Abstract: Background/Objectives: This study describes the development and validation of the Danish Sentence Test (DAST), a Danish-language, adaptive speech-in-noise test constructed from a linguistically balanced corpus using a template-based method. This approach enables controlled linguistic variation while maintaining lexical consistency and may serve as a model for developing similar speech materials in other languages. Methods: Sentences spoken by one female talker from the DAST corpus were sorted into 44 balanced lists of 20 sentences using a psychometric optimization procedure. Speech reception thresholds (SRTs) were measured in 20 normal-hearing participants using headphone playback with speech-shaped noise. Results: The mean SRT across lists was −5.3 dB SNR, with list means within ±0.5 dB of the grand average. The average within-subject standard deviation was 0.7 dB, and the grand average psychometric slope was 18.5%/dB. A relatively small training effect was observed, consistent with the use of linguistically varied, low‑predictability material. Conclusions: DAST provides a linguistically rich and psychometrically well-controlled speech-in-noise test with substantially more material than existing Danish corpora. The template-based method and optimization approach may be of broader methodological interest for developing speech materials in other languages. DAST complements existing Danish-language tests and enables more extensive assessments of speech understanding, including studies requiring large numbers of non-repeated sentence lists.

Abstract: Words matter because they have profound power to shape thoughts, emotions, actions, and social realities. They influence our thoughts and actions daily by shaping our perceptions, and behaviors at both conscious and subconscious levels. Beyond words, semantics are concerned with how language conveys meaning and how people understand and use that meaning in each particular context. The words and semantics used in the European Health Technology Assessment (EU-HTA) Regulation [1], guidance documents, guidelines, and implementation acts play a crucial role in shaping our understanding, interpretation, and conceptualization of EU-HTA reality. Our perception of the EU-HTA Regulation and its implementation will be significantly influenced by the terminology employed by the European Commission (EC) and the Member States Health Technology Assessment Coordination Group (MS-HTA-CG). Several terms and expressions used in official documents such as EU-HTA Regulation and Guidance documents or guidelines, appear semantically imprecise or misleading, as they may create systematic bias and inaccurate vision of the EU-HTA. They may distort general understanding of Health Technology Assessment (HTA) as well. This paper analyzes words and semantics used by the EC and MS-HTA-CG in publicly available materials that appear misused. This editorial does not report such misuses in a systematic way, but underlines several of the most prominent ones to raise awareness on this important phenomenon.

Abstract: Background: Mental health problems often begin in adolescence, yet early detection and intervention remain limited. This study assesses the prevalence of psychological distress and its correlates among high-school students in Makkah, Saudi Arabia, and explores whether specific symptom clusters of depression, anxiety and bipolar/mania can be identified using the General Health Questionnaire‑30 (GHQ‑30). Methods: A cross‑sectional survey was conducted during the 2025–2026 academic year using stratified cluster sampling. A total of 535 students aged 15‑18 years completed a questionnaire containing the validated Arabic GHQ‑30 and demographic, socioeconomic and lifestyle items. The GHQ‑30 was scored with binary 0‑0‑1‑1 scoring (cut‑off ≥ 6) to define cases of psychological distress. Item clusters were used to screen for probable depression, anxiety and bipolar/mania. Descriptive statistics characterized the sample. Associations were examined using chi‑square tests and multivariable logistic regression. Results: Overall, 70.5 % of participants screened positive for psychological distress. The prevalences of probable depression, anxiety and bipolar/mania were 33.1 %, 28.2 % and 31.2 %, respectively. In adjusted models, female gender, insufficient sleep, lack of physical activity and exposure to bullying were associated with increased odds of psychological distress; longer sleep was protective. History of mental health conditions was a strong predictor of probable depression, whereas medication use was protective. Older age and higher paternal education were protective for anxiety. Bullying was the most consistent predictor across all symptom clusters. Conclusions: Psychological distress is highly prevalent among Makkah high-school students. Key determinants include gender, sleep duration, lack of physical activity and bullying. Routine school‑based mental health screening, sleep‑hygiene education, anti‑bullying initiatives and early referral pathways are warranted. Further research should examine and validate GHQ‑30 item clusters for specific disorders.

Abstract: Background: Local vaccine manufacturing is being pursued across Africa to improve pandemic preparedness and reduce reliance on imports. In Nigeria, where COVID-19 vaccines were largely imported, willingness to accept locally produced vaccines is important for sustainable domestic production. The objective of this study was to estimate willing-ness to accept a locally manufactured COVID-19 vaccine among adults in Lagos, Nigeria, and to identify demographic predictors. Methods: We conducted a cross-sectional survey of adults in Lagos State using a questionnaire administered in four open-air markets. The primary outcome was willingness to accept a COVID-19 vaccine manufactured in Nigeria (yes/no). We summarized respondent characteristics, tested bivariate associations with chi-square, and estimated adjusted odds ratios (AORs) using multivariable logistic regression. Model calibration and discrimination were assessed using Hosmer-Lemeshow testing and the area under the ROC curve (AUC). Results: Of 388 consenting respondents, 335 provided complete data (86.3%). 75.8% reported willingness to accept a Nigerian-made COVID-19 vaccine. Willingness differed by age group (p=0.0028; trend p=0.0002) and religion (p=0.0403). In adjusted models, respondents aged 45-54 years (AOR 6.54; 95% CI 1.73-24.79) and 55-64 years (AOR 4.97; 95% CI 1.05-23.55) had higher odds of acceptance than those aged 18-24 years. Christian affiliation was associated with lower odds than Muslim affiliation (AOR 0.41; 95% CI 0.20-0.83). Discrimination was acceptable (AUC 0.75; 95% CI 0.69-0.80). Conclusions: Most respondents were willing to accept a Nigerian-made COVID-19 vaccine, suggesting demand-side readiness. Confidence-building strategies tailored to younger adults and implemented with faith-based and community institutions may support uptake of locally produced vaccines.

Abstract: Background: Psoriasis is a chronic, systemic and immune-mediated disease that affects over 60 million people worldwide. Although phototherapy is a safe and effective treatment, its demanding thrice-weekly clinical regimen imposes a significant treatment burden that can disrupt the patient’s life narratives. Despite its clinical importance, little is known about how patients navigate the logistical and emotional complexities of this therapy within specialised nursing-led units. Objective: To explore the lived experiences, disease management strategies, and healthcare expectations of patients with psoriasis undergoing phototherapy. Methods: A descriptive phenomenological design was adopted. Between 2019 and 2022, purposive and exhaustive sampling was used to recruit 72 participants receiving treatment at a specialised nursing-led phototherapy unit in a tertiary hospital in Spain. Data were collected through semi-structured interviews and analysed using inductive thematic content analysis supported by NVivo 12 Pro. Results: Eleven subtopics emerged within four main thematic areas: (1) Knowledge about the disease and treatment options: A striking dichotomy exists between a well-recognised psychological burden and a persistent lack of awareness regarding systemic physical comorbidities and biological therapies; (2) Triggers of the disease and flare-ups: Psychological stress was identified as the primary driver of disease activity, overshadowing secondary external factors; (3) Functional and logistical stressors: The rigorous frequency of sessions creates an "adherence-stress cycle," where the effort to maintain therapeutic continuity paradoxically generates the stress that exacerbates clinical flares, leading to profound biographical disruption and a perceived incapacity to fulfil professional and family roles; (4) Healthcare expectations and systemic barriers: Participants identified diagnostic delays and inequities in the financing of supportive care, manifesting as a collective demand for a permanent professional nursing referent to act as an anchor for integrated care. Conclusions: Phototherapy functions as a "double-edged sword" where clinical efficacy frequently conflicts with the logistical rigour of the treatment. Clinical skin clearance is insufficient if the biographical and systemic gaps remain unaddressed. This investigation advocates for a paradigm shift toward integrated care models where specialised dermatology nurses provide the necessary clinical navigation to support patients "beyond the surface" of the disease.

Abstract: Burden of diseases measured as disability-adjusted life years per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias amongst the highest contributors to the burden; that drug use disorders and colorectal cancer are showing worsening trends and require health promotion and disease prevention measures from ages 15 and 25 respectively, especially in Aberdeen City; and that males are more vulnerable to atrial fibrillation and flutter, diabetes mellitus and oesophageal cancer, while females are to cerebrovascular disease. We demonstrate the usefulness of our analysis and methodology for the wider health system, allowing targeted medical research investments and coordinated response from public health and health service delivery. We also show the need for up-to-date surveillance data, forecasts and evidence on the impact of interventions to be made available widely.

Abstract: The incidence of insulin resistance and its complications is rising across societies worldwide, making its treatment a significant economic challenge. The disease is multifactorial, and its pathophysiology varies accordingly. Genetic factors, aging, and coexisting diseases are major contributors to its development. Among the coexisting conditions are autoimmune diseases and other conditions requiring treatment with therapeutic agents, some of which can induce insulin resistance. Research indicates that the free radical theory plays a significant role in initiating this complex cycle and in shaping the full clinical picture of diabetes syndrome. In this work, we discuss the pathophysiology of insulin resistance, the role of free radicals in its etiology, and drug treatments for diseases that may contribute to insulin resistance. We also explore the antioxidant effects of vitamin D and oral hypoglycemic agents, as well as their notable adverse effects, including cobalamin (vitamin B12) deficiency. A total of 147 scientific studies, including comprehensive meta-analyses, have been selected to address these questions and have been analyzed and discussed objectively to minimize scientific bias and confusion. This narrative work will help doctors and primary health caregivers envision the dimensions of diabetes syndrome from multiple perspectives and update their knowledge about the significance of vitamin D as an effective tool to combat insulin resistance

Abstract: Objectives: The study aim was to investigate the relationship between oral hygiene behaviors, periodontal awareness, and self-reported periodontal symptoms among adults using a questionnaire and an internally consistent awareness scoring system. Materials and Methods: A cross-sectional questionnaire study was conducted for adults aged 18-65 years. The dataset comprised 412 respondents, of whom 386 questionnaires were complete and eligible for analysis. The survey included sociodemographic variables, toothbrushing frequency and duration, interdental cleaning, mouthrinse use, smoking, dental attendance patterns, previous periodontal treatment history, awareness of common periodontal signs, and self-reported symptoms. Awareness scores were calculated on a 0-20 scale. Descriptive statistics, chi-square analysis, one-way ANOVA, post hoc Tukey tests, and multivariable logistic regression were used with p< 0.05. Results: Mean age was 31.8 +- 9.6 years; 58.0% of participants were women. Twice-daily toothbrushing was reported by 56.0%, while 38.6% used interdental cleaning aids. The mean periodontal awareness score was 12.7 +- 3.8. Higher awareness scores were observed among respondents with university education, regular dental attendance, and interdental cleaning habits (p< 0.001). Gingival bleeding was the most frequently reported symptom (47.4%), followed by dentin hypersensitivity (33.9%) and halitosis (29.8%). In multivariable analysis, irregular dental attendance, current smoking, and absence of interdental cleaning independently increased the odds of reporting at least one periodontal symptom. Conclusions: Within the limits of this survey-based study, better oral hygiene behaviors and regular preventive dental attendance were associated with stronger periodontal awareness and a lower burden of self-reported periodontal symptoms. Public-health strategies in periodontology should address not only knowledge deficits but also the translation of knowledge into daily plaque-control behavior.

Abstract: Objective: To identify demographic, clinical, and behavioural determinants of COVID-19 vaccination and antiviral uptake in Australia using the Capability, Opportunity, Motivation - Behaviour (COM-B) framework with psychometric validation and LASSO-enhanced variable selection. Methods: Cross-sectional analysis of the 2024 KAB BREATHE survey (n=5,177) of Australian adults, intentionally enriched for risk-stacked (more than 1 chronic condition). Primary outcomes included 2023/2024 COVID-19 booster receipt, future vaccine intentions, vaccine/antiviral beliefs and antiviral uptake. Predictors included demographics, chronic conditions, and domain-specific leave-one-out (LOO) COM-B scores standardised to mean=0, SD=1. COM-B domains were assessed using Cronbach’s alpha. Univariate and multivariable logistic regression models were complemented by LASSO penalised logistic regression with 10-fold cross-validation. Results: Mean age was 51.5 years (SD 16.5); 61.4% were female; 70.3% were risk-stacked. Booster uptake declined sharply from 50.8% (2023) to 19.1% (2024). Cronbach’s alpha showed poor internal consistency for Capability (α=0.006) and Opportunity (α=−0.383) but acceptable for full Motivation (α=0.78). In adjusted models, age (aOR 1.02–1.03 per year), medically associated risk factors (aOR 1.66–3.51), and tertiary education (aOR 1.34–1.79) consistently predicted higher uptake and intention. Renting (aOR 0.59–0.78) and current employment (likely inversely associated with age) (aOR 0.73–0.83) were associated with lower uptake across all vaccine outcomes. Adding LOO COM-B scores substantially improved model fit (e.g., 2024 booster AUC 0.73→0.83); Motivation per SD was the strongest predictor (aOR 2.44–4.94 for vaccine outcomes, 1.52–2.49 for antivirals). LASSO models achieved CV-AUCs of 0.78–0.87. Among COVID-positive respondents (n=2,576), only 15.2% received antiviral treatment. Conclusions: Age, clinical risk, and socioeconomic factors, particularly housing tenure and employment status are key drivers of COVID-19 preventive behaviours (either positively or negatively). The COM-B framework, when corrected for circular prediction and validated via Cronbach’s alpha and LASSO, provides substantial explanatory value. Targeted interventions should address structural barriers faced by renters and younger, employed individuals while leveraging high motivation among older adults and clinically vulnerable groups. Implications for Public Health: These findings support a shift from knowledge-based campaigns towards equity-focused, multi-level public health strategies that address structural barriers to COVID-19 vaccination and antiviral access in Australia.

Abstract: Travel-associated Legionnaires’ disease (TALD) investigations in hotels generate extensive environmental monitoring data. However, the occupational implications for workers who operate, maintain, clean, or inspect the same systems are rarely assessed. We developed a hybrid framework integrating a semi-quantitative environmental hazard model with deterministic Quantitative Microbial Risk Assessment (QMRA). In the first model, culture concentration bands were combined with physicochemical deviation indicators (temperature, free residual chlorine, and pH) to derive point-level hazard (Hi) and zone-level hazard (Hz). In the second model, a job-based presence matrix was combined with zone-specific serogroup-based severity using a simplified World Health Organization (WHO)-style 3×3 likelihood–severity approach. L. pneumophila (≥50 CFU/L) was detected in 29.94% of water samples and was significantly associated with low chlorine (<0.2 mg/L; RR 2.90) and hot water temperature <50 °C (RR 3.00). To enhance precision, QMRA was applied to estimate the daily inhaled dose (d) for 15 worker groups, indicating variability in modeled biological exposure across occupational categories. These findings suggest that occupational risk is shaped by the combined effect of pathogen concentration and exposure time. Under the hazard model, the highest zone-level hazard estimate was observed in kitchens and food and beverage (F&B) areas (Hz = 2.607), followed by machinery rooms (Hz= 2.022) and guest rooms (Hz= 1.874). These findings support the integration of worker protection into water safety management, particularly in areas and groups overlooked in routine investigations.

Abstract: Background: Globally, over 2.1 billion people lack safe drinking water, leading to significant impacts, especially from diarrhea. This study evaluates the health and economic impacts of point-of-use water filter distribution in an urban setting with partial water infrastructure. Methods: In 2024 and 2025, households (N=7,973) in Ciudad Victoria, Mexico, re-ceived a hollow fiber membrane point-of-use water filter and basic WASH training. A pseudo-randomized study design was used to assign household to receive one of three different filter implementation systems (tap, bucket, or squeeze). Baseline and follow-up surveys with each household were conducted over an 8–14 week time frame. Results: Filter utilization was high across all three delivery types, with only minor differences in outcomes observed. Self-reported two-week diarrhea prevalence de-clined from 24.3% at baseline to 3.1% at 8–14 weeks, with similar reductions in oth-er health symptoms. Household water expenditures decreased by 56%, and work-days missed due to diarrhea declined by 94%. Impacts were similar in covariate ad-justed statistical models. Conclusions: This study suggests that point-of-use filtration combined with WASH training can substantially reduce illness and economic burden in urban contexts, with effectiveness comparable across different filter implementation approaches. Limitations include reliance on self-reported data and a short follow-up period, which should be explored in future studies.

Abstract: University students face dietary transitions shaped by time constraints, campus food environments, and intensive exposure to food-related content on social media, yet the mechanisms linking digital exposure to observable food choices and overall diet quali-ty remain insufficiently modeled in Latin American contexts. This study examined whether social-media-driven food norms (NI) and in-restaurant food choices (CD) se-quentially mediate the effect of Instagram (IG) and TikTok (TK) exposure on overall diet quality (Y), while incorporating physical activity (PA) as an independent predic-tor. A cross-sectional survey was administered to 615 university students consuming in campus restaurants in La Libertad, Northern Peru. Data were analyzed through PLS-SEM (SmartPLS 4) with 5,000 bootstrap resamples and BCa 95% confidence in-tervals; Y was operationalized through a culturally adapted KIDMED index. All five structural hypotheses were supported: TK → NI (β = 0.479) exceeded IG → NI (β = 0.349); NI → CD (β = 0.473) and PA → CD (β = 0.216) operated as independent path-ways; and CD → Y (β = 0.255) confirmed the distal link. NI fully mediated both digital pathways toward food choices. Diet quality in university restaurants is reconfigured primarily through normative, not informational, digital mechanisms, suggesting norm-based interventions over nutrition-information campaigns.

Abstract: Background: Gender equity is an increasingly relevant dimension in psychosocial risk assessment within Organisational seĴings. This pilot study examines the integration of a Perceived Gender Disparity subscale into the Organisational and Psychosocial Risk Assessment (OPRA) inventory in an Italian manufacturing sample (N = 65). Methods: The five-item subscale, grounded in the literature on workplace gender discrimination and harassment, underwent reliability analysis (Cronbach’s α = 0.706), bivariate correlations (Pearson’s r), Exploratory Factor Analysis (EFA), and non-parametric sensitivity analysis (Spearman’s ρ). Results: results indicate statistically significant associations with seven of nine OPRA subscales: a large correlation with Role (r = 0.508, p < 0.001), medium-sized associations with Organisational Culture, Workload, Quality of Relationships, and Career Development (|r| = 0.331–0.427, p ≤ 0.007), and small-to-medium associations with Environment and Safety and Autonomy (|r| = 0.268–0.275, p < 0.05). No significant associations emerged for Working Hours or Work–Life Balance. Spearman’s correlations confirmed and strengthened all significant associations. EFA revealed a unidimensional structure with adequate loadings (λ = 0.475–0.785), accounting for 41.90% of common variance. Conclusions: Despite the limitations of a single-site, male-dominated sample, findings provide preliminary support for including perceived gender disparity as a source of Organisational risk within the OPRA framework.

Abstract: Background/Objectives: Operational Assistants (OAs), as non-teaching staff responsible for playground supervision and school hygiene, play a vital role in ensuring safe and well-organized school environments. Despite their importance, research on their working conditions, job satisfaction, and well-being remains limited. This study aims to examine the quality of work life (QoWL) and job satisfaction (JS) of OAs in public schools in the Municipality of Setúbal, Portugal, and to explore their relationship with absenteeism. Methods: A quantitative research design was adopted using a survey questionnaire administered to Operational Assistants (N = 119). Data were collected on QoWL, job satisfaction, and absenteeism indicators to assess patterns and relationships among these variables. Results: Findings indicate that OAs experience significant challenges related to working conditions and health risks, which are associated with higher levels of absenteeism. Nonetheless, many participants report valuing the stability associated with public-sector employment. Conclusions: The results highlight the need for targeted interventions, including improved working conditions, enhanced training, and mental health support, to reduce absenteeism and promote employee well-being. This study contributes to a better understanding of an often-overlooked workforce and offers practical implications for policymakers and school administrators aiming to foster more supportive and sustainable school environments.

Abstract: Zucchelli and Smith [1] described a biomathematical fatigue model for recreational passage-making — the Integrated Fatigue Model (IFM) — with output expressed as a blood-alcohol-concentration (BAC) equivalence anchored on Dawson and Reid [2]. The IFM reproduces the dose-response using simpler linear extrapolations for multi-day fatigue accumulation and a simpler pre-departure accounting; Zucchelli and Smith marked 48 hours as the primary validation horizon. This paper extends the scientific treatment to multi-day offshore passage-making: transits of 48 hours and longer, non-rested departures, and short-handed watch-rotation choices. The engine is rebuilt on the McCauley–Ramakrishnan unified model [3-5] — a two-state framework with fast homeostatic S and slow allostatic L — and recalibrated against the Dawson–Reid 17 h / 24 h anchors so the BAC output of Zucchelli and Smith [1] is preserved. Maritime tuning combines sea-state [6] and fragmentation [7] effects multiplicatively on the sleep time constant, yielding effective τ_s from 4.9 h (calm + deep at sea) to 25.5 h (storm + fragmented); the 4.2 h shore-laboratory baseline is not reachable at sea in the current calibration. A combinatorial consequence — the circadian-burden-distribution property of crew-rotation cycles whose length is coprime with the crew size — formalises the effectiveness of the Swedish watch system.

Abstract: The COVID-19 pandemic highlighted the interplay between metabolic health and infectious disease outcomes, with conditions such as obesity, insulin resistance, micronutrient deficiencies, endothelial dysfunction, and sarcopenia associated with increased risk of severe illness and mortality. This study synthesizes evidence from immunology, metabolic medicine, clinical nutrition, microbiome research, and public health to examine the role of nutrition in supporting resilience in the post-COVID (“Meta-COVID”) context. Mechanistic pathways, including inflammatory signaling (e.g., NF-κB, NLRP3), immune regulation, mitochondrial function, and gut-lung axis interactions, are reviewed to illustrate how nutritional status may influence host defense. Key nutrients, including vitamin D, zinc, selenium, vitamin C, and omega-3 fatty acids, are discussed for their roles in modulating immune and inflammatory responses. Dietary patterns such as the Mediterranean diet are associated with improved metabolic health, reduced inflammation, and enhanced microbiome diversity. In addition, adequate protein intake and resistance exercise are considered important for mitigating sarcopenia and supporting immune function. The findings suggest that integrating nutritional strategies into clinical and public health frameworks may contribute to improved resilience against infectious and chronic diseases.

Abstract: Background: Substance Use Disorder (SUD) is characterized by recurrent craving episodes frequently associated with emotional dysregulation and altered reward processing. This study aimed to evaluate whether emotional states associated with craving episodes can be detected through automated facial emotion recognition during controlled emotional induction. Methods: Forty-one participants completed a 14-day ecological momentary assessment (EMA) monitoring anxiety and craving levels, followed by an emotional induction task using standardized stimuli from the EmoMadrid database and addiction-related images. Facial expressions were recorded and analyzed in real time using a computational facial emotion recognition model trained on the FER-2013 dataset. Results: Participants with SUD exhibited significantly reduced positive emotional valence and activation in response to positive stimuli compared with HC (p &lt; 0.01). Item-level analyses revealed that most differences occurred in stimuli depicting social interactions. Positive emotions and energy were linked to less intense cravings and shorter substance use. People with SUD showed more fear and less disgust in their facial expressions than controls (p = 0.02). Conclusions: These results suggest that people with SUD have changes in how they process emotions, showing less response to positive things and unique facial expressions related to craving.

Abstract: High consumption of ultra-processed foods (UPFs) contributes to the growing burden of non-communicable disease, yet many consumers struggle to recognise and interpret levels of processing. Digital tools using artificial intelligence (AI) offer potential to support nutrition literacy and UPF awareness. This study explored user perceptions, usability and cultural relevance of a Human Interference Scoring System (HISS)-based mobile application designed to classify foods and support reflection on food quality and dietary choices. A qualitative study was conducted in New Zealand, where participants used the HISS app for three days followed by semi-structured interviews. Thirty-one participants were recruited via social media and word of mouth, including adolescents (n=13), tertiary students (n=9), and Māori and Pacific health coaches (n=9). Transcripts were analysed using inductive thematic analysis. Three evaluative categories were identified: positive user experiences (intuitive interface, perceived AI accuracy, enhanced nutrition literacy, visual feedback, inclusivity of cultural foods); challenges (technical issues, database gaps, limited depth for advanced users); and suggested improvements (expanded food database, enhanced logging, culturally tailored education, optional advanced features). Participants reported increased awareness of UPF intake and reflection on food choices. The HISS app was perceived as usable, acceptable and relevant across diverse user groups, particularly for those with lower nutrition literacy. Addressing technical limitations and expanding functionality may enhance engagement and applicability. AI-enabled, culturally responsive food classification tools such as HISS show promise as scalable health promotion approaches to support UPF awareness and dietary reflection in community and clinical settings.

Abstract: Background: Retained surgical items (RSIs) remain preventable never events associated with failures in counting processes, communication, documentation, and perioperative safety culture. Although patient safety in the operating room has been widely studied in healthcare teams, evidence remains limited regarding how these competencies are developed during undergraduate surgical instrumentation training, particularly in Latin American settings. Objective. To assess knowledge, safe practices, and perceived safety culture related to RSI prevention among surgical instrumentation students in clinical training at a university in Barranquilla, Colombia. Methods. A quantitative cross-sectional study was conducted among students in advanced semesters of a Surgical Instrumentation program. Data were collected through a structured, self-administered questionnaire that included sociodemographic characteristics, knowledge of RSI prevention, safe perioperative practices, perceived safety culture, and need for further training. The instrument showed good internal consistency (Cronbach’s alpha = 0.88) in the 48 completed questionnaires analyzed. Descriptive statistics were calculated for all variables. Because of sample size and ordinal outcomes, Mann-Whitney U, Kruskal-Wallis H, and Spearman’s rho were used. Results. A total of 48 complete questionnaires were analyzed. Mean age was 21.10 years (SD 2.25), and 75.0% of participants were women. Global knowledge scores were high (mean 8.60/9; SD 0.92), with ceiling effects across several items. Safe practices (mean 4.58/5; SD 0.63) and safety culture (mean 4.67/5; SD 0.49) were also high overall. However, lower-performing items were institutional count documentation, verification during staff handovers, and requesting a formal count pause. Knowledge scores were significantly higher among students reporting prior training in count/recording procedures (p=0.018). The strongest association was a moderate positive correlation between safety culture and safe practices (rho=0.520; p<0.001). Conclusions. Surgical instrumentation students showed strong theoretical knowledge and favorable self-reported preventive practices regarding RSI prevention. Nonetheless, important gaps persisted in handover verification, institutional documentation, and count-pause activation. The positive association between safety culture and safe practices suggests that undergraduate perioperative education should integrate technical counting skills with structured communication, supervision, teamwork, and speaking-up behaviors.

Abstract: Accurate reconstruction of epidemic dynamics is challenging when reported infection data are incomplete or affected by significant under-reporting. Excess mortality indicators provide an alternative source of information that can be used to infer epidemic trajectories. In this study, we propose a regularized inverse calibration framework for a SEIRD epidemi-ological model using excess mortality data. The calibration problem is formulated as an inverse problem and stabilized through a Gaussian functional regularization that constrains the admissible epidemic trajectories. This approach reduces sensitivity to noise in mortality observations and prevents oscillatory solutions typically associated with ill-posed param-eter estimation. The model is numerically integrated using a fourth-order Runge–Kutta scheme and calibrated against mortality data from Catalonia. Cross-context validation is further performed using mortality data from Ecuador to assess the structural robust-ness of the approach. The results show that the regularized calibration produces smooth and epidemiologically consistent epidemic trajectories while maintaining agreement with observed mortality patterns. The proposed framework provides a robust methodology for reconstructing epidemic dynamics from mortality indicators and may contribute to improved epidemiological surveillance in situations where case reporting is limited or unreliable.