Abstract: Diabetes is a widespread and growing global health concern, particularly in low- and middle-income countries. Standardized treatment protocols have shown limitations in addressing the complex needs of individuals living with the condition, reinforcing the need for more tailored therapeutic approaches. In contrast, personalized medicine presents significant potential to improve diagnostic and treatment efficiency by considering patients' individual characteristics. To evaluate the applicability and impact of personalized medicine in diabetes management, a literature review was conducted using the Web of Science, Scopus, and PubMed electronic databases. Analysis of the selected studies revealed that patients treated with personalized strategies demonstrated better glycemic control, greater treatment adherence, and a lower incidence of complications. Moreover, studies indicate a reduction in long-term costs due to fewer hospitalizations and adverse events. Personalized medicine emerges as a promising alternative to overcome the limitations of the conventional approach in diabetes treatment. Despite implementation challenges such as costs, technological infrastructure, and professional training, the clinical and economic benefits suggest that this approach is likely to become increasingly consolidated in the coming years.

Abstract: Respiratory infections are a leading cause of sickness and death in Australia. In Australia, an adult- and pediatric-funded immunization program has been established for the prevention and control of vaccine preventable respiratory infections (VPRI), including pneumococcal disease (PD), influenza A/B, respiratory syncytial virus (RSV) infection, and COVID-19. This narrative review outlines the current Australian adult and pediatric immunization guidance for VPRIs and the literature underlying current risk group recommendations, including the clinical and economic burden of VPRIs, vaccination effectiveness, and coverage. Gaps in current risk group definitions, as well as additional risk groups that could be included in vaccine recommendations, are also discussed. Further research is needed to determine the optimum age for vaccination in adults which may enable alignment of age recommendations across different VPRIs. The presence of multiple risk factors, known as risk stacking, has been shown to increase the risk of severe disease for several VPRIs emphasizing the importance of vaccinating individuals with multiple risk factors. Further research is necessary to determine the effectiveness of vaccines in older adults and to develop more effective vaccines for high-risk pediatric groups, such as those with compromised immunity or for children who have undergone hematopoietic stem cell transplantation.

Abstract: Aquatic environments have been a critical source of nutrition for millennia, with wild capture fisheries supplying protein and essential nutrients to populations worldwide. In recent decades, however, a notable shift has occurred with the expansion of aqua-culture, which now represents one of the fastest-growing sectors in food production. Aquaculture plays a key role in mitigating the depletion of wild fish stocks and ad-dressing issues related to overfishing. Despite its potential benefits, the sustainability of both wild and farmed aquatic food systems is increasingly challenged by anthropogenic pollution. Contaminants originating from agricultural runoff, industrial discharges, and domestic effluents enter freshwater systems and eventually reach marine environ-ments, where they may be transported globally through ocean currents. Water is an indispensable input not only for the cultivation of aquatic organisms but also across the broader agri-food sector. Consequently, maintaining water quality is paramount to food safety, environmental integrity, and long-term food security. In ad-dition to conventional seafood products such as fish and shellfish, foods such as those derived from microalgae are gaining attention in Western markets for their high nutri-tional value and potential functional properties. These organisms have been consumed traditionally in Asia for generations and are now being explored as sustainable foods and ingredients as an alternative source of protein. Contaminants of concern in aquatic food products include residues of agrochemicals (e.g., pesticides, veterinary pharmaceuticals), persistent organic pollutants (POPs) such as dioxins, polychlorinated biphenyls (PCBs), and per- and polyfluoroalkyl substances (PFAS), as well as brominated flame retardants, heavy metals (e.g., mercury, cadmium, lead), and inorganic arsenic. In parallel, public and scientific attention has intensified around plastic pollution, particularly microplastics and nanoplastics, which are in-creasingly detected in aquatic organisms and are the subject of ongoing toxicological and ecological risk assessments. While the presence of these chemical hazards neces-sitates robust risk assessment and regulatory oversight, it is essential to balance these concerns against the documented health benefits of aquatic foods, which are rich in omega-3 fatty acids, high-quality proteins, vitamins, and trace elements. Furthermore, beyond direct human health implications, the environmental impact of pollutant sources must be addressed through integrated management approaches to ensure the long-term sustainability of aquatic ecosystems and the food systems they support.

Abstract: Background: It is unclear whether histologic subtypes are associated with site-specific metastases or impact overall survival. Thus, the objective of this study was to evaluate metastatic patterns according to four histologic subtypes of non-small cell lung cancer (NSCLC) and assess their impact on overall survival. Study Design: In this observational study 290,313 patients from 2004 to 2017 with metastatic NSCLC were identified from the National Cancer Database and categorized by histologic subtype. Multivariable logistic regression was performed to assess the association between histologic subtype and specific single-site and multiple-site metastatic patterns. Multivariable Cox proportional hazard models were used in survival analysis. Results: Metastatic site patterns and histologic subtypes significantly affected overall survival (OS). In multivariate analysis, histologic subtypes correlated with distinct metastatic patterns. In single site metastasis median survival time from longest to shortest was lung, brain, bone, and liver across adenocarcinoma (AD), squamous cell carcinoma (SCC), and adenosquamous cell carcinoma (ADS). In dual-site metastatic disease longest median survival time was brain and bone across AD and large cell carcinoma (LCC) and lung and bone across SCC and ADS. Conclusion: NSCLC histologic subtypes are associated with distinct metastatic patterns and may confer prognostic importance.

Abstract:

Background and Objectives: The Quick Speech-in-Noise test is a widely used clinical tool for assessing an individual’s ability to understand speech in the presence of background noise. Building on this framework, the present study aimed to develop a Speech-in-Noise Test for European Portuguese (SiN-EP), specifically adapted for native speakers of European Portuguese. The goal was to create a reliable and linguistically appropriate tool to evaluate speech perception under realistic listening conditions. Materials and Methods: The development of the SiN-EP involved several stages. Sentences were drafted to reflect natural speech patterns and reviewed by native speakers for clarity and grammatical correctness. Selected sentences were recorded by a female native speaker in a controlled environment. The recordings were then combined with multi-talker babble noise at varying levels to simulate different listening situations, ranging from easy to challenging. A pre-test was conducted in a free field setting at 65 dB SPL with fifteen young adults with normal hearing. Participants listened to and repeated each sentence, and their responses were used to refine the test materials. Results: Participants understood the sentences clearly and consistently across all listening conditions, showing that the SiN-EP effectively reflects speech perception in noise. The final version included thirteen lists of six sentences, carefully designed to maintain natural phonetic balance and realistic speech structure. Conclusion: The SiN-EP represents a significant advancement in evaluating speech understanding in noise for Portuguese-speaking populations. This standardized and linguistically adapted test provides valuable information about auditory performance and supports both clinical assessments and research on hearing and auditory processing challenges.

Abstract: Cancer is one of the biggest health burdens for women in the Middle East and North Africa (MENA), with the incidence of breast, cervical and colorectal cancer on the rise. Although preventive measures such as the HPV vaccination and population-based screening are available, access to them remains very unequal. Women in rural, low-income and refugee communities face additional barriers, cultural stigmatisation, low health literacy, gender norms and fragile health systems, leading to delayed diagnoses and poorer outcomes. This review summarises the results of 724 peer-reviewed publications to assess the current situation of cancer screening in MENA and Mediterranean countries. The studies were categorised along four dimensions: Cancer type (breast, cervical, colorectal), behavioural constructs (awareness, uptake, education), population vulnerability (e.g. migrants, refugees, low literacy groups) and geographical context (indigenous MENA population vs. diaspora communities). The results show large inequalities in access and participation due to fragmented policies, socio-cultural resistance and infrastructure gaps. Nevertheless, promising approaches are emerging: community-led outreach, mobile screening programmes, AI-assisted triage and culturally appropriate digital health interventions. Comparisons between the local and diaspora populations make it clear that systemic and cultural barriers persist even in well-equipped facilities. Closing the screening gap requires a culturally sensitive, digitally enabled and policy aligned approach. Key priorities include engaging religious and community leaders, promoting men's engagement in women’s health and securing sustainable funding. With coordinated action across all sectors, MENA countries can build inclusive screening programmes that reach vulnerable women and reduce preventable cancer mortality.

Abstract: Background: The triglyceride–glucose (TyG) index, calculated from fasting triglyceride and glucose levels, has emerged as a simple and cost-effective surrogate marker of insulin resistance (IR). Given that IR is a pivotal mechanism underlying cardiovascular disease (CVD), the TyG index has gained increasing attention in recent years. Objective: This review summarizes the current evidence on the association between the TyG index and cardiovascular risk, exploring its biochemical basis, role in metabolism, epidemiological findings, and clinical implications. Methods: A narrative review of published studies was conducted, focusing on the predictive value of the TyG index for insulin resistance, diabetes, metabolic syndrome, and CVD outcomes. Findings from cohort, cross-sectional, and meta-analysis studies were integrated to provide a comprehensive overview. Results: Multiple epidemiological and clinical studies demonstrate that higher TyG index values are associated with an increased risk of cardiovascular events, independent of traditional risk factors. Compared to the homeostasis model assessment of insulin resistance (HOMA-IR), the TyG index shows greater accessibility and predictive capacity. However, heterogeneity in cut-off thresholds and limited prospective and interventional trial data remain major challenges. Conclusions: The TyG index represents a promising biomarker for cardiovascular risk assessment and may serve as a supplementary tool for early screening, particularly in young and asymptomatic adults. Future large-scale prospective and interventional studies are warranted to standardize cut-off values and establish its role in clinical practice.

Abstract: Wearable light loggers and optical radiation dosimeters are increasingly used to quantify personal light exposure in research and clinical contexts. However, the growing diversity of devices poses challenges for researchers selecting appropriate instruments. We present an open-access, web-based specification tool for wearable light loggers and optical radiation dosimeters that provides a structured framework for defining, comparing, and communicating device requirements. The tool integrates expert-informed parameters spanning usability, fidelity, and data requirements and generates exportable Word or PDF specifications suitable for procurement or documentation. By supporting transparent and consistent specification, the tool contributes to harmonisation in light exposure research and facilitates reproducibility and interoperability.

Abstract: National Tuberculosis Reference Laboratories (NTRLs) are central to tuberculosis (TB) control programs. Between 2018 and 2025, the Republic of Congo, a country of 6 million inhabitants, achieved a transformative strengthening of its TB diagnostic system, coordinated by the NTRL. Strategic investments, supported mainly by international partners, enabled a substantial decentralization of services, expanding the diagnostic network from 40 to 113 facilities and increasing GeneXpert sites from 3 to 31. This was bolstered by a national sample transport system that slashed diagnostic inequities and a robust External Quality Assessment framework to ensure reliability. Critically, the establishment of a BSL-3 facility and the deployment of advanced assays like Xpert MTB/XDR ended the reliance on overseas testing by introducing in-country capacity for multidrug-resistant and extensively drug-resistant TB detection. These systemic improvements directly translated into significant outcomes including an annual molecular testing surging from 11,609 to over 27,000, bacteriological confirmation rates rose from 34 to 73%. This comprehensive laboratory systems strengthening, which also facilitated cross-programmatic initiatives like HIV, Mpox testing integration, underscores how sustained investment in infrastructure, logistics, and quality management is fundamental to improving case detection, surveillance, and progress toward the WHO End TB Strategy milestones.

Abstract: Tuberculosis (TB) remains a major public health challenge, particularly in sub-Saharan Africa, where the emergence and spread of drug-resistant Mycobacterium tuberculosis (MTB) strains threaten current control efforts. This study aimed to characterize the frequency and distribution of genetic mutations associated with resistance to rifampicin, isoniazid, ethambutol, fluoroquinolones, and second-line injectable agents in MTB isolates from culture-positive pulmonary TB patients in the Republic of Congo. A total of 45 MTB culture-positive samples collected between 2018 and 2019 were analyzed using targeted next-generation sequencing (MinION). Key resistance associated genes, including rpoB, katG, embB, gyrA, and rrs, were examined. Overall, 48% (22/45) of isolates harbored at least one mutation conferring drug resistance. Drug resistance associated mutations were detected in 48% (15/22) of sequences for rifampicin, mainly driven by Ser531Leu, Asp516Val, and His526Tyr. For Ethambutol, the prevalence was 50% (11/22), mainly associated with Met306Val mutation. Isoniazid represented 40.9% (9/22), primarily linked with Ser315Thr mutation. The floroquinolone represented 9% (2/22) mainly driven by Ala90Val and Asp94Gly. Lastly aminoglycosides resistance counted for 4% (1/22) mainly A1401G mutation. The results underscore the critical need to enhance molecular surveillance and strengthen treatment protocols for drug-resistant TB in the Republic of Congo to effectively combat this evolving health crisis.

Abstract: This study explores the association between early-life vaccine scheduling intensity and autism prevalence across 12 high-income countries, aiming to inform evidence-based public health policy. We examined whether the number and timing of vaccine doses administered to infants under one year correlate with standardized autism incidence rates. Using cross-national data from countries with comparable healthcare systems and diagnostic standards, we applied descriptive statistics, partial correlations (controlling for overall vaccination coverage), and multivariate regression models. Nations with higher autism prevalence (USA, Canada, Australia, Japan, South Korea, Singapore) averaged 15 vaccine types and 20 doses for infants ≤1 year, whereas lower-prevalence countries (Norway, Denmark, Finland, Italy, Sweden, UK) averaged 8 vaccines and 9 doses. Partial correlations revealed strong positive associations between autism prevalence and both vaccine types (r = 0.87, p < 0.001) and doses (r = 0.79, p < 0.01). Regression analysis indicated that a 1% increase in vaccine types corresponded to a 0.47% increase in autism prevalence (p = 0.001), explaining 81% of variance. While these findings do not establish causality, they identify patterns warranting further investigation. For practitioners and policymakers, these results underscore the importance of evaluating vaccine scheduling strategies alongside developmental outcomes. More gradual schedules, as observed in countries with lower autism prevalence, may merit consideration in future research and policy discussions to optimize neurodevelopment while maintaining high immunization coverage. This study provides actionable insights for disease prevention and health promotion professionals seeking to balance immunization goals with long-term child health outcomes.

Abstract: Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. While international research has explored diverse ethical perspectives and challenges related to these issues, little is known about how LTC nurses in Germany experience and navigate them. This study examines German LTC nurses’ ethical perspectives on assisted suicide and suicide prevention and explores the associated ethical challenges. Methods: A qualitative design employing both in-person and online focus groups was used. Data were analyzed following Mayring’s qualitative content analysis. Results: Twelve focus groups with a total of 96 nurses working in residential and home-based LTC were conducted between February and September 2025. Findings show that nurses perceive assisted suicide and suicide prevention as ethically complex and emotionally demanding. Three overarching themes emerged: (1) Intuitive and Emotional Reactions, (2) Ethical Perception and Ethical Reflection, and (3) Ethical Challenges. Conclusions: LTC nurses expressed varying ethical perspectives on and attitudes towards assisted suicide and suicide prevention. The ethical challenges identified may contribute to the development of moral distress. To help nurses navigate these ethically demanding situations, strategies at multiple levels are required. These include continuous ethics education, an open ethical culture, role definitions and clear professional guidance, alongside societal support for equitable access to general healthcare and suicide prevention services.

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Stress- and inflammation-related disorders remain the dominant global health burdens, yet few preventive tools operate across molecular, psychological, and social scales. We hypothesize that OM-induced vibrational coherence functions as a mathematical–cum-biophysical regulator capable of harmonizing energy from cellular metabolism to genomic expression through the vagal–microbiome–brain axis. Following the physical law that energy transforms but is conserved, the OM-to-Genome continuum extends this principle to living systems, where metabolic, immune, reproductive, and neural energies represent biological analogues of potential, chemical, and kinetic forms. Mathematics provides the syntax of these transformations—frequency, proportion, and rhythm—governing energy construction and deconstruction from birth to death. Within the author’s Evolution-to-Solution framework, OM vibration mediates these conversions, translating conscious intent into physiological order. Evidence from neuroimaging, electrophysiology, and molecular biology supports this pathway as a low-cost, culturally neutral mechanism for stress regulation and immune balance. Integrating mathematics, physics, chemistry, and physiology thus yields a unified One Health model linking awareness and biology through a single law of energy coherence.

Abstract: Background: The consequences of video games have been a hotly debated topic in recent decades. While the media tend to focus on and publicize the alleged negative effects of video games, the empirical literature continues to research to illustrate the benefits of playing certain types of video games. With this paper we want to highlight the utility of virtual reality technology for improving reaction time. Methods: In the intervention program we used the Oculus Quest 2 HMD (Head Mounted Display) device (Facebook Technologies, LLC. 1 Hacker Way, Menlo Park, CA 94025, USA). To assess simple and complex reaction time we used the Deary-Liewald reaction time test. Results: Subjects in the experimental group showed statistically significant improvements (p < 0.05) between initial and final testing in reaction time tests. Subjects in the experimental group showed statistically significant improvements (p < 0.05) at the final test compared to the control group in simple and complex reaction time tests. Conclusions: With the development of technology, new opportunities have arisen to reduce reaction time using state-of-the-art technology such as virtual reality. Virtual reality by specific means - exergames or active video games, as they are also called, can be used as physical exercises and can be used as a mean to improve reaction time.

Abstract: Post-Traumatic Stress Disorder (PTSD) is a global mental health concern, with recent research focusing on psychological mechanisms that contribute to its development and maintenance. Alexithymia, characterised by difficulty identifying and expressing emotions, has been identified as a potential risk factor for PTSD. This study investigates a model of the relationship between alexithymia and PTSD symptoms, focusing on the potential mediating roles of self-compassion and emotional regulation deficits. Participants (N = 310), who were university students and members of the community, completed self-report measures of the key variables. As expected, alexithymia was a strong predictor of higher levels of PTSD symptoms. Two mediation pathways were also significant: one through emotion regulation difficulties for negative emotions, and the other a serial mediation involving self-compassion followed by negative emotion regulation difficulties. Contrary to expectation Self-compassion had no direct predictive relationship with PTSD symptoms. Although alexithymia and self-compassion predicted greater difficulty in regulating positive emotions the mediation pathway to PTSD symptoms was non-significant. The general pattern of results was found to extend to the specific PTSD symptom groupings of re-experiencing, negative affect, avoidance and hyperarousal symptoms although some differences were evident among the symptom groupings. The theoretical and clinical implications of these findings are discussed.

Abstract: In hospitals with limited resources, chlorine solutions are commonly used for biocleaning. The effectiveness of these solutions depends on the concentration of active chlorine and how they are prepared and stored. A study conducted in six University Hospitals in Benin from March 10 to July 11, 2025, aimed to evaluate the stability of active chlorine and the bactericidal efficacy of chlorine solutions used for disinfecting hospital environments. A total of 103 samples were analyzed using iodometric titration following AFNOR standard NF EN ISO 7393-3 (2000) and WHO recommendations. Bactericidal activity was tested on multi-resistant hospital strains using the germ carrier method based on standard NF T72-281. The study found that 88.4% of the solutions had inadequate active chlorine concentrations. Overall, the bactericidal efficacy was low at 14.6%, particularly ineffective against Gram-negative bacilli (79.6%) and Gram-positive cocci (84.5%). There was a significant association between compliance with active chlorine levels and bactericidal efficacy (OR = 42.5; p < 0.000001). Factors contributing to inefficiency included storage without light protection, use of transparent containers, storage for more than two days, inadequate active chlorine concentration, and incorrect pH levels. These issues compromise hospital disinfection and contribute to the persistence of multi-resistant bacteria in the hospital environment.

Abstract: Introduction Violence against women and girls (VAWG) is a major public health and human rights issue in Africa, with prevalence consistently among the highest globally. According to WHO and UNFPA, one in three women worldwide experience violence in their lifetime, but in sub-Saharan Africa the burden is compounded by poverty, food insecurity, conflict, and weak health systems. Despite its scale, evidence is fragmented across countries and populations, often excluding vulnerable groups such as pregnant women, sex workers, healthcare workers, adolescents, and HIV-positive women. This review synthesises available data to provide a comprehensive understanding of the scope, determinants, outcomes, and interventions addressing VAWG in Africa.Methods We conducted a systematic review in accordance with PRISMA 2020 guidelines. PubMed, Embase, Web of Science, Scopus, African Journals Online, WHO, UNFPA, and Demographic and Health Survey (DHS) repositories were searched (2000–2024). Eligible studies were conducted in African countries and reported prevalence, determinants, outcomes, or interventions for VAWG, including IPV, sexual violence, workplace violence, reproductive coercion, in-law abuse, or community-based violence. Data were extracted independently by two reviewers, appraised for quality, and synthesised using thematic, contextual, trend, and intersectional analyses.Results Eighty studies from 22 African countries were included. Lifetime IPV ranged from 30–65%, pregnancy IPV 25–60%, childhood sexual abuse ~33%, workplace violence 30–62%, and >50% among sex workers. Determinants included alcohol use, poverty, food insecurity, conflict, and inequitable gender norms. Outcomes included maternal morbidity, depression, adverse birth outcomes, HIV/STI risk, and sexual dysfunction. Interventions such as SASA!, Indashyikirwa, CETA, and MAISHA reduced IPV and improved secondary outcomes.ConclusionVAWG in Africa is pervasive, persistent, and particularly concentrated among marginalised groups. Integrated, trauma-informed, and equity-sensitive responses are urgently required to reduce its health and social consequences.

Abstract:

Introduction: Parotid tumours represent about 3% of head and neck neoplasms, of which 80% are benign. The most common being the Pleomorphic Adenoma (PA). Objective: To analyse the morphological characteristics of the PA by Magnetic Resonance (MRI scan) and its behaviour in advanced diffusion (ADC - Apparent Diffusion Coefficient- value) and perfusion sequences. Materials and methods: Descriptive and inter-observer study of patients with a suspected PA diagnosis in an MRI scan and subsequent histological confirmation. All studies were carried out with the same MRI. The MRI protocol included enhanced sequences in T1 (T1W), T2 (T2W) diffusion study (DWI) and enhanced sequences in T1 with fat saturation (T1W FS) after injecting the contrast. Results: 39 of the 43 cases with suspected PA were confirmed (90.67%). They were morphologically well defined homogeneous tumours, with an average value of high ADC (1.85 x 10-3 mm2/s) and a type A perfusion curve (associated to benignity). The inter-observer concordance was 100%. Conclusions: PAs show typical morphological characteristics in an MRI scan. In case of diagnostic doubt, the diffusion and perfusion sequences help establish a definite diagnosis.

Abstract: This study investigates the classification of nine sitting postures using pressure distribution data from hard and soft seat surfaces. Three neural network architectures (FNN, CNN, ResNet) were evaluated under single-surface and mixed-domain training regimes. While all models achieved high accuracy (>96%) when trained on mixed-domain dataset, significant performance degradation occurred in cross-domain testing. CNN demonstrated superior capability in leveraging spatial pressure features under mixed training conditions, while FNN exhibited relatively better cross-domain robustness. Results indicate model performance highly depends on architectural inductive biases and training data diversity. These findings underscore the importance of employing representative multi-surface datasets for ensuring generalization in practical sitting posture recognition systems.

Abstract: Background/Objectives: This study evaluates the effectiveness of an ecological momentary assessment (EMA) tool for real-time monitoring of burnout among healthcare workers during times of crisis. Methods: Utilizing an intensive longitudinal design, 398 healthcare workers, including physicians, physician assistants, nurses, and trainees, were surveyed every five days over the first year of the COVID-19 pandemic. Results: The EMA approach successfully captured dynamic trends in burnout, identifying significant associations between workforce redeployment, elevated caseloads, and increased burnout, with effects persisting beyond a return to usual roles. Nurses were particularly vulnerable, reporting the highest burnout levels during periods of high patient volume. Conclusions: These findings validate EMA as an innovative and scalable method for continuous burnout surveillance, enabling the early identification of at-risk groups, guiding resource allocation, and informing timely interventions. This study highlights the critical role of real-time burnout monitoring tools in fostering workforce resilience and operational readiness during public health emergencies and other extended crises.