Abstract: Refugees are exposed to cumulative pre-migration, migration, and post-migration stressors that increase vulnerability to depressive disorders and impaired quality of life. Aim of this study was to assess the prevalence and severity of depressive symptoms among adult refugees in Serbia and associations with sociodemographic characteristics, traumatic experiences, social support, and Health Related Quality of Life (HQoL). This study included 324 refugees in four reception centers in Serbia. Data were collected between November 2022 and April 2023 using self-report questionnaires. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), while HQoL was evaluated using the SF-36 Health Survey. Sociodemographic, migration-related, and psychosocial variables were collected through a structured questionnaire. The mean PHQ-9 score indicated mild to moderate depressive symptomatology. Significant depressive symptoms were present in 41.4% of participants, while more than 70% reported mild symptoms. Depressive symptom severity was negatively correlated with energy/fatigue, emotional well-being, social functioning, general health, and pain. Energy/Fatigue emerged as the strongest independent predictor of depressive symptom severity. Depressive symptoms are highly prevalent among refugees and are closely associated with impaired quality of life and psychosocial stressors. These findings highlight the need for systematic screening and psychosocial interventions targeting mental health issues in refugees.

Abstract: Upper respiratory tract infections such as the common cold are highly prevalent and impose a substantial health and economic burden, with many individuals relying on over-the-counter (OTC) medications for symptomatic relief despite limited real‑world evidence on perceived effectiveness. This non‑interventional, retrospective, cross‑sectional survey evaluated the product attributes most valued when selecting cold and flu medications and assessed perceptions of the effectiveness, quality‑of‑life impact, and overall attitudes toward MED‑LEMON. A total of 249 adults completed a structured questionnaire covering symptom relief priorities, medication attributes, perceived effectiveness, quality of life outcomes, and post-intake attitudes. Relief of fever, sore throat, headache, and sinus congestion, along with fast action, long‑lasting relief, and ease of use, were identified as key drivers of OTC cold and flu medication choice. MED‑LEMON was widely perceived as effective, with over 90% of participants reporting overall symptom improvement and strong relief of pain, headache, and fever. Adherence to the recommended dosing regimen was associated with better symptom control and improved quality of life, including sleep, emotional well‑being, and daily functioning. Overall attitudes toward MED‑LEMON were highly positive. From a public health perspective, these findings highlight the role of effective OTC treatments in supporting health promotion and responsible self-care during cold/flu period.

Abstract: Background: China and India represent a large proportion of the Asian birth cohort and have produced extensive but heterogeneous evidence on neonatal hearing screening. This scoping review summarizes studies published between 2005 and 2025 on otoacoustic-emission-based neonatal hearing screening programs in these countries, with emphasis on program implementation, screening coverage, prevalence of congenital and bilateral hearing loss, follow-up, and intervention pathways. Methods: Searches were conducted in PubMed, Scopus, and Google Scholar using predefined keywords. Studies reporting screening protocols, coverage, prevalence, or follow-up outcomes were included. The standard English language filter was used. A total of 19 papers were considered for this review. Results: The data from the two assessed Asian states show two clearly different screening implementation profiles. In China, Universal hearing screening has evolved into a large-scale and increasingly standardized system, supported by technical specifications and regional or municipal databases; The reported screening coverage was 85.8% in early rural programs, 93.6% in Shanghai, and 97.9% in Liuzhou, while national institutional surveys indicate that UNHS has been substantially implemented in many regions. Reported Hearing Loss prevalence estimates generally ranged from 1.66 to 3.43 per 1,000 newborns, although follow-up and regional equity remain problematic, especially in rural settings. In India, the evidence is dominated by tertiary-hospital feasibility studies rather than a uniformly implemented national program. Reported Hearing loss prevalence estimates varied more widely, from 0.29 to 5.60 per 1,000 screened newborns, largely reflecting differences in study design, screening timing, referral completion, and population risk profile. Across both countries, OAE-based two-stage or sequential OAE+AABR protocols reduced referral rates and improved case identification, but loss to follow-up remained a recurrent limitation. Conclusions: China and India provide complementary models of neonatal hearing screening expansion: China demonstrates the effects of system-level scale-up, whereas India highlights the feasibility and constraints of hospital-based implementation in a highly diverse healthcare environment. Future priorities include stronger follow-up systems, harmonized reporting standards, and broader dissemination of outcome data through peer-reviewed publications.

Abstract: Introduction: Maternal diet during pregnancy has profound effect on brain and cognitive development of the child and thus an important risk factor in the occurrence of childhood neurodevelopmental disorders. Objectives To our knowledge very few studies examined the association between maternal dietary quality during pregnancy and neurodevelopmental outcomes (ADHD and ASD) posing a need for a comprehensive review of the complex synergies among nutrients and foods and relation with ADHD and ASD to enable evidence-based recommendation on dietary patterns. Method To achieve this, a systematic review and meta-analysis was conducted in accordance with the general recommendations of the PRISMA and MOOSE guidelines with an inverse variance-weighted random-effects model. Results are presented as odds ratio (OR) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed by the Higgins I2 statistic. Interpretation followed Cochrane Handbook guidance and was based on the magnitude of I2 statistics alongside the direction and consistency of the estimates. The review protocol was preregistered on PROSPERO with an ID CRD420251137377. The risk of bias (RoB) for all included studies was independently assessed using the ROBINS-E tool. The GRADE framework was used to assess the overall certainty and accuracy of evidence. Result The study included 9 studies and 22 cohorts studies. On pro-inflammatory dietary patterns for ADHD (8 studies including 17,114 samples), no significant association was observed between higher pro-inflammatory dietary patterns and the risk of offspring ADHD (OR = 1.07, 95% CI 0.96 to 1.20; p = ) with substantial heterogeneity (I² = 79%, Q = 13.87, p = 0.0077) while For ASD (3 studies including 6,511 samples), no significant association was observed (OR 1.55, 95% CI 1.10 to -2.19; p = 0.57), with low heterogeneity (I² = 20%, Q = 7.29, p = 0.12). Anti-inflammatory healthy dietary patterns for ADHD (n = 6, samples 17,028), higher maternal adherence was associated with reduced risk (OR 0.97, 95% CI 0.95 to -0.99; p = 0.002), with low heterogeneity (I² = 21%, Q = 5.87, p = 0.32). For ASD (n = 5, samples 100,908), higher adherence was associated with reduced risk (OR 0.79, 95% CI 0.69 to -0.91; p = 0.003), with no observed heterogeneity (I² = 0%, Q = 4.08, p = 0.54). Conclusion Across the included studies, anti-inflammatory dietary patterns were associated with lower odds of neurodevelopmental disorders, while pro-inflammatory dietary patterns were associated with increased odds of ASD. These findings suggest that the inflammatory profile and quality of the maternal diet may be relevant to offspring neurodevelopment. Maternal diet at the level of dietary patterns may provide clearer insights than nutrient-specific analyses alone.

Abstract: Organophosphate-induced delayed neuropathy (OPIDN) is a rare, serious neurological consequence of organophosphate poisoning. Unlike acute toxicity, which causes cholinergic crises, OPIDN develops insidiously, often weeks after exposure, leading to progressive sensorimotor deficits. 44-year-old African male pesticide applicator with nine years of organophosphate exposure presented with progressive lower limb weakness, gait disturbances, and paresthesia. The patient exhibited no signs of acute cholinergic symptoms. Neurological examination revealed symmetrical limb weakness, diminished deep tendon reflexes, and distal sensory deficits. Serum cholinesterase levels were decreased. Electrophysiological studies demonstrated axonal degeneration with demyelination, and MRI showed mild spinal cord atrophy. Other causes of neuropathy were excluded. He received supportive care, including physical therapy, pain and spasticity management, antioxidants, vitamins, and off-label intravenous methylprednisolone. Over four months, he regained partial functional improvement, with residual weakness and mild gait disturbance. Chronic low-level organophosphate exposure can cause OPIDN even without acute poisoning. Diagnosis relies on occupational history, neurological examination, and electrophysiological findings. Management is primarily supportive; off-label therapies such as methylprednisolone may reduce neuroinflammation and oxidative stress but are not part of standard care. Early recognition, timely preventive measures, and long-term rehabilitation are essential to improve functional outcomes and quality of life.

Abstract: BackgroundMobile health (mHealth) interventions have shown promise in supporting tuberculosis care, but their association with patient knowledge, attitudes, and practices (KAP) among people with multidrug-resistant tuberculosis (MDR-TB) remains poorly evaluated in high-burden, programmatic settings. We assessed the association between a smartphone-based mHealth application and KAP regarding treatment adherence and adverse events within the V-SMART randomised controlled trial in Vietnam.MethodsThis nested cross-sectional study included 528 patients with MDR-TB (278 intervention, 250 control) enrolled across seven provinces in Vietnam between 2023 and 2025. KAP was measured using a validated questionnaire (Knowledge 0–17, Attitude 0–44, Practice 0–19, total 0–80). Multivariable linear regression adjusted for age, sex, province, education, time on treatment, PHQ-9, stigma, and social support. Dose-response relationships with self-reported app usage were examined in the intervention arm.ResultsThe mHealth intervention was associated with higher total KAP scores (adjusted mean difference 5.0 points, 95% CI 3.3–6.7, p<0.001), with largest gains in practice (+2.2 points) and knowledge (+1.1 points). Clear dose-response relationships were observed: each additional month of app use was associated with a 0.81-point increase in total KAP score (p<0.001).ConclusionThe smartphone-based mHealth intervention was associated with meaningfully higher KAP scores among MDR-TB patients in Vietnam. These findings support integration of mHealth tools into routine programmatic management of drug-resistant tuberculosis in high-burden settings.

Abstract: Background: Several research has revealed that dehydration remains a major cause of preventable illnesses, particularly among children and older adults. Existing tools such as the WHO IMCI, Gorelick, and Clinical Dehydration Scale (CDS) are limited by population focus and absence of quantitative weighting or digital integration. This study developed and prototyped an evidence-based dehydration-risk prediction model derived from meta-analytic data to enable more objective and universal risk estimation. Methods: Building on our recent systematic review and meta-analysis (Ogbolu et al., 2025), sixteen (16) clinical and demographic predictors were extracted from validated dehydration scales and pooled diagnostic evidence. Heuristic weights (1–4 points) were assigned according to pooled sensitivity and specificity, yielding a total score of 0–42. The total score was transformed to generate continuous probability estimates using logistic regression. The scoring algorithm was embedded within an interactive R Shiny software prototype that supports real-time computation and visualization. Prototype evaluation involved functional verification and usability testing using simulated patient profiles. Results: High-weight predictors, thirst, inability to drink, and lethargy showed the strongest diagnostic value, while modifiers such as age (≥ 65 years) and comorbidity carried lower weights. The cumulative score was transformed into a continuous dehydration-risk probability using a logistic function, reflecting the nonlinear increase in risk with symptom burden. Prototype evaluation of the MetaDehydrate application using simulated profiles demonstrated accurate score computation, consistent probability outputs, sub-second computation latency (< 0.2 s per calculation), and favorable usability feedback. Conclusion: This study presents the design and technical feasibility evaluation of an evidence-informed dehydration risk–scoring algorithm and its implementation as a prototype digital decision-support tool. While no clinical effectiveness was assessed, the findings demonstrate the feasibility of translating pooled diagnostic evidence into a functional, user-interactive application. The tool’s simplicity, limited input requirements, and rapid computation suggest potential utility for future evaluation in community and resource-constrained healthcare settings. Further prospective studies are required to assess effectiveness in real-world and low-resource healthcare settings.

Abstract: Rationale: Mother-to-child transmission (MTCT) of HIV remains a critical public health challenge in Nigeria, particularly in resource-constrained regions. Public health education is a cornerstone of the national PMTCT programme, yet limited evidence exists on its awareness, accessibility, usefulness, and acceptance among pregnant women in Cross River State. Understanding these dimensions is essential for optimizing programme design and maternal and child health outcomes. Objectives: The study aimed to assess public health education services in the prevention of MTCT of HIV among pregnant women attending St. Joseph’s Hospital, Ikot Ene. Specifically, it evaluated: (1) awareness of PMTCT programmes, (2) accessibility to services, (3) perceived usefulness, and (4) acceptance of the programmes. Methods: A cross-sectional descriptive survey was conducted with 222 randomly selected pregnant women attending antenatal care. Data were collected using a structured, validated questionnaire covering socio-demographics and PMTCT programme domains. Descriptive statistics summarized responses, and mean domain scores were calculated. Results: Participants were predominantly married (55.0%) with a mean age of 26.4 years; over half had no formal education. Awareness of PMTCT programmes was moderate-to-high (mean score: 64.0%), while accessibility was generally reported as adequate despite systemic barriers (mean score: 75.5%). Perceived usefulness was high (mean score: 68.0%), and programme acceptance was strongest among all domains (mean score: 78.8%). Notably, 40.5% of participants lacked full awareness, and 65.3% had experienced discouragement, highlighting areas for improvement. Conclusion: Public health education programmes significantly contribute to PMTCT knowledge and uptake, yet structural and socio-cultural barriers limit their full effectiveness. Recommendation: Short- and long-term strategies should include culturally tailored education, health system strengthening, community engagement, and continuous monitoring to enhance awareness, accessibility, and utilization. Thus, effective public health education directly reduces MTCT risk, improves neonatal outcomes, and strengthens maternal health, supporting national and global HIV elimination targets

Abstract:

Background and Objectives: Multiple sclerosis (MS) is a chronic autoimmune neuroinflammatory condition associated with significant disability. Given the increasing number of patients with MS, the growing number of available disease-modifying therapies (DMTs), and the substantial economic burden associated with MS, it is critically important to determine which treatment options are the most cost-effective. The economic burden of MS is considerable, and high-cost DMTs, whose prices continue to rise, represent the primary driver of health expenditures related to MS. The primary aim of this narrative review is to provide a brief review of the economic issues related to MS DMTs, including pricing trends, economic burden, and their impact on patient care, and to propose potential policy solutions. Materials and Methods: The aim of the study was to compare the cost effectiveness of The annual costs of DMTs from 1993 to 2023 in USA. An examination of DMT pricing trends suggests that pricing has been influenced in part by within-class competition and the availability of generic DMT options. Results: Over the past decade, the prices of DMTs have increased by more than 50%. Currently, the annual cost of many DMTs used in the treatment of MS has exceeded $100,000, and their economic value is widely debated. The high cost of DMTs and difficulties in timely access to medications can lead to psychological stress among many patients. Studies on cost-effectiveness indicate that the clinical benefits provided by DMTs do not fully justify their high costs, which further exacerbates issues related to economic accessibility. Conclusions: Collaborative neuropsychiatric care models, in which neurologists and mental health professionals work in coordination, may improve symptom recognition, optimize adherence to DMTs, and enhance overall functioning. Given that treatment non-adherence and reduced quality of life negatively affect cost-effectiveness outcomes, early psychiatric intervention may indirectly improve the economic value profile of high-cost DMTs.

Abstract: Background: Non-communicable diseases (NCDs) account for the majority of global mortality, yet healthcare systems remain largely oriented toward the treatment of acute conditions. This study examines the structural mismatch between contemporary disease patterns and healthcare system organization. Methods: A narrative analytical review was conducted using secondary data from the Global Burden of Disease (GBD) study and World Health Organization (WHO) reports, supplemented by literature from PubMed, Scopus, and Google Scholar (2000–2026). Findings were interpreted using epidemiological transition theory, health systems analysis, and political economy frameworks. Results: The analysis identifies multiple structural drivers of treatment-oriented healthcare systems, including economic incentives favoring curative services, short-term political decision-making cycles, and the historical dominance of the biomedical model. These factors contribute to systematic underinvestment in prevention, rising healthcare expenditures, and persistent global inequalities in access to medical technologies, as demonstrated during the COVID-19 pandemic. The current model is associated with increasing economic burden and projected losses in global productivity by 2030–2050. Conclusions: The findings indicate that the current healthcare model is structurally misaligned with population health needs. Improving health outcomes and system sustainability requires a reorientation toward prevention, long-term health metrics, and the evidence-based integration of complementary approaches within healthcare systems.

Abstract: Sarcopenia—the progressive loss of skeletal muscle mass and function—is a growing public health challenge in ageing populations. Island territories face compounded vulnerabilities due to distinct epidemiological and socio-economic profiles. This study examines sarcopenia risk prevalence among community-dwelling older adults in Tenerife (Canary Islands, Spain) and estimates the economic burden alongside the cost-effectiveness of evidence-based interventions. A cross-sectional study was conducted among 374 community-dwelling older adults (mean age 80.4 years, SD 4.8; 51.1% female) recruited from primary care health centres across three health zones in Tenerife. Participants were stratified into a control group without established chronic disease-related functional decline (Group 1; n = 274) and a case group with multimorbidity and functional limitations (Group 3; n = 100). Sarcopenia risk was assessed using the SARC-F questionnaire (threshold ≥4). A comprehensive geriatric battery—including the Barthel Index, FRAIL scale, MNA-SF, Pfeiffer test, SPPB, handgrip dynamometry, and IPAQ—characterised multidimensional vulnerability. Annual direct and indirect costs were estimated using unit costs from Spanish national health accounts, and intervention cost-effectiveness was modelled using published meta-analytic data. Overall sarcopenia risk prevalence was 36.4% (n = 136; SARC-F ≥4), rising to 83.0% in the case group versus 19.3% in controls (OR ≈21.5, p < 0.001). Prevalence was 42.1% in males and 30.9% in females. Diabetes was independently associated with elevated risk (44.8% vs. 29.9%; OR 1.90, 95% CI 1.23–2.92; p = 0.003). Health Zone 1 exhibited the highest prevalence (63.0%) versus Zones 2 (23.5%) and 3 (32.8%). Multidimensional vulnerability was pervasive: 71.4% were frail, 56.6% had nutritional compromise, 58.8% showed moderate cognitive impairment, and 89.8% reported low or inactive physical activity. The estimated annual socio-economic cost of sarcopenia in Tenerife is approximately EUR 88.9 million (Spain nationally: EUR 12.1 billion). Combined exercise–nutrition interventions yield cost-per-QALY ratios of EUR 3,800–7,000, far below Spain's EUR 25,000/QALY threshold. Sarcopenia constitutes a major, multidimensionally compounded health burden in Tenerife's older population, concentrated among frail, diabetic, nutritionally compromised, and physically inactive individuals. The economic case for universal SARC-F screening and multicomponent intervention is compelling, exceeding cost-effectiveness thresholds by a wide margin. Territorial disparities in burden call for equity-oriented, place-based resource allocation within the Canarian health system.

Abstract: Singapore’s rapidly ageing population presents significant challenges for healthcare planning and long-term care provision. This study applies ARIMA time-series modeling to forecast the number of older adults requiring assistance in daily living between 2025 and 2035. Using historical population data, nursing home residency figures, and simulated indicators of disability and living arrangements, the model projects assisted living demand rising from 19,741 individuals in 2025 to 29,443 in 2035—a 49.2% increase. While forecasts are conservative due to reliance on informal care from family members and foreign domestic helpers, structural shifts such as smaller family sizes and reduced caregiver availability may drive demand higher. The methodology highlights the importance of accounting for disability prevalence and informal care. Findings underscore the need for strategic planning to expand assisted living infrastructure, workforce capacity, and policy frameworks. Singapore’s case contributes to global literature by illustrating ageing trajectories relevant to other developed societies.

Abstract: Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gra-dients. Objectives: This multicenter study aimed to describe caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the Italian Centre for Diseases Control and Prevention (CCM) 2024 program (ID 10), 795 children aged 6–11 years were examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedici-ne/AI supported follow up for high risk children. Descriptive and multivariable statistical analyses were performed. Results: Overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with mediocre hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries expe-rience. In multivariable models, oral hygiene emerged as the main independent pre-dictor of dmft/DMFT. Conclusions: In this low caries cohort, oral hygiene was confirmed as the principal mo-difiable determinant of caries risk. A tiered, school and community based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical inter-ventions appears feasible and potentially scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health.

Abstract: Background: The continued evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) created ongoing challenges for molecular diagnostics and variant surveillance. Reliable assays capable of maintaining diagnostic sensitivity across emerging variants while providing rapid variant information remain essential for clinical management and public health monitoring. This study evaluated the performance of the GXT96 X3 extraction kit in combination with the FluoroType® SARS-CoV-2 varID Q version 1.0 assay (Hain LifeScience SA (Pty) Ltd, South Africa) for the detection, semi-quantitative assessment, and variant characterization of SARS-CoV-2. Methods: A total of 220 samples were evaluated, including residual nasopharyngeal clinical specimens (n = 183), reference materials, and cultured SARS-CoV-2 virus dilutions. Residual specimens collected during multiple COVID-19 waves in South Africa (wild type, Beta, Delta, and Omicron) were compared against standard-of-care (SOC) molecular assays used for routine diagnosis. RNA extraction was performed using the automated GXT96 X3 platform, followed by amplification on the FluoroCycler® XT using the FluoroType® SARS-CoV-2 varID Q assay targeting RdRp and N genes, with additional spike gene mutation detection for variant identification. Diagnostic accuracy, agreement (Cohen’s kappa), precision, linearity, and limit of detection (LoD) were assessed. Results: The assay demonstrated a sensitivity of 98.4% (95% CI: 94.2–99.8) and specificity of 100% (95% CI: 95.9–100.0) compared with SOC assays, with an overall agreement of κ = 0.981. Precision analysis showed acceptable reproducibility with standard deviation ≤1.49 and coefficient of variation ≤3.83%. Regression analysis demonstrated strong linearity across dilution series (R² = 0.9882 for RdRp and 0.994 for N genes). The LoD was ≤100 copies/mL for the RdRp gene and 250 copies/mL for the N gene. Variant-associated spike mutations detected by the assay corresponded broadly with epidemiological wave patterns observed in South Africa. Conclusions: The GXT96 X3 extraction platform combined with the FluoroType® SARS-CoV-2 varID Q assay demonstrated high diagnostic accuracy, reproducibility, and reliable SARS-CoV-2 detection across a range of viral loads. The assay additionally provides rapid mutation-based variant information, supporting its utility for routine diagnostic testing and complementary variant surveillance.

Abstract: Modern residential toilets pose a significant biomechanical challenge for older adults with diminished muscle strength, as standard seat heights necessitate excessive joint range of motion (ROM) and compensatory upper-limb reliance. This study evaluated the biomechanical efficacy of a biomimetic Stand-assist Toilet Seat designed to facili-tate sit-to-stand (STS) transitions through a proactive curvilinear trajectory. Thirty community-dwelling older adults were stratified into high-, moderate-, and low-functioning groups based on 30-second Chair Stand Test normative data. A mul-ti-modal assessment framework was employed, integrating MediaPipe-based AI pose estimation for joint kinematics and instrumented armrests with high-precision load cells for kinetic analysis. The results demonstrated that the biomimetic seat signifi-cantly optimized movement efficiency, evidenced by a robust reduction in hip and knee ROM with a large effect size (η²p > .70, p< .001). Kinetic data further revealed sub-stantial upper-limb unloading, with significant decreases in peak arm-support force (Fmax,p=.001, η²p =.35) and cumulative impulse (Iarm,p< .001, η²p =.42). While no signifi-cant interaction was found, a clinical trend (η²p =.17) suggested that low-functioning individuals derived the greatest mechanical advantage from the device. By actively guiding the user’s center of mass toward a biomechanically advantageous "power zone," the biomimetic trajectory minimizes compensatory trunk flexion and armrest reliance. These findings provide evidence-based insights into the role of trajecto-ry-informed assistive technology in enhancing toileting safety and functional inde-pendence for the aging population, particularly those exhibiting signs of possible sar-copenia.

Abstract: Objectives: To assess the prevalence of depressive symptoms and examine their associations with tuberculosis-related knowledge, attitudes, and practices (KAP) among patients with multidrug-resistant tuberculosis (MDR-TB). Methods: A cross-sectional study was conducted among 528 MDR-TB patients. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), with a score of ≥10 indicating clinically relevant depression. KAP domains were assessed using a structured scoring system. Associations were analyzed using Spearman correlation and multivariable logistic regression. Results: The mean PHQ-9 score was 5.32 ± 4.35, and 14.96% of participants (n = 79) had clinically relevant depressive symptoms. Among them, 57 had moderate, 17 had moderately severe, and 5 had severe symptoms. Multivariable analysis showed that higher attitude scores were associated with lower odds of depression (aOR = 0.936; 95% CI: 0.886–0.990; p = 0.02). Higher practice scores were also strongly associated with reduced depression risk (aOR = 0.837; 95% CI: 0.778–0.901; p < 0.001). Knowledge score was not independently associated with depression (p = 0.622). Conclusions: Depressive symptoms are common among MDR-TB patients and are more strongly linked to attitudes and practices than to knowledge alone. These findings highlight the importance of integrating mental health screening and behavioral support into MDR-TB management programs to improve comprehensive patient care.

Abstract: Background/Objectives: The management of diabetic foot ulcers and/or peripheral arterial disease requires an interdisciplinary approach. Little has been written to demonstrate the effect of podiatry in non-academic settings. To demonstrate the impact of podiatrist on major non-traumatic lower extremity amputations (NTLEA) among patients with type 2 diabetes with foot ulcer and/or Peripheral arterial disease (PAD) using national administrative data. Methods: A retrospective cohort study using administrative data from all U.S states and territories between 2010 to 2022 to examine odds for major amputation (i.e., above-ankle) with and without podiatry. Interdisciplinary approach was defined as any surgical services performing major NTLEA in addition to podiatry care. Multivariable regression models were conducted to assess the primary outcome while controlling for age, gender, Charlson Comorbidity Index, obesity, tobacco use, chronic kidney disease, peripheral neuropathy, heart disease, presence of an ulcer, and presence of PAD. Results: Overall, 2% of the population experienced a major NTLEA (n=5,493). Adjusted odds of vascular and general surgeons performing major amputation were 3.82 (97.5% CI [3.61-4.06]) and 2.59 (97.5% CI [2.42-2.77]), respectively. Adjusted odds decreased to 1.38 (97.5% CI [1.21-1.57]) and 1.10 (97.5% CI [0.90-1.33]), respectively, when podiatry was involved in the care. Conclusions: Regardless practice settings, including podiatry with other surgical providers as part of the interdisciplinary approach for amputation prevention reduces the odds of major non-traumatic lower extremity amputation.

Abstract: The act of receiving and giving help is commonly expected to improve older people’s health. In this article, this expectation is explored through a longitudinal analysis of a representative sample of 29,995 respondents aged 59 to 100 from 12 European countries documented in the Survey of Health, Ageing and Retirement in Europe (SHARE) for the period 2011 to 2022. An unordered correlated random-effects Mundlak (CRE), an ordered fixed-effects logistic (FEO), as well as an ordered random-effects Mundlak logistic panel estimator (REO), all with longitudinal calibrated weights, are used to estimate the relationship between self-perceived health and receiving and giving help. Additionally, a stereotype ordered logistic estimator (SO) is included to benchmark the findings, given that the parallel regression assumption is violated. On top, the estimators are repeated for testing the robustness of the findings across the five available imputed SHARE datasets. Overall, the study supports the positive impact on self-reported health status of income, doing activities and being satisfied with life, as well as the negative impact of age, having limitations and being permanently sick or disabled. The Danish older people report the best health status, while the Swedish, Belgian, and Dutch jointly hold the second-best health status. Above all, the average respondent who receives and gives help tends to report a more favourable health status compared to the average respondent who merely receives help. Overall, the study confirms the positive value of a helping hand.

Abstract: Abstract Background: Mobile health has been increasingly integrated into tuberculosis care to support patient education, communication, and treatment engagement. However, evidence remains limited regarding whether positive engagement with mHealth is associated with knowledge, attitudes, and practices among patients with multidrug-resistant tuberculosis. This study aimed to evaluate the psychometric properties of a positive mHealth engagement score and to examine its association with knowledge, attitude, practice, and total KAP among patients with multidrug-resistant tuberculosis. Methods: A cross-sectional study was conducted among patients with multidrug-resistant tuberculosis. A positive mHealth engagement score was constructed from 12 mHealth-related items after harmonizing item directionality so that higher scores indicated more favorable engagement. Internal consistency was assessed using Cronbach’s alpha and corrected item-total correlations, and structural validity was explored using principal component analysis. Adjusted linear regression models were used to examine associations between the engagement score and Knowledge, Attitude, Practice, and total KAP scores, controlling for age, sex, and occupation. Sensitivity analyses were performed after excluding a poorly performing item, and tertile analyses were used to assess dose-response patterns. Results: The positive mHealth engagement score showed good internal consistency, with a Cronbach’s alpha of 0.852. One item demonstrated poor psychometric performance, and Cronbach’s alpha increased to 0.864 after its exclusion. The data were suitable for dimensionality assessment, with a Kaiser-Meyer-Olkin value of 0.870 and a significant Bartlett’s test. Principal component analysis identified a dominant first component explaining 43.29% of the total variance. Using the refined score, higher positive mHealth engagement was significantly associated with higher Knowledge scores (β = 2.06; 95% CI: 1.28–2.85; p < 0.001), higher Attitude scores (β = 4.68; 95% CI: 3.30–6.06; p < 0.001), and higher total KAP scores (β = 6.68; 95% CI: 4.62–8.74; p < 0.001), whereas no significant association was observed for the Practice score (β = −0.07; 95% CI: −0.63 to 0.49; p = 0.804). In tertile analyses, Knowledge, Attitude, and total KAP scores increased significantly across engagement levels, while Practice scores did not. Conclusions: Positive mHealth engagement was associated with better knowledge, attitudes, and overall KAP among patients with multidrug-resistant tuberculosis, but not with practice. The engagement score demonstrated good reliability and acceptable structural validity and may be a useful summary measure for evaluating patient interaction with mHealth interventions in tuberculosis care.

Abstract: Misuse of over the counter (OTC) and prescription only medicines (POM) is increasingly recognised as a public health and medicines safety concern. Pharmacists and specialist substance misuse services (SMS) are often the first to encounter emerging patterns of problematic use, yet little is known about SMS staff experiences in supporting affected adults. This study explored their experiences to inform pharmacy focused practice and policy. Ethical approval was obtained. Confidential semi structured interviews were conducted with staff across five community adult English SMS. Audio recordings were transcribed verbatim and analysed thematically using NVivo®. Twenty interviews with varied professionals achieved data saturation. Three overarching themes emerged: (1) characteristics of OTC/POM misuse; (2) distinct groups of people affected; and (3) negative experiences and concerns. Dependence on orally administered opioids (particularly co-deine containing products) benzodiazepines and gabapentinoids predominated. Polypharmacy including illicit substance use was also reported. Withdrawal symptoms frequently perpetuated misuse, and abrupt supply cessation created additional risks. Routine enquiry about OTC/POM misuse and provision of tailored harm reduction inter-ventions are essential. Findings highlight opportunities for enhanced pharmacist in-volvement in early identification and medicines optimisation. Further research should examine whether dedicated OTC/POM pathways are required and explore differences in demographic and treatment needs across medicine types.