccination uptake with illness and economic burden is limited. Methods: We conducted a cross-sectional electronic survey of adults aged 18-49 years who lived, worked, or studied in the San Francisco Bay Area during the 2025 to 2026 influenza season. Measures included vaccination uptake, influenza-like illness, recovery, functional and economic burden, vaccination sites, and vaccine information exposure. Multivariable logistic regression examined factors associated with vaccination uptake; Kaplan-Meier and Cox models examined time to recovery. Results: Of 554 responses, 463 were included. Vaccination uptake was 86.2% (n=399; 95% confidence interval [CI], 82.7%-89.2%), and 38.4% reported influenza-like illness. Among those with illness, median recovery time was 5 days, median missed work or school was 2 days, and median direct out-of-pocket cost was US$20. Prior season vaccination (adjusted odds ratio [aOR], 2.24; 95% CI, 1.15-4.34) and greater trust in Centers for Disease Control and Prevention or public health agencies (aOR, 1.46; 95% CI, 1.05-2.02) were associated with vaccination. Pharmacies were the second most common vaccination site and preferred future site. Conclusion: Influenza prevention for young adults may benefit from pharmacy-inclusive, multichannel access paired with trusted communication.

Abstract: Background and Objectives: Suicide represents a major global public health concern, involving complex interactions between sociodemographic and clinical factors. Understanding these characteristics at a regional level is essential for the development of targeted prevention strategies. Materials and Methods: We conducted a retrospective observational study including 210 confirmed suicide deaths recorded at a single forensic center between 2023 and 2025. Sociodemographic variables (age, sex, education, marital status, and employment) and toxicological findings (alcohol presence) were collected. Descriptive statistics and inferential analyses, including chi-square tests and multivariate logistic regression, were performed to examine associations between these variables and suicide characteristics, particularly the method of suicide. Results: The study population was predominantly male (82.86%). Hanging was the most frequent method of suicide. Alcohol was detected in 43.81% of cases. Although variations were observed across demographic groups, multivariate logistic regression did not identify statistically significant independent predictors of suicide method (male sex: OR = 1.98, p = 0.122; age: p = 0.579; alcohol presence: p = 0.728). Conclusions: Sociodemographic and toxicological factors contribute to the characterization of suicide deaths; however, no independent predictors of suicide method were identified. These findings highlight the complexity of suicide behavior and underscore the importance of integrating clinical, behavioral, and public health approaches to suicide prevention, including the responsible communication of suicide-related findings.

Abstract: Background/Objectives: Artificial intelligence (AI) is integrated into diagnostic, thera-peutic, administrative, and communicative healthcare domains in Italy under regulations requiring human oversight. Empirical evidence on AI attitudes, acceptance, and per-ceptions in Italian healthcare is rapidly accumulating but not systematically mapped. This scoping review aimed to (i) map empirical evidence on AI attitudes, acceptance, and perceptions in Italy by population and domain; (ii) identify measurement instruments used in studies and their origins; and (iii) characterize determinants, themes, and methodological gaps in the Italian evidence base. Methods: The review used Joanna Briggs Institute methodology, reported via PRISMA-ScR (protocol Open Science Framework doi: 10.17605/OSF.IO/TZRVF). PubMed and Embase were searched on 27 April 2026 from January 2018 in English, Italian, or German, combining controlled vo-cabulary and free-text terms across AI, attitudes-acceptance, and healthcare delivery, with an Italian-context qualifier. Eligibility criteria used the Population–Concept–Context mnemonic. Results: Of 1,510 unique records screened, 35 empirical studies were retained, comprising seven studies of Italian patients and the general population, 22 studies of healthcare professionals, three psychometric validation studies of AI-acceptance instru-ments, one mixed-population study and two international comparator studies with sub-stantial Italian sub-samples. Acceptance was consistently positive but conditional on physician oversight, training and regulatory clarity. A recurrent optimism–knowledge gap and an absence of probabilistic, population-representative evidence were identified as principal gaps. Conclusions: Italian evidence on AI attitudes is expanding but methodologically narrow. Three Italian-validated acceptance instruments are now available. Population-representative, multilingual and longitudinal evidence is required.

Abstract: (1) Background: Tungiasis is a cutaneous ectoparasitosis caused by the penetration of gravid female Tunga penetrans fleas into the epidermis. Although endemic in tropical and subtropical regions, it remains rare in Europe, where most cases are travel-associated and secondary household transmission is seldom documented. This study describes imported tungiasis in Greece and investigates possible secondary household transmission in a non-endemic setting. (2) Methods: Seven Greek men residing in Attica developed tungiasis following occupational exposure in Tanzania, together with one secondary case in a non-travelling household contact who had never travelled outside Greece. Diagnosis was based on clinical and dermoscopic findings and confirmed by amplification and sequencing of the mitochondrial cytochrome oxidase I (COI) gene. Household investigations were also performed. (3) Results: Eight male patients presented with painful plantar and/or subungual nodular lesions. Sequence analysis of COI demonstrated 657/662 bp (99%) identity with the Tunga penetrans reference sequence, and identical sequences were identified in all samples. All patients exhibited mild-to-moderate elevations of hepatocellular and cholestatic liver enzymes, which resolved within two weeks following treatment. Only one secondary household case was identified, and no infestation was detected among additional cohabitants or companion animals. (4) Conclusions: This report documents imported tungiasis with probable secondary household transmission in Greece and highlights the importance of clinical awareness and environmental assessment in non-endemic settings.

Abstract: (1)Background: Burn injuries lead to long-term physical, psychological, and functional sequelae, with socioeconomic, clinical, and health system factors contributing to inequities in outcomes. Chronic neuropathic pain, fragmented care, and limited access to rehabilitation remain persistent challenges, particularly among vulnerable populations. (2) Methods: A scoping review was conducted following PRISMA-ScR guidelines, searching PubMed, Scopus, Web of Science, and ScienceDirect for studies published between 2010 and 2026 in English, Spanish, or Portuguese. Thirty-one studies were included, encompassing quantitative, qualitative, mixed-methods research, literature reviews, guidelines, and reports addressing continuity of care and follow-up after skin grafting in burn patients of any cause or age. Data were extracted independently and synthesized using descriptive and narrative approaches. (3) Results: The incidence of chronic neuropathic pain was 6%, often refractory and associated with smoking and substance use, with gabapentin and ascorbic acid showing significant pain reduction. Structured follow-up programs improved quality of life and psychosocial outcomes but did not reduce readmissions. Indigenous populations experienced greater severity and complications, while approximately half of the patients were at risk of post-traumatic stress disorder linked to body image dissatisfaction. Telemedicine reduced access barriers, yet delays in specialized care contributed to contractures and pathological scarring. Early rehabilitation mitigated functional disability, though gaps persist in pain management, psychosocial support, and continuity of care. (4) Conclusions: Post-burn recovery is a multidimensional process requiring structured follow-up, early rehabilitation, telemedicine, and culturally adapted interventions to promote equity and patient-centered outcomes. Keywords: Burns; Chronic neuropathic pain; Postoperative follow-up; Rehabilitation; Health inequities; Pa-tient-centered outcomes.

Abstract: Objective. Non-communicable diseases (NCDs) are major contributors to morbidity and mortality in Thailand, yet the effectiveness of lifestyle counselling within routine practice is underexplored. This rapid realist review examined how, for whom, and under what circumstances lifestyle counselling supports behaviour change among Thai adults. Design. Rapid realist review following guidance from the Realist and Meta-narrative Evidence Synthesis: Evolving Standards. Setting. Lifestyle counselling and health-coaching interventions for NCD prevention and management delivered in Thai primary care, community settings, or digitally supported programmes. Data sources. Six international and Thai databases (Scopus, Google Scholar, ProQuest, PubMed, EMBASE (Ovid), ThaiJo) were searched for studies published between 2005 and 2025. Eligibility criteria. Empirical studies involving adults (≥18 years) in Thailand that described lifestyle counselling or coaching interventions for NCD-related prevention or management and reported outcomes. Data extraction and synthesis. Data were extracted to identify contexts (C), mechanisms (M), outcomes (O), and equity considerations. These were synthesised into context–mechanism–outcome configurations (CMOCs) and helped to form programme theories. Two Thai doctoral students with community health experience provided public involvement feedback on cultural relevance and feasibility. Results. Thirteen studies were included. Nineteen explanatory configurations were identified across six mechanisms: self-efficacy, social support, motivation, accountability, emotional resilience, and relevance and engagement. Mechanisms were strengthened by family-centred education, routine self-monitoring with feedback, culturally or literacy-tailored materials, and brief stress-regulation strategies. Barriers included low health and digital literacy, conflicting norms, short programme duration, and rural workforce constraints. Facilitators included plain-language materials, low-tech or hybrid follow-up, co-designed dietary strategies, and task-sharing with village health volunteers and family members. Public contributors emphasised cultural alignment, feasibility, and equity. Conclusions. Lifestyle counselling in Thailand operates through six key mechanisms shaped by cultural norms, family dynamics, village health volunteers and service capacity. Effective programmes should prioritise long-term, low-intensity support; cultural and literacy tailoring; and hybrid low-tech maintenance. These findings provide theory-driven guidance for designing and implementing future lifestyle counselling interventions.

Abstract: Background: Drug-resistant tuberculosis (DR-TB) remains a major threat to global tuberculosis control, particularly in high-burden rural settings where transmission is driven by both biological and socio-structural determinants. Although genomic surveillance and mathematical transmission modelling have improved understanding of resistance evolution and transmission dynamics, these approaches often insufficiently incorporate community-level behavioral and social drivers of disease spread. This study integrated Community-Based Participatory Research (CBPR) within a genomic–epidemiological modelling framework to develop a biosocial understanding of DR-TB transmission dynamics in a rural South African setting. Methods: Whole-genome sequencing (WGS) was performed on 32 Mycobacterium tuberculosis isolates to identify resistance-associated mutations, phylogenetic lineages, and potential transmission clusters. A deterministic two-strain transmission model distinguishing drug-sensitive (DS) and drug-resistant (DR) tuberculosis was developed to simulate transmission dynamics. CBPR-informed mechanisms were incorporated into the model through modifications of key epidemiological parameters, including transmission rate (β), treatment initiation rate (γ), and resistance amplification rate (α), reflecting the influence of community engagement, treatment adherence, and health-seeking behavior. Scenario-based simulations evaluating varying levels of community-engaged interventions were conducted over a 10-year period. Results: A substantial burden of drug resistance was observed, with 84.4% of isolates resistant to at least one anti-tuberculosis drug. Multidrug-resistant tuberculosis (MDR-TB) accounted for 46.9% of isolates, while recurrent combinations of resistance-associated mutations suggested ongoing transmission of resistant strain lineages. Lineage 2 (Beijing genotype) and Lineage 4 predominated, with advanced resistance patterns occurring mainly within Lineage 2 isolates. Model simulations indicated that CBPR-informed interventions could reduce DS-TB transmission by approximately 40–60% and DR-TB transmission by 20–35%. Scenario-based estimates also indicated a higher transmission potential for DR-TB (R₀ ≈ 2.04) than for DS-TB (R₀ ≈ 1.29). Community-engaged interventions reduced transmission by improving treatment adherence, earlier diagnosis, and enhanced infection-prevention behaviors. Conclusions: Integrating CBPR into genomic and transmission modelling frameworks provides a novel biosocial approach for understanding tuberculosis dynamics in high-burden settings. The findings suggest that community-engaged interventions can substantially influence key epidemiological drivers of transmission and resistance amplification. Embedding community participation within TB surveillance and control strategies may strengthen efforts to reduce transmission, improve treatment continuity, and address the social determinants underpinning DR-TB persistence in rural settings.

Abstract: Prior authorization in the United States relies on payer coverage policies expressed as unstructured narrative text, creating fundamental barriers to automation, consistency, and auditability. Large language model (LLM) approaches to policy interpretation suffer from hallucination, nondeterminism, and clinically unsafe outputs—we argue these failures stem not from model capability but from a representation problem: policies written for human interpretation are not inherently computable. We introduce policy computability: the representation of coverage policies in machine-interpretable forms that support deterministic execution, formal verification, provenance tracking, and reproducible reasoning. To operationalize this concept, we present a six-layer neuro-symbolic framework that transforms payer policy documents into executable policy artifacts. Neural components are constrained to language-processing tasks—document ingestion, ontology normalization, and structured rule extraction under symbolic guardrails—while all coverage determinations are executed by a symbolic verification engine using deterministic logical evaluation. The framework incorporates ontology mapping, rule-graph construction, a Python-embedded domain-specific language (DSL), logical conflict resolution, and provenance-aware reasoning traces. We validate the symbolic pipeline using a lumbar fusion prior authorization policy across six synthetic clinical scenarios, demonstrating reproducible coverage determinations with complete reasoning traces. In a preliminary evaluation of the neural extraction layer, Llama 3.2 3B achieved 100% recall on inclusion and exclusion criteria from a narrative policy document across three trials, though extraction quality depended on prompt formulation. Comparative analysis of two representative payer policies reveals clinically meaningful variation—including greater than twofold differences in required conservative therapy duration—highlighting the need for structured policy representations. This work establishes a pathway from narrative payer policies toward deterministic, transparent, and machine-executable coverage systems, providing a foundation for trustworthy automation in prior authorization.

Abstract: Background/Objectives: The Geri-Fit® program, recognized by the National Council on Aging, is known to improve strength in older adults, yet it lacks robust evidence on clinical outcomes. The current study was performed to assess the change in clinical outcomes in addition to patient-reported change in mobility and general well-being Methods: A total of 227 adults aged 60 and older were recruited from clinics and community sites across Galveston and Harris counties and participated in 45-minute classes twice weekly for 12 weeks, led by trained Geri-Fit® instructors. A mixed-methods approach includes pre- and post-collection of biometric measures of Hemoglobin A1c, total cholesterol, weight, and waist circumference. Participants also completed mid- and post-program surveys reporting changes in health behaviors, psychosocial outcomes, and physical changes, and provided qualitative feedback. Results: showed that 44% of participants lost weight, nearly half reduced their waist circumference, 43.5% improved their Hemoglobin A1c, and total cholesterol decreased significantly (from 167.77 to 155.04 mg/dL; p=0.02). Self-reported outcomes indicated that almost 100% of participants showed improvement or maintenance in mobility, strength, physical activity, and well-being. Conclusions: These findings suggest that Geri-Fit® is associated with favorable clinical outcomes and improved functional health, supporting its potential as a community-based intervention to enhance physical activity, improve self-management, or reduce the risk of chronic disease among older adults.

Abstract: Physical activity (PA) can provide protective benefits for prostate cancer (PCa) survivors. Healthcare practitioners are ideally positioned to promote PA to their PCa patients. This study was designed to identify how practitioners have advised and supported their PCa patients to try and overcome barriers to PA. A secondary aim was to identify if there were differences in the types of PA advice provided based on practitioner specialty and number of years in practice. Participants were 13 healthcare practitioners from Auckland, New Zealand who provide biomedical (urology, oncology) and allied health services (physiotherapy) to men who have received a diagnosis of PCa. Participants were individually interviewed and data was analyzed using an inducive thematic approach. Four main themes and three sub-themes were identified. Physical activity advice did not appear to differ based on practitioner specialty or length of time in practice, rather, PA advice was provided to help counteract the associated side effects of specific PCa treatments. Verbal information, encouragement and resources were provided to help support PA. Specialist cancer nurses can provide long-term PA advice and support. Individualized exercise programs through physiotherapy can benefit men receiving active PCa treatment, as well as for men in remission experiencing treatment-related side effects.

Abstract: Breast cancer screening patterns exhibit geographic variation across Zip Code Tabulation Areas (ZCTAs) in Florida, yet most spatial analyses rely on frequentist point estimation without formally characterizing uncertainty. This study applied a three-stage analytical framework to ZCTA-level breast cancer screening data in Hillsborough County, Florida (n = 55 ZCTAs): frequentist Poisson regression with stepwise multicollinearity diagnostics, global spatial autocorrelation analysis using Moran’s I with inverse-distance weighting, and Bayesian Poisson and Bayesian negative binomial regression with Jeffreys non-informative priors estimated via the No-U-Turn Sampler in R (brms/Stan). Spatial analysis was conducted in ArcGIS Pro. Racial and ethnic female population counts for White, Black or African American, and Hispanic or Latino groups were the strongest and most consistent predictors of screening counts. Median household income, insurance status, and age-stratified variables showed no independent association at the ZCTA level. Global Moran’s I was near zero and non-significant (I = 0.003, z = 0.326, p = 0.745). The Bayesian Poisson model showed superior fit compared with the Bayesian negative binomial model (Bayesian R² = 0.91, DIC = 367.2, RMSE = 5.40, MBE = 0.02). These findings associate screening concentration with the geographic distribution of demographic groups and demonstrate the value of a Bayesian uncertainty-oriented framework for small-area public health analysis.

Abstract: Background/Objectives: Eating disorders (EDs) are among the most severe psychiatric conditions affecting young people, with increasing prevalence in the post-pandemic period. This study assessed the prevalence of ED risk and dysfunctional eating behaviors among Italian university students, a population poorly characterized with respect to ED risk, and examined associations with key socio-demographic and anthropometric variables. Methods: A cross-sectional online screening study was conducted between August 2023 and February 2026 with 401 Italian university students (women: n = 306; men: n = 95). Participants completed the validated Italian versions of the Eating Attitudes Test-26 (EAT-26) and the Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0), alongside self-reported anthropometric data. Multiple linear regression analyses were performed to identify predictors of ED risk scores. Results: 37.9% of participants had an abnormal BMI (19.7% underweight; 18.2% overweight or obese). EAT-26 scores exceeded the clinical cut-off in 28.4% of participants (women: 35.6%; men: 5.3%). EDE-Q 6.0 global scores exceeded the clinical cut-off in 21.0% (women: 25.8%; men: 5.3%). Only 45.4% showed no anthropometric or psychometric risk indicators. Gender was the strongest predictor of both EAT-26 and EDE-Q 6.0 scores. BMI was negatively associated with EAT-26 scores in the total sample and in women, while a positive association between BMI and EDE-Q 6.0 scores was observed in men. Conclusions: A substantial proportion of Italian university students, particularly women, presented clinically significant ED risk. The combined use of anthropometric and psychometric screening tools provides a more comprehensive risk assessment than either measure alone, highlighting the need for multidimensional screening programs.

Abstract: Background: To inform epidemic control, Rapid Test for Recent Infection (RTRI) assays, such as the Asanté HIV-1 Rapid Recency Assay (ARRA), have been developed to detect potential signals of increased HIV acquisition. However, ensuring the accuracy of these tests remains a challenge in resource-limited settings. While ARRA has been implemented for surveillance, there is a lack of documented experiences and lessons learned regarding quality assurance through Proficiency Testing (PT). This study examined Uganda's recent HIV infection PT program from 2020 through 2022 to highlight challenges and successes of implementation in resource-limited settings. Methods: We analyzed proficiency testing (PT) implementation for HIV recency testing in Uganda from 2020–2022. The study included biannual PT cycles (Cycle 1: Jan–Jun, Cycle 2: Jul–Dec) across 676 facilities in 133 districts. We assessed performance using pass rates (percentage of testers correctly identifying all samples in a PT panel) and response rates (proportion of testers submitting results within the stipulated timeframe out of the total number expected to participate). To evaluate sustainability, we longitudinally tracked a fixed cohort of the first 175 testers enrolled at the project's inception, representing diverse facility levels and cadres. Results: Analysis of six proficiency testing cycles from 2020-2022 revealed two key trends: a significant expansion in program participation and a concurrent longitudinal decline in performance among a consistent cohort. Overall, participation grew from 175 testers in Cycle 1, 2020, to 568 testers by Cycle 2, 2022. Among all participating facilities in each cycle, pass rates fluctuated, ranging from a high of 87.3% (Cycle 2, 2020) to a low of 54.9% (Cycle 2, 2021). A longitudinal analysis of the initial 175-testing-site cohort, however, revealed a significant inverse relationship between participation and performance. Non-response within this cohort increased drastically from 0% to 81.7% by early 2022 (p-value for trend <0.001). Among the diminishing subset of sites that continued to submit results, the pass rate showed a statistically significant declining trend, from 85.1% to 76.6% over the study period (p-value for trend = 0.012). Conclusion: This study identified three critical challenges: a steep rise in non-response, declining pass rates, and persistent performance gaps at lower-level health facilities. To address these gaps, we recommend individual tracking with digital feedback and targeted mentorship to re-engage staff and sustain competency at lower-level facilities.