A transversal cross-sectional study of factors related to HPV vaccination status and cancer screening participation among French women aged 25-40
In 2020, uterine cervical cancer (UCC) was the 12th most common cancer among women in France and the 4th worldwide. French health authorities wanted to increase Human Papilloma Virus (HPV) vaccination and screening rates. There were still many barriers to these measures among young women, their families, and health professionals and teachers. Between 2014 and 2019, international studies found inconsistent effects of HPV vaccination on UCC screening. In 2022, a survey was conducted among women aged 25 to 40 in the Nord-Pas-de-Calais region to assess participation 1) in HPV vaccination and its barriers, 2) in UCC screening as a function of HPV vaccination status.
Horizontal gene transfer of the Mer operon is associated with large effects on the transcriptome and increased tolerance to mercury in nitrogen-fixing bacteria
Mercury (Hg) is highly toxic and has the potential to cause severe health problems for humans and foraging animals when transported into edible plant parts. Soil rhizobia that form symbiosis with legumes may possess mechanisms to prevent heavy metal translocation from roots to shoots in plants by exporting metals from nodules or compartmentalizing metal ions inside nodules. Horizontal gene transfer has potential to confer immediate de novo adaptations to stress. We used comparative genomics of high quality de novo assemblies to identify structural differences in the genomes of nitrogen-fixing rhizobia that were isolated from a mercury (Hg) mine site that show high variation in their tolerance to Hg.
Elevated plasma neurofilament light was associated with multi-modal neuroimaging features in Alzheimer's disease signature regions and predicted future tau deposition
Neurofilament Light (NfL) is a biomarker for early neurodegeneration in Alzheimer's disease (AD). This study aims to examine the association between plasma NfL and multi-modal neuroimaging features across the AD spectrum and whether NfL predicts future tau deposition.
Intersectional socioeconomic disparities in continuous smoking through pregnancy among pre-pregnant smokers in Sweden between 2006 and 2016
While well-established associations exist between socioeconomic conditions and smoking during pregnancy (SDP), less is known about social disparities in the risk of continuous SDP. Intersectional analyses that consider multiple social factors simultaneously can offer valuable insight for planning smoking cessation interventions.
Prevalence of skin diseases among elderly prisoners in Taiwan: an examination of skin health in prison
Although prisoner health is a topic of significant importance, it has received limited attention in epidemiological studies, likely due to challenges in obtaining data. Therefore, this study aimed to investigate the prevalence of skin diseases among elderly prisoners in Taiwan.
Efficacy of relational agents for loneliness across age groups: a systematic review and meta-analysis
Loneliness is a serious public health concern. Although previous interventions have had some success in mitigating loneliness, the field is in search of novel, more effective, and more scalable solutions. Here, we focus on "relational agents", a form of software agents that are increasingly powered by artificial intelligence and large language models (LLMs). We report on a systematic review and meta-analysis to investigate the impact of relational agents on loneliness across age groups.
Experiences with implementing advance care planning (ACP-GP) in Belgian general practice in the context of a cluster RCT: a process evaluation using the RE-AIM framework
General practice is often recommended as an ideal setting to initiate advance care planning (ACP), but uptake of ACP in this setting is low. ACP-GP is a complex intervention to facilitate ACP for patients with chronic, life-limiting illness in Belgian general practice. It aims to increase patient ACP engagement and general practitioner (GP) ACP self-efficacy. In a cluster-randomized controlled trial, the intervention was not superior to control in increasing these outcomes. A parallel process evaluation aimed to enhance understanding of how the intervention was implemented, and which factors might have influenced trial results.
Positive public attitudes towards agricultural robots
Robot technologies could lead to radical changes in farming. But what does the public know and think about agricultural robots? Recent experience with other agricultural technologies-such as plant genetic engineering-shows that public perceptions can influence the pace and direction of innovation, so understanding perceptions and how they are formed is important. Here, we use representative data from an online survey (n = 2269) to analyze public attitudes towards crop farming robots in Germany-a country where new farming technologies are sometimes seen with skepticism. While less than half of the survey participants are aware of the use of robots in agriculture, general attitudes are mostly positive and the level of interest is high. A framing experiment suggests that the type of information provided influences attitudes. Information about possible environmental benefits increases positive perceptions more than information about possible food security and labor market effects. These insights can help design communication strategies to promote technology acceptance and sustainable innovation in agriculture.
Novel genomic variants related to visceral adiposity index (VAI) and body adiposity index (BAI) in Indian sib-pairs
Obesity is among the leading public health threats globally. Over the last few years, visceral adiposity index (VAI), and body adiposity index (BAI), derived from anthropometric, and biochemical measures, have gained importance as a measure of obesity. However, unlike other common indices like body mass index, and waist circumference, the genetic predisposition of VAI, and BAI under-examined.
The association between infectious agents and breast cancer: a review of the epidemiologic evidence
Several viruses have been casually linked to human cancers, including cervical, nasopharyngeal, liver, sarcoma, and Merkel cell carcinomas. However, the etiologic contribution of viral infections to breast cancer, the number one incident cancer among women worldwide, is not well established. Among studies exploring associations of viruses with breast cancer, potential linkages have been identified between breast cancer and five viruses: beta retrovirus, (i.e., mouse mammary tumor virus), human papillomavirus, Epstein Barr virus. bovine leukemia virus, and human cytomegalovirus.
Reduced dynamic changes in pulmonary artery compliance during isometric handgrip exercise in patients with heart failure
Exercise intolerance is a debilitating symptom in heart failure (HF), adversely affecting both quality of life and long-term prognosis. Emerging evidence suggests that pulmonary artery (PA) compliance may be a contributing factor. This study aims to non-invasively assess PA compliance and its dynamic properties during isometric handgrip (HG) exercise in HF patients and healthy controls, using cardiovascular magnetic resonance (CMR). We prospectively enrolled 36 subjects, comprising 17 HF patients (NYHA class II and III) and 19 healthy controls. Participants performed an HG test, and we assessed changes in PA compliance and hemodynamic flow parameters using advanced CMR techniques. We also explored the relationship between CMR-derived PA compliance metrics and established clinical indicators, ensuring the validity of our findings through intra- and interobserver agreements. HF patients had significantly lower resting PA compliance compared to controls (28.9% vs. 50.1%, p < 0.01). During HG exercise, HF patients exhibited a dampened adaptability in PA compliance. Hemodynamic responses, including heart rate and blood pressure, were not significantly different between the groups. Further analyses revealed a significant correlation between changes in PA compliance and functional capacity, and an inverse relationship with NYHA class. Our study demonstrates a marked difference in PA vascular responses during HG exercise between HF patients and healthy controls. The compromised adaptability in PA compliance in HF patients is correlated with diminished functional capacity. These findings have significant clinical implications and may guide future interventional strategies in HF management.
Urological outcomes in adult females born with anorectal malformation or Hirschsprung disease
Women born with anorectal malformation (ARM) or Hirschsprung disease (HD) may have impaired urologic function resulting in sequelae in adulthood. This study assessed and compared self-reported urinary outcomes in adult females born with ARM or HD to a reference population.
Modulation of the Meisenheimer complex metabolism of nitro-benzothiazinones by targeted C-6 substitution
Tuberculosis, caused by Mycobacterium tuberculosis, remains a major public health concern, demanding new antibiotics with innovative therapeutic principles due to the emergence of resistant strains. Benzothiazinones (BTZs) have been developed to address this problem. However, an unprecedented in vivo biotransformation of BTZs to hydride-Meisenheimer complexes has recently been discovered. Herein, we present a study of the influence of electron-withdrawing groups on the propensity of HMC formation in whole cells for a series of C-6-substituted BTZs obtained through reductive fluorocarbonylation as a late-stage functionalization key step. Gibbs free energy of reaction and Mulliken charges and Fukui indices on C-5 at quantum mechanics level were found as good indicators of in vitro HMC formation propensity. These results provide a first blueprint for the evaluation of HMC formation in drug development and set the stage for rational pharmacokinetic optimization of BTZs and similar drug candidates.
Universal eye screening: perinatal risk factors and ocular abnormalities in 1795 newborns not meeting retinopathy of prematurity criteria
This prospective cohort study aimed to investigate the ocular outcomes of universal eye screening in newborns and assess the relationship between different perinatal risk factors and various ocular abnormalities in infants who do not meet the criteria for retinopathy of prematurity (ROP) screening.
Comparative genomics of quinolone-resistant Escherichia coli from broilers and humans in Norway
The usage of fluoroquinolones in Norwegian livestock production is very low, including in broiler production. Historically, quinolone-resistant Escherichia coli (QREC) isolated from Norwegian production animals rarely occur. However, with the introduction of a selective screening method for QREC in the Norwegian monitoring programme for antimicrobial resistance in the veterinary sector in 2014; 89.5% of broiler caecal samples and 70.7% of broiler meat samples were positive. This triggered the concern if there could be possible links between broiler and human reservoirs of QREC. We are addressing this by characterizing genomes of QREC from humans (healthy carriers and patients) and broiler isolates (meat and caecum).
The limited role of serum neurofilament light chain in predicting pain severity of patients with diabetic polyneuropathy
Pain is one of many complaints expressed by patients with diabetic polyneuropathy. However, no objective measure for pain severity has been available. Neurofilament light chains have been widely used for assessing axonal damage in the neuronal system. Hence, we sought to investigate whether neurofilament light chains can serve as a marker reflecting pain severity in diabetic polyneuropathy. We enrolled the patients with diabetic polyneuropathy. Serum concentrations of neurofilament light chain were then measured using a single-molecule array. Pain severity was evaluated using painDETECT and the Brief Pain Inventory. Moreover, laboratory results including, serum creatinine, HbA1c, and glomerular filtration rate. A correlation test was used to analyze each variable. A total of 42 patients were enrolled. Neurofilament light chain levels were unable to reflect current neuropathic pain severity. However, high levels of neurofilament light chain were a significant predictor of poor diabetes control (r = 0.41; p = 0.02) and kidney damage (r = 0.45; p = 0.01). Serum levels of neurofilament light chain could not reflect current pain severity but was strongly associated with kidney dysfunction and poor diabetes control. Other biomarkers that could predict pain severity need to be uncovered.
Cost-effectiveness of single-pill and separate-pill administration of antihypertensive triple combination therapy: a population-based microsimulation study
Single-pill combination (SPC) of three antihypertensive drugs has been shown to improve adherence to therapy compared with free combinations, but little is known about its long-term costs and health consequences. This study aimed to evaluate the lifetime cost-effectiveness profile of a three-drug SPC of an angiotensin-converting enzyme inhibitor, a calcium-channel blocker, and a diuretic vs the corresponding two-pill administration (a two-drug SPC plus a third drug separately) from the Italian payer perspective.
Efficient deep learning-based automated diagnosis from echocardiography with contrastive self-supervised learning
Advances in self-supervised learning (SSL) have enabled state-of-the-art automated medical image diagnosis from small, labeled datasets. This label efficiency is often desirable, given the difficulty of obtaining expert labels for medical image recognition tasks. However, most efforts toward SSL in medical imaging are not adapted to video-based modalities, such as echocardiography.
Genome-wide analysis of wheat xyloglucan endotransglucosylase/hydrolase (XTH) gene family revealed TaXTH17 involved in abiotic stress responses
Environmental stresses, including high salinity and drought, severely diminish wheat yield and quality globally. The xyloglucan endotransglucosylase/hydrolase (XTH) family represents a class of cell wall-modifying enzymes and plays important roles in plants growth, development and stress adaptation. However, systematic analyses of XTH family genes and their functions under salt and drought stresses have not been undertaken in wheat.
Epidemic modelling suggests that in specific circumstances masks may become more effective when fewer contacts wear them
The effectiveness of non-pharmaceutical interventions to control the spread of SARS-CoV-2 depends on many contextual factors, including adherence. Conventional wisdom holds that the effectiveness of protective behaviours, such as wearing masks, increases with the number of people who adopt them. Here we show in a simulation study that this is not always true.
The use of diagnostic ultrasound by primary care physicians in Switzerland - a cross-sectional study
Diagnostic ultrasound has become a bedside tool widely available to many primary care physicians (PCPs) in Europe. It is often used as point-of-care ultrasonography (POCUS) in this setting. In Switzerland, certain POCUS examinations are listed as learning objectives in existing ultrasound training programs (we defined these examinations as swissPOCUS = sPOCUS). Ultrasound performed by PCPs can lead to faster diagnostic workup and reduce referral to secondary care units. However, adequate training is crucial to guarantee high quality. To guide the development of ultrasound training programs for PCPs, this study explores the use of ultrasound in primary care in Switzerland.
Development and validation of a nomogram for breast cancer-related lymphedema
To establish and validate a predictive model for breast cancer-related lymphedema (BCRL) among Chinese patients to facilitate individualized risk assessment. We retrospectively analyzed data from breast cancer patients treated at a major single-center breast hospital in China. From 2020 to 2022, we identified risk factors for BCRL through logistic regression and developed and validated a nomogram using R software (version 4.1.2). Model validation was achieved through the application of receiver operating characteristic curve (ROC), a calibration plot, and decision curve analysis (DCA), with further evaluated by internal validation. Among 1485 patients analyzed, 360 developed lymphedema (24.2%). The nomogram incorporated body mass index, operative time, lymph node count, axillary dissection level, surgical site infection, and radiotherapy as predictors. The AUCs for training (N = 1038) and validation (N = 447) cohorts were 0.779 and 0.724, respectively, indicating good discriminative ability. Calibration and decision curve analysis confirmed the model's clinical utility. Our nomogram provides an accurate tool for predicting BCRL risk, with potential to enhance personalized management in breast cancer survivors. Further prospective validation across multiple centers is warranted.
Obesity, abdominal obesity, metabolic obesity phenotypes, and Helicobacter pylori infection: results from NHANES 1999-2000
Recent studies on the association between Helicobacter pylori (H. pylori) infection and obesity have reported conflicting results. Therefore, the purpose of our study was to investigate the association of obesity, abdominal obesity, and metabolic obesity phenotypes with H. pylori infection.
Exploring the impacts of risk factors on mortality patterns of global Alzheimer's disease and related dementias from 1990 to 2021
Alzheimer's Disease and Related Dementias (ADRD) affect millions of people worldwide, with mortality rates influenced by several risk factors and exhibiting significant heterogeneity across geographical regions. This study aimed to investigate the impact of risk factors on global ADRD mortality patterns from 1990 to 2021, utilizing clustering and modeling techniques. Data on ADRD mortality rates, cardiovascular disease, and diabetes prevalence were obtained for 204 countries from the GBD platform. Additional variables such as HDI, life expectancy, alcohol consumption, and tobacco use prevalence were sourced from the UNDP and WHO. All the data were extracted for men, women, and the overall population. Longitudinal k-means clustering and generalized estimating equations were applied for data analysis. The findings revealed that cardiovascular disease had significant positive effects of 1.84, 3.94, and 4.70 on men, women, and the overall ADRD mortality rates, respectively. Tobacco showed positive effects of 0.92, 0.13, and 0.39, while alcohol consumption had negative effects of - 0.59, - 9.92, and - 2.32, on men, women, and the overall ADRD mortality rates, respectively. The countries were classified into five distinct subgroups. Overall, cardiovascular disease and tobacco use were associated with increased ADRD mortality rates, while moderate alcohol consumption exhibited a protective effect. Notably, tobacco use showed a protective effect in cluster A, as did alcohol consumption in cluster B. The effects of risk factors on ADRD mortality rates varied among the clusters, highlighting the need for further investigation into the underlying causal factors.
Random survival forest for predicting the combined effects of multiple physiological risk factors on all-cause mortality
Understanding the combined effects of risk factors on all-cause mortality is crucial for implementing effective risk stratification and designing targeted interventions, but such combined effects are understudied. We aim to use survival-tree based machine learning models as more flexible nonparametric techniques to examine the combined effects of multiple physiological risk factors on mortality. More specifically, we (1) study the combined effects between multiple physiological factors and all-cause mortality, (2) identify the five most influential factors and visualize their combined influence on all-cause mortality, and (3) compare the mortality cut-offs with the current clinical thresholds. Data from the 1999-2014 NHANES Survey were linked to National Death Index data with follow-up through 2015 for 17,790 adults. We observed that the five most influential factors affecting mortality are the tobacco smoking biomarker cotinine, glomerular filtration rate (GFR), plasma glucose, sex, and white blood cell count. Specifically, high mortality risk is associated with being male, active smoking, low GFR, elevated plasma glucose levels, and high white blood cell count. The identified mortality-based cutoffs for these factors are mostly consistent with relevant studies and current clinical thresholds. This approach enabled us to identify important cutoffs and provide enhanced risk prediction as an important basis to inform clinical practice and develop new strategies for precision medicine.
Age, comorbidity burden and late presentation are significant predictors of hospitalization length and acute respiratory failure in patients with influenza
Influenza viruses are responsible for a high number of infections and hospitalizations every year. In this study, we aimed to identify clinical and host-specific factors that influence the duration of hospitalization and the progression to acute respiratory failure (ARF) in influenza. We performed an analysis of data from a prospective active influenza surveillance study that was conducted over five seasons (2018/19 to 2022/23). A total of 1402 patients with influenza were included in the analysis, the majority of which (64.5%) were children (under 18 years), and 9.1% were elderly. At least one chronic condition was present in 29.2% of patients, and 9.9% of patients developed ARF. The median hospital stay was 4 days (IQR: 3, 6 days). The most important predictors of prolonged hospital stay and development of ARF were extremes of age (infants and elderly), presence of chronic diseases, particularly the cumulus of at least 3 chronic diseases, and late presentation to hospital. Among the chronic diseases, chronic obstructive pulmonary disease, cardiovascular disease, cancer, diabetes, obesity, and chronic kidney disease were strongly associated with a longer duration of hospitalization and occurrence of ARF. In this context, interventions aimed at chronic disease management, promoting influenza vaccination, and improving awareness and access to health services may contribute to reducing the impact of influenza not only in Romania but globally. In addition, continued monitoring of the circulation of influenza viruses is essential to limit their spread among vulnerable populations.
Impact of non-emergency surgical timing on postoperative recovery quality in mild or asymptomatic SARS-CoV-2 infected patients: a grouped cohort study
To explore the relationship between the timing of non-emergency surgery in mild or asymptomatic SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infected individuals and the quality of postoperative recovery from the time of confirmed infection to the day of surgery.
Presurgical management of ulnar nerve entrapment in patients with and without diabetes mellitus
Diabetes mellitus (DM) is a risk factor for the development of ulnar nerve entrapment (UNE). Differences in surgical outcomes for UNE between patients with and without DM have been reported, but studies on presurgical management are scarce. This study aimed to evaluate the presurgical management of UNE in patients with (DM diagnosis < 2 years of UNE diagnosis) and without DM regarding the level of care for diagnosis and the proportion that proceeds to surgery. Data from 6600 patients with UNE between 2004 and 2019 were included from the Skåne Health Care Register (SHR) and cross-linked with data from the Swedish National Diabetes Register (NDR). The group with UNE and DM was compared to the group with UNE without DM and prevalence ratios were calculated using Cox regression analysis. Patients with DM more often got their first UNE diagnosis in secondary care than in primary care (643/667, 96% vs. 5361/5786; 93%). Patients with and without DM, regardless of the type of DM, presence of retinopathy, or HbA1c levels, were surgically treated for UNE to the same extent (258/667, 39% of patients with DM vs. 2131/5786, 37% of patients without DM). The proportion of surgically treated was significantly lower among patients diagnosed with UNE in primary care compared to secondary care (59/449, 13% vs. 2330/5786, 38%). Men were more often surgically treated than women (1228/3191, 38% vs.1161/3262 36%). Patients with UNE and DM are surgically treated to the same extent as patients with UNE but without DM and are more likely to be diagnosed in specialized care.
HIV and gender identity expression among transfeminine people in the Western Cape, South Africa - a thematic analysis of data from the HPTN 071 (PopART) trial
Transfeminine people in South Africa have a high HIV risk due to structural, behavioural, and psychosocial factors. Transfeminine people and feminine identifying men who have sex with men (MSM) are often conflated or grouped with transgender or MSM categories in HIV service programming, although they don't necessarily identify as either. We aimed to investigate gender expression among feminine identifying people who were assigned male at birth. We examined how local conceptualizations of sexuality and gender intersect with the key population label of 'transgender' imported into local HIV programming.
A health economic pilot study comparing two diabetic retinopathy screening strategies
To compare two screening strategies for diabetic retinopathy (DR), and to determine the health-economic impact of including optical coherence tomography (OCT) in a regular DR screening. This cross-sectional study included a cohort of patients (≥ 18 years) with type 1 or 2 diabetes mellitus (T1D or T2D) from a pilot DR screening program at Oslo University Hospital, Norway. A combined screening strategy where OCT was performed in addition to fundus photography for all patients, was conducted on this cohort and compared to our existing sequential screening strategy. In the sequential screening strategy, OCT was performed on a separate day only if fundus photography indicated diabetic macular edema (DME). The presence of diabetic maculopathy on fundus photography and DME on OCT was determined by two medical retina specialists. Based on the prevalence rate of diabetic maculopathy and DME from the pilot, we determined the health-economic impact of the two screening strategies. The study included 180 eyes of 90 patients. Twenty-seven eyes of 18 patients had diabetic maculopathy, and of these, 7 eyes of 6 patients revealed DME on OCT. When diabetic maculopathy was absent on fundus photographs, OCT could not reveal DME. Accordingly, 18 patients (20%) with diabetic maculopathy would have needed an additional examination with OCT in the sequential screening strategy, 6 (33%) of whom would have had DME on OCT. In an extended healthcare perspective analysis, the cost of the sequential screening strategy was higher than the cost of the combined screening strategy. There was a weak association between diabetic maculopathy on fundus photography and DME on OCT. The health economic analysis suggests that including OCT as a standard test in DR screening could potentially be cost-saving.
Prevalence of stunting and its correlates among children under 5 in Afghanistan: the potential impact of basic and full vaccination
Child stunting is prevalent in low and middle-income countries (LMICs), but an information gap remains regarding its current prevalence, correlates, and the impact of vaccination against this condition in Afghanistan. This study aimed to determine the prevalence and correlates of moderate and severe stunting and the potential impact of basic and full vaccination among children under five in Afghanistan.
Validation of the Hungarian version of the 6-item turnover intention scale among elderly care workers
This research examines the psychometric characteristics and reliability of the 6-item turnover intention scale (TIS-6) by Bothma and Roodt (SA J Hum Resour Manag 11:a507, 2013) on a Hungarian sample. The internal validity of the TIS-6 was assessed using data from 269 Hungarian elderly care institution workers. Confirmatory factor analysis was performed to analyse the structural validity. Convergent and discriminant validity were examined with questions on job characteristics and using the Maslach Burnout Inventory and Effort-Reward Imbalance Scale. IBM SPSS 28.0 software was used for the statistical analysis, and the results were considered significant at p < 0.05. The internal consistency of the questionnaire's scale proved to be acceptable (α = 0.826). Convergent validity was confirmed by the relationships between the components of the questionnaire and burnout (r = 0.512; p < 0.001; r = 0.419; p < 0.001) and workplace stress (r = 0.565; p < 0.001; r = 0.310; p < 0.001). There were significant differences between the TIS-6 scores among the groups with different degrees of burnout (p < 0.001), which indicated adequate discriminant validity of the questionnaire. The structural validity of the questionnaire was acceptable, and the scale questions fit well. The Hungarian version of the TIS-6 scale is a valid and reliable tool for assessing turnover intention among elderly care institution workers in Hungary.
Infectivity of Plasmodium parasites to Aedes aegypti and Anopheles stephensi mosquitoes maintained on blood-free meals of SkitoSnack
Aedes and Anopheles mosquitoes are responsible for tremendous global health burdens from their transmission of pathogens causing malaria, lymphatic filariasis, dengue, and yellow fever. Innovative vector control strategies will help to reduce the prevalence of these diseases. Mass rearing of mosquitoes for research and support of these strategies presently depends on meals of vertebrate blood, which is subject to acquisition, handling, and storage issues. Various blood-free replacements have been formulated for these mosquitoes, but none of these replacements are in wide use, and little is known about their potential impact on competence of the mosquitoes for Plasmodium infection.
Using real-time modelling to inform the 2017 Ebola outbreak response in DR Congo
Important policy questions during infections disease outbreaks include: i) How effective are particular interventions?; ii) When can resource-intensive interventions be removed? We used mathematical modelling to address these questions during the 2017 Ebola outbreak in Likati Health Zone, Democratic Republic of the Congo (DRC). Eight cases occurred before 15 May 2017, when the Ebola Response Team (ERT; co-ordinated by the World Health Organisation and DRC Ministry of Health) was deployed to reduce transmission. We used a branching process model to estimate that, pre-ERT arrival, the reproduction number was (95% credible interval ). The risk of further cases occurring without the ERT was estimated to be 0.97 (97%). However, no cases materialised, suggesting that the ERT's measures were effective. We also estimated the risk of withdrawing the ERT in real-time. By the actual ERT withdrawal date (2 July 2017), the risk of future cases without the ERT was only 0.01, indicating that the ERT withdrawal decision was safe. We evaluated the sensitivity of our results to the estimated value and considered different criteria for determining the ERT withdrawal date. This research provides an extensible modelling framework that can be used to guide decisions about when to relax interventions during future outbreaks.
Effects of a blood-free mosquito diet on fitness and gonotrophic cycle parameters of laboratory reared Anopheles gambiae sensu stricto
The current rise of new innovative tools for mosquito control, such as the release of transgenic mosquitoes carrying a dominant lethal gene and Wolbachia-based strategies, necessitates a massive production of mosquitoes in the insectary. However, currently laboratory rearing depends on vertebrate blood for egg production and maintenance. This practice raises ethical concerns, incurs logistical and cost limitations, and entails potential risk associated with pathogen transmission and blood storage. Consequently, an artificial blood-free diet emerges as a desirable alternative to address these challenges. This study aims to evaluate the effects of a previously formulated artificial blood-free diet (herein referred to as BLOODless) on Anopheles gambiae (An. gambiae s.s.; IFAKARA) gonotrophic parameters and fitness compared with bovine blood.
Association of preserved ratio impaired spirometry with mortality and cardiovascular diseases: a systematic review and meta-analysis
Preserved ratio impaired spirometry (PRISm) is a type of abnormal lung function. PRISm and mortality have been explored in several studies, but a comprehensive evaluation of the associations is limited. The current study aims to conduct a systematic review and meta-analysis in order to investigate the mortality and cardiovascular diseases in patients with PRISm.
Prevalence, antibiogram and molecular characterization of Listeria monocytogenes from ruminants and humans in New Valley and Beheira Governorates, Egypt
Listeriosis is a global health threat to both animals and humans, especially in developing countries. This study was designed to isolate Listeria monocytogenes from faeces; environmental samples; and cow, sheep and goat milk, as well as human stool, to study its molecular characteristics and antibiotic sensitivity in the New Valley and Beheira Governorates, Egypt. The isolation and identification of L. monocytogenes were carried out using traditional culture and biochemical methods, followed by antibiography, genus confirmation of some isolates and detection and sequencing of InlB genes via PCR.
Secondary attack rate following on-site isolation of patients with suspected COVID-19 in multiple-bed rooms
The implementation of isolation precautions for patients with suspected Coronavirus Disease 2019 (COVID-19) and pending test results is resource intensive. Due to the limited availability of single-bed rooms at our institution, we isolated patients with suspected COVID-19 together with patients without suspected COVID-19 on-site in multiple-bed rooms until SARS-CoV-2-test results were available. We evaluated the likelihood of SARS-CoV-2 transmission to individuals sharing the room with patients isolated on-site. This observational study was performed at the University Hospital Basel, Switzerland, from 03/20 - 11/20. Secondary attack rates were compared between patients hospitalized in multiple-bed rooms and exposed to individuals subjected to on-site isolation precautions (on-site isolation group), and patients exposed to individuals initially not identified as having COVID-19, and not placed under isolation precautions until the diagnosis was suspected (control group). Transmission events were confirmed by whole-genome sequencing. Among 1,218 patients with suspected COVID-19, 67 (5.5%) tested positive for SARS-CoV-2. Of these, 21 were isolated on-site potentially exposing 27 patients sharing the same room. Median contact time was 12 h (interquartile range 7-18 h). SARS-CoV-2 transmission was identified in none of the patients in the on-site isolation group vs. 10/63 (15.9%) in the control group (p = 0.03). Isolation on-site of suspected COVID-19-patients in multiple-bed rooms avoided single-room occupancy and subsequent in-hospital relocation for many patients without confirmed SARS-CoV-2-infection. The absence of secondary transmission among the exposed patients in the on-site isolation group allows for assessment of the risk/benefit ratio of this strategy given the limitation of a small sample size.
The effectiveness and safety of acupoint herbal patching for allergic rhinitis: protocol for a systematic review and meta-analysis
Allergic rhinitis (AR) is a common inflammatory disease of the nasal mucosa that is characterized by symptoms such as sneezing, nasal congestion, nasal itching, and rhinorrhoea. In recent years, acupoint herbal patching (AHP) therapy has gained a growing interest as a potential management option for AR. This systematic review and meta-analysis will evaluate the clinical research evidence on the effectiveness and safety of AHP as a treatment option for AR outside of the Sanfu or Sanjiu days (summer or winter solstice). The results of this review will provide up-to-date evidence-based guidance for healthcare providers and individuals seeking alternative treatments for AR.
The mediating role of ego depletion in the relationship between state anxiety and academic procrastination among University students
The issue of academic procrastination is highly prevalent among university students. It not only has a deterimental effect on students' academic performance but also poses a risk to their physical and mental well-being. Anxiety, as a negative emotion, has attracted researchers' attention in relation to academic procrastination. Research indicates a correlation between state anxiety and academic procrastination, but the underlying mechanisms that drive this association remain unclear. When individuals experience ego-depletion, it can lead to psychological exhaustion, subsequently leading to procrastination. Gender role conceptions, shaped by sociocultural and psychological mechanisms, have profound implications on individuals' cognition, emotions, and behaviors. This study primarily aims to explore the relationship between state anxiety and academic procrastination among university students, with a particularly focus on the mediating role of ego-depletion and the moderating role of gender. A survey using the State Anxiety Scale, Ego-Depletion Scale, and Irrational Procrastination Scale was administered to 3370 undergraduates. State anxiety shows positive correlations with ego depletion and academic procrastination (r = 0.665, p < 0.01; r = 0.491, p < 0.01), while ego depletion is also positively linked to academic procrastination (r = 0.500, p < 0.01). State anxiety serves as a positive predictor of academic procrastination, with a confidence interval of 95% [0.626, 0.696]; additionally, ego depletion partially mediates the relationship between state anxiety and academic procrastination, with a confidence interval of 95% [0.168, 0.251]. Gender acts as a moderator in directly predicting the impact of state anxiety on academic procrastination and in the latter stage of mediating the effect of ego depletion. State anxiety can significantly and positively predict academic procrastination among university students. Ego-depletion partially mediates the relationship between state anxiety and academic procrastination. The direct predictive effect of state anxiety on academic procrastination, as well as the mediating role of ego-depletion, is moderated by gender. This provides educators and university students themselves with reference for addressing the issue of academic procrastination.
Beyond the diagnosis of drug-resistant Tuberculosis in Norway: patients' experiences before, during and after treatment
This study aims to explore the varied experiences of patients with drug-resistant tuberculosis in Norway. The study emphasizes challenges and implications of being diagnosed with drug-resistant tuberculosis, including the impact on psychosocial health during the diagnosis, disease, treatment, isolation and recovery phases. Norway is a low endemic country of tuberculosis. Most patients are immigrants, and some of them have recently arrived in the country. Patients undergoing treatment for drug-resistant tuberculosis endure prolonged and demanding treatment that could affect their psychosocial health.
Comparative effectiveness of mesenchymal stem cell versus bone-marrow mononuclear cell transplantation in heart failure: a meta-analysis of randomized controlled trials
There is no clear evidence on the comparative effectiveness of bone-marrow mononuclear cell (BMMNC) vs. mesenchymal stromal cell (MSC) stem cell therapy in patients with chronic heart failure (HF).
Effect of in-line filtration in newborns: study protocol of the Intravenous Neonatal Central Access Safety (INCAS) randomized controlled trial
Particulate contamination due to infusion therapy (administration of parenteral nutrition and medications) carries a potential health risk for infants in neonatal intensive care units (NICUs). This particulate consists of metals, drug crystals, glass fragments, or cotton fibers and can be generated by drug packaging, incomplete reconstitution, and chemical incompatibilities. In-line filters have been shown to remove micro-organisms, endotoxin, air, and particles in critically ill adults and older infants, but its benefits in newborn remain to be demonstrated. Moreover, 50% of inflammatory episodes in the setting of NICUs are blood culture-negative. These episodes could be partly related to the presence of particles in the infusion lines.
Clinical application of plasma P-tau217 to assess eligibility for amyloid-lowering immunotherapy in memory clinic patients with early Alzheimer's disease
With the approval of disease-modifying treatments (DMTs) for early Alzheimer's disease (AD), there is an increased need for efficient and non-invasive detection methods for cerebral amyloid-β (Aβ) pathology. Current methods, including positron emission tomography (PET) and cerebrospinal fluid (CSF) analysis, are costly and invasive methods that may limit access to new treatments. Plasma tau phosphorylated at threonine-217 (P-tau217) presents a promising alternative, yet optimal cutoffs for treatment eligibility with DMTs like aducanumab require further investigation. This study evaluates the efficacy of one- and two-cutoff strategies for determining DMT eligibility at the Butler Hospital Memory & Aging Program (MAP).
Risk factors for postpartum readmission: a prediction model in Iranian pregnant women
Postpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran.
Human health risk assessment of heavy metals in vegetables of Bangladesh
This study aims to evaluate the heavy metal concentration in fifteen species of vegetables as well as associated health risk. Atomic absorption spectrometry is used to assess heavy metals. The mean concentrations of Pb, Cd, Cr, Ni and Fe in vegetables were 4.78, 0.713, 9.266, 0.083, 5.06 mg/kg/fw exceeding the reference value of FAO/WHO indicating unsafe to consumption. Based on principal component analysis, the Pb, Cr, Ni and Fe are from same sources. Health risk was estimated in terms of estimated daily intake (EDI), target hazard quotient, hazard index (HI) and cancer risk (CR). The EDI values of metals except Cr were found to be lower than maximum tolerable daily intake (MTDI). The total THQs of metals were > 1 indicating non-carcinogenic health risk. The individual HI values for vegetables except potato (0.831) and total HI values were found to be > 1 (94.747). The TCR of Pb, Cd and Cr were > 1.0E-04 which indicating carcinogenic risk. Fruit and pod vegetables contribute much in carcinogenic risk for Pb and Cr whereas fruit, root and stems vegetables for Cd. The study revealed potential human health risk associated with the consumption of different types of vegetables in Bangladeshi adult population that might assist the regulatory bodies to develop new strategies to minimize the risk to human.
Molecular and serological prevalence of Leptospira spp. among slaughtered cattle and associated risk factors in the Bahr El Ghazal region of South Sudan
Leptospirosis is a neglected emerging and zoonotic disease reported worldwide. This study sought to determine the molecular and serological prevalence of Leptospira spp. and the associated risk factors in slaughtered cattle from the Bahr El Ghazal region of South Sudan.
Targeted axillary dissection reduces residual nodal disease in clinically node- positive breast cancer after neoadjuvant chemotherapy
Any advantage of performing targeted axillary dissection (TAD) compared to sentinel lymph node (SLN) biopsy (SLNB) is under debate in clinically node-positive (cN+) patients diagnosed with breast cancer. Our objective was to assess the feasibility of the removal of the clipped node (RCN) with TAD or without imaging-guided localisation by SLNB to reduce the residual axillary disease in completion axillary lymph node dissection (cALND) in cN+ breast cancer.
A multifaceted risk management program to improve the reporting rate of patient safety incidents in primary care: a cluster-randomised controlled trial
While patient safety incident reporting is of key importance for patient safety in primary care, the reporting rate by healthcare professionals remains low. This study aimed to assess the effectiveness of a risk management program in increasing the reporting rate within multiprofessional primary care facilities.
Comprehensive insights into health services accessibility and quality of life of families with individuals with 22q11.2 deletion syndrome in Brazil
The 22q11.2 Deletion Syndrome (22q11.2 DS) presents unique healthcare challenges for affected individuals, families, and healthcare systems. Despite its rarity, 22q11.2 DS is the most common microdeletion syndrome in humans, emphasizing the need to understand and address the distinctive healthcare requirements of those affected. This paper examines the multifaceted issue of health service access and caregivers' quality of life in the context of 22q11.2 DS in Brazil, a condition with diverse signs and symptoms requiring multidisciplinary care. This study employs a comprehensive approach to evaluate health service accessibility and the quality of life of caregivers of individuals with 22q11.2 DS. It utilizes a structured Survey and the WHOQOL-bref questionnaire for data collection.
Understanding health literacy in men: a cross-sectional survey
Males have a shorter life expectancy than females. Men are less likely to seek the advice of a health professional or utilise preventive health services and programs. This study seeks to explore health literacy and the characteristics affecting this among Australian men.
Diagnostic efficiency of intravoxel incoherent motion-based virtual magnetic resonance elastography in pulmonary neoplasms
The aim of the study were as below. (1) To investigate the feasibility of intravoxel incoherent motion (IVIM)-based virtual magnetic resonance elastography (vMRE) to provide quantitative estimates of tissue stiffness in pulmonary neoplasms. (2) To verify the diagnostic performance of shifted apparent diffusion coefficient (sADC) and reconstructed virtual stiffness values in distinguishing neoplasm nature.
Adjusting the 15-method to Danish general practice: identification of barriers, facilitators, and user needs
The 15-method is an opportunistic screening and brief intervention tool for alcohol-related problems in primary healthcare. A Danish feasibility study of the 15-method indicated that adjustments were needed to improve its contextual fit to Danish general practice. This adjustment process was conducted in two parts. The first part focused on identifying barriers, facilitators, and user needs for addressing alcohol using the 15-method. The second part will address the identified barriers and user needs to finalize a Danish version of the method. This study reports on part one of the adjustment process.
Study protocol for an adaptive, multi-arm, multi-stage (MAMS) randomised controlled trial of brief remotely delivered psychosocial interventions for people with serious mental health problems who have experienced a recent suicidal crisis: Remote Approaches to Psychosocial Intervention Delivery (RAPID)
People with serious mental health problems (SMHP) are more likely to be admitted to psychiatric hospital following contact with crisis services. Admissions can have significant personal costs, be traumatic and are the most expensive form of mental health care. There is an urgent need for treatments to reduce suicidal thoughts and behaviours and reduce avoidable psychiatric admissions.
The ten-year evaluation of clinical characteristics in congenital lung anomaly in pediatrics; a retrospective study in North of Iran
Congenital lung anomalies (CLA) are a group of anomalies, including congenital cystic adenomatoid malformation (CCAM), bronchopulmonary sequestrations (BPS), congenital lobar emphysema (CLE), and bronchogenic cysts (BC). The prevalence of these rare anomalies has risen in recent years, according to various population-based studies due to advances in fetal ultrasound technology.
Efficacy and safety of chloroquine plus primaquine for the treatment of Plasmodium vivax malaria in Hamusit site, Northwestern Ethiopia
Plasmodium vivax malaria is still an important public health problem in Ethiopia. Unlike Plasmodium falciparum, P. vivax has a dormant liver stage (hypnozoite) that can be a risk of recurrent vivax malaria unless treated by radical cure with primaquine. Drug resistance to chloroquine is threatening malaria control and elimination efforts. This study assessed the therapeutic efficacy and safety of chloroquine plus 14 days of primaquine on P. vivax infection based on parasitological, clinical, and haematological parameters.
Comparison of remimazolam tosilate and propofol during induction and maintenance of general anesthesia in patients undergoing laparoscopic cholecystectomy: a prospective, single center, randomized controlled trial
Remimazolam tosilate (RT) is a new, ultrashort-acting benzodiazepine. Here, we investigated the efficacy and safety of RT for general anesthesia in patients undergoing Laparoscopic Cholecystectomy (LC).
Faith and vaccination: a scoping review of the relationships between religious beliefs and vaccine hesitancy
Throughout history, vaccines have proven effective in addressing and preventing widespread outbreaks, leading to a decrease in the spread and fatality rates of infectious diseases. In a time where vaccine hesitancy poses a significant challenge to public health, it is important to identify the intricate interplay of factors exemplified at the individual and societal levels which influence vaccination behaviours. Through this analysis, we aim to shed new light on the dynamics of vaccine hesitancy among religious groups, contributing to the broader effort to promote vaccine uptake, dispel misunderstandings, and encourage constructive dialogue with these groups.
The edutainment program on knowledge, perception, and uptake of cervical cancer screening among Muslim women in Southern Thailand: a quasi experimental study
Cervical cancer is a significant global health concern and is the third most common cancer in women. Owing to their religious beliefs, Muslim women in Thailand are less likely to be screened for cervical cancer.
Impact of the COVID-19 pandemic on extended-spectrum β-lactamase producing Escherichia coli in urinary tract and blood stream infections: results from a nationwide surveillance network, Finland, 2018 to 2022
Before the COVID-19 pandemic there has been a constant increase in antimicrobial resistance (AMR) of Escherichia coli, the most common cause of urinary tract infections and bloodstream infections. The aim of this study was to investigate the impact of the COVID-19 pandemic on extended-spectrum β-lactamase (ESBL) production in urine and blood E. coli isolates in Finland to improve our understanding on the source attribution of this major multidrug-resistant pathogen.
Reliability, validity and minimal detectable change of the Chinese Version of the Assessment of Physical Activity in Frail Older People (APAFOP-C)
Physical activity (PA) is essential in mitigating frailty syndrome, and it is necessary to measure PA in older adults with frailty. Assessment of Physical Activity in Frail Older People (APAFOP) is a suitable patient-reported outcome measure (PROM) for assessing PA among older adults with frailty. This study aimed to determine the reliability, validity and minimal detectable change of the Chinese version of the APAFOP (APAFOP-C).
Development and validation of machine learning models to predict MDRO colonization or infection on ICU admission by using electronic health record data
Multidrug-resistant organisms (MDRO) pose a significant threat to public health. Intensive Care Units (ICU), characterized by the extensive use of antimicrobial agents and a high prevalence of bacterial resistance, are hotspots for MDRO proliferation. Timely identification of patients at high risk for MDRO can aid in curbing transmission, enhancing patient outcomes, and maintaining the cleanliness of the ICU environment. This study focused on developing a machine learning (ML) model to identify patients at risk of MDRO during the initial phase of their ICU stay.
Relationship between oral hypofunction and salivary biomarkers in older adults: a cross-sectional study
Oral health problems have increased among older adults. Oral hypofunction is characterized by seven signs and symptoms: oral uncleanness, oral dryness, decline in occlusal force, decline in the movement function of the tongue and lips, decline in tongue pressure, decline in masticatory function, and decline in swallowing function, the latter being a significant risk factors for oral frailty. Recent research has suggested that salivary biomarkers can be used to assess not only oral diseases, including dental caries and periodontitis, but also systemic diseases, such as cancer and diabetes mellitus. This cross-sectional study investigated the relationship between oral hypofunction and the levels of salivary biomarkers.
Prevalence of anxiety symptoms in infertile men: a systematic review and meta-analysis
Infertility in men causes problems in various aspects of their lives, including personal, family and social life. One of the most important of these problems is anxiety. Anxiety in infertile men can affect their health, quality of life, and response to treatment, highlighting the significance of anxiety in these men. Thus, this systematic review and meta-analysis was conducted to investigate the prevalence of anxiety symptoms in infertile men.
Association between the nutritional quality of food purchases and household food at home expenditures in Mexico
Poor-quality diets are a major risk factor for non-communicable diseases. Few studies in Mexico have tested whether higher expenditures are needed to purchase high quality food.
Molecular and diffusion features for identification of clinically significant prostate cancer in PI-RADS 3 lesions
The recommendation to perform biopsy of PIRADS 3 lesions has not been adopted with strength as compared to higher scored lesions on multiparametric MRI. This represents a challenging scenario and an unmet need for clinicians to apply a risk adapted approach in these cases. In the present study, we examined clinical and radiologic characteristics in men with PI-RADS 3 index lesions that can predict csPCa on mpMRI-target biopsy.
Corrigendum to "Effectiveness of COVID-19 vaccines administered in the 2023 autumnal campaigns in Europe: results from the VEBIS primary care test-negative design study, September 2023-January 2024" [Vaccine 42(19) (2024)]
Exploring the impact of a digital health tool on patients' interaction with community pharmacists: A pilot randomized controlled study
The use of digital Patient- Reported Outcomes (PRO) tools has been shown to enhance the exchange of information and shared decision-making in medical encounters. However, their influence on patient-pharmacist interactions has not yet been explored.
Prevalence and incidence of skin tear in older adults：A systematic review and meta-analysis
Skin tear (ST) is a public health problem in older adults; they substantially increase the risk of complications and cause serious adverse consequences and health care burden.
Facilitators and Barriers to Medicaid Doula Benefit Implementation in California: Perspectives From Managed Care Plans and Risk-Bearing Organizations
Medicaid coverage of doula services is increasing as a policy strategy to reduce maternal health inequities in the United States. However, early adopter states struggled to offer accessible, equitable Medicaid doula benefits when implementation began. California began covering doula services through its Medicaid program, Medi-Cal, in 2023. Managed care plans (MCPs) and risk-bearing organizations (RBOs) play an important role in ensuring pregnant and birthing people can access doula support through Medicaid benefits.
Cost-effectiveness of recombinant influenza vaccine compared with standard dose influenza vaccine in adults 18-64 years of age
The Advisory Committee on Immunization Practices (ACIP) uses the Evidence to Recommendations Framework that includes cost-effectiveness analyses (CEA) for determining vaccine recommendations. ACIP's preference for protecting adults ≥ 65 years is enhanced vaccines, including recombinant influenza vaccine (RIV4), adjuvanted or high dose influenza vaccine. Less is known about the CEA of enhanced vaccines for younger adults.
Differential Target Multiplexed Spinal Cord Stimulation: A UK Cost-Effectiveness Analysis
The aim of this economic analysis was to evaluate the cost-effectiveness of differential target multiplexed spinal cord stimulation (DTM-SCS) for treating chronic intractable low back pain, compared with conventional spinal cord stimulation (C-SCS) and conservative medical management (CMM), by updating and expanding the inputs for a previously published cross-industry model.
Feasibility of transperineal minimal invasive surgery when performing sacrectomy for advanced primary and recurrent pelvic malignancies
This study aimed to clarify the efficacy and safety of minimally invasive transabdominal surgery (MIS) with transperineal minimal invasive surgery (tpMIS) for sacrectomy in advanced primary and recurrent pelvic malignancies.
Spinal Cord Stimulator Inequities Within the US Military Health System
Although studies have described inequities in spinal cord stimulation (SCS) receipt, there is a lack of information to inform system-level changes to support health care equity. This study evaluated whether Black patients exhaust more treatment options than do White patients, before receiving SCS.
Hearing intervention and cognitive decline: the ACHIEVE trial - Authors' reply
Germany's role in global health at a critical juncture
In 2017, we set out-along with a larger group of authors-to assess Germany's contribution and potential leadership role in global health. We considered the ambitions and manifold efforts of Chancellor Angela Merkel's administration to become a trusted leader in global health governance and a reliable supporter of multilateral institutions, especially WHO. Based on the recommendations of our 2017 paper, in this Review we determine whether the country has indeed lived up to its vision and ambitions expressed in the Global Health Strategy adopted by the cabinet in 2020. Also, we outline what challenges Germany is now facing in a more complex global health environment and geopolitical situation, where leadership in the field is being redefined following the impact of the COVID-19 pandemic and amid broader shifts in the international order.
SIRT1-mediated tunnelling nanotubes may be a potential intervention target for arsenic-induced hepatocyte senescence and liver damage
Arsenic, a widespread environmental poison, can cause significant liver damage upon exposure. Mitochondria are the most sensitive organelles to external factors. Dysfunctional mitochondria play a crucial role in cellular senescence and liver damage. Tunnelling nanotubes (TNTs), membrane structures formed between cells, with fibrous actin (F-actin) serving as the scaffold, facilitate mitochondrial transfer between cells. Notably, TNTs mediate the delivery of healthy mitochondria to damaged cells, thereby mitigating cellular damage. Although limited studies have suggested that F-actin may be modulated by the longevity gene SIRT1, the association between arsenic-induced liver damage and this mechanism remains unexplored. The findings of the current study indicate that arsenic suppresses SIRT1 and F-actin in the rat liver and MIHA cells, impeding the formation of TNTs and mitochondrial transfer between MIHA cells, thereby playing a pivotal role in mitochondrial dysfunction, cellular senescence and liver damage induced by arsenic. Notably, increasing SIRT1 levels effectively mitigated liver mitochondrial dysfunction and cellular senescence triggered by arsenic, highlighting SIRT1's crucial regulatory function. This research provides novel insights into the mechanisms underlying arsenic-induced liver damage, paving the way for the development of targeted preventive and therapeutic drugs to address arsenic-induced liver damage.
A gold standard dataset and evaluation of methods for lineage abundance estimation from wastewater
During the SARS-CoV-2 pandemic, genome-based wastewater surveillance sequencing has been a powerful tool for public health to monitor circulating and emerging viral variants. As a medium, wastewater is very complex because of its mixed matrix nature, which makes the deconvolution of wastewater samples more difficult. Here we introduce a gold standard dataset constructed from synthetic viral control mixtures of known composition, spiked into a wastewater RNA matrix and sequenced on the Oxford Nanopore Technologies platform. We compare the performance of eight of the most commonly used deconvolution tools in identifying SARS-CoV-2 variants present in these mixtures. The software evaluated was primarily chosen for its relevance to the CDC wastewater surveillance reporting protocol, which until recently employed a pipeline that incorporates results from four deconvolution methods: Freyja, kallisto, Kraken 2/Bracken, and LCS. We also tested Lollipop, a deconvolution method used by the Swiss SARS-CoV-2 Sequencing Consortium, and three additional methods not used in the C-WAP pipeline: lineagespot, Alcov, and VaQuERo. We found that the commonly used software Freyja outperformed the other CDC pipeline tools in correct identification of lineages present in the control mixtures, and that the VaQuERo method was similarly accurate, with minor differences in the ability of the two methods to avoid false negatives and suppress false positives. Our results also provide insight into the effect of the tiling primer scheme and wastewater RNA extract matrix on viral sequencing and data deconvolution outcomes.
Mortality risk in patients with anti-MDA5 antibody-positive dermatomyositis: A risk assessment
Concepts for the development of person-centred, digitally-enabled, Artificial Intelligence-assisted ARIA care pathways (ARIA 2024)
The traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be experts in their own life based on their lived experiences. Improving healthcare safety, quality and coordination, as well as quality of life, are important aims in the care of patients with chronic conditions. Person-centred care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (i) digital care pathways for rhinitis and asthma multimorbidity and (ii) digitally-enabled person-centred care (1). It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally-enabled, patient-centred care. The paper includes (i) Allergic Rhinitis and its Impact on Asthma (ARIA), a two-decade journey, (ii) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (iii) mHealth impact on airway diseases, (iv) from guidelines to digital care pathways, (v) embedding Planetary Health, (vi) novel classification of rhinitis and asthma, (vi) embedding real-life data with population-based studies, (vii) the ARIA-EAACI strategy for the management of airway diseases using digital biomarkers, (viii) Artificial Intelligence, (ix) the development of digitally-enabled ARIA Person-Centred Care and (x) the political agenda. The ultimate goal is to propose ARIA 2024 guidelines centred around the patient in order to make them more applicable and sustainable.
Teeth and alveolar bones as tracers of metals and radionuclides in inhabitants of a uranium region
Biodosimetry can define risks in inhabitants of areas with potential contaminants, ensuring environmental protection and living conditions due to toxic and radioactive effects. This study aimed to evaluate metals and radionuclides in dental structures and alveolar bones in residents of a uranium area in Paraíba and Pernambuco, Brazil. Eighty-nine specimens were pulverized, fractionated, and chemically prepared for analysis by EDXRF, FAAS, and ICP-MS. Levels of Ca, Cu, Fe, Si, Mn, Ni, Pb, Sr, Ti, V, Zn, K, Mn, Th, and U were investigated. Higher concentrations were measured for Ca, with an average of 272,986.4 mg.kg. Ni presented in lower concentrations, with an average of 30.4 mg.kg. For U, concentrations ranged from 1.5 to 145.0 mg.kg, with more than 27% of the samples above the reference value of 8.1 μg.kg. For Th, almost 38% of the results were above the limit of 3.5 μg.kg. In the bone spicules, the contents of U and Th ranged from 45.1 to 1,451.2 μg.kg and from 7.5 to 78.4 μg.kg, in this order. The levels of radionuclides were more expressive for the teeth collected in São José do Sabugi, suggesting contamination through food and water consumption. In the bone spicules, the levels of U were up to 179 times higher than the safety limit. The results indicate a possible risk of contamination with probable induced radiobiological effects.
The Evolution of Science and Regulation of Dietary Supplements: Past, Present, and Future
Dietary supplement use in the United States is widespread and increasing, especially among certain population groups, such as older Americans. The science surrounding dietary supplements has evolved substantially over the last few decades since their formal regulation in 1994. Much has been learned about the mechanisms of action of many dietary supplement ingredients, but the evidence on their health effects is still building. As is true of much nutrition research, there are many studies that point to health effects, but not all are at the level of scientific evidence (e.g., randomized controlled interventions), rigor, or quality needed for definitive statements of efficacy regarding clinical endpoints. New technologies and approaches are being applied to the science of dietary supplements, including nutrigenomics and microbiome analysis, data science, artificial intelligence, and machine learning - all of which can elevate the science behind dietary supplements. Products can contain an array of bioactive compounds derived from foods as well as from medicinal plants, which creates enormous challenges in data collection and management. Clinical applications, particularly those aimed at providing personalized nutrition options for patients, have become more sophisticated as dietary supplements are incorporated increasingly into clinical practice and self-care. The goals of this paper are to provide historical context for the regulation and science of dietary supplements, identify research resources, and suggest some future directions for science in this field.
Cardiovascular disease risk after a SARS-CoV-2 infection: a systematic review and meta-analysis
To our knowledge, there is no systematic review examining CVD risks after a SARS-CoV-2 infection over time, while also taking into account disease severity. All evidence on the risk for pulmonary embolism (PE), myocardial infarction (MI), ischaemic stroke (IS), haemorrhagic stroke (HS), and arterial thrombosis following infection was evaluated.
Analyzing the use of non-pharmaceutical personal protective measures through self-interest and social optimum for the control of an emerging disease
Non-pharmaceutical personal protective (NPP) measures such as face masks use, and hand and respiratory hygiene can be effective measures for mitigating the spread of aerosol/airborne diseases, such as COVID-19, in the absence of vaccination or treatment. However, the usage of such measures is constrained by their inherent perceived cost and effectiveness for reducing transmission risk. To understand the complex interaction of disease dynamics and individuals decision whether to adopt NPP or not, we incorporate evolutionary game theory into an epidemic model such as COVID-19. To compare how self-interested NPP use differs from social optimum, we also investigated optional control from a central planner's perspective. We use Pontryagin's maximum principle to identify the population-level NPP uptake that minimizes disease incidence by incurring the minimum costs. The evolutionary behavior model shows that NPP uptake increases at lower perceived costs of NPP, higher transmission risk, shorter duration of NPP use, higher effectiveness of NPP, and shorter duration of disease-induced immunity. Though social optimum NPP usage is generally more effective in reducing disease incidence than self-interested usage, our analysis identifies conditions under which both strategies get closer. Our model provides new insights for public health in mitigating a disease outbreak through NPP.
Reasons for gun ownership among demographically diverse new and prior gun owners
Pandemic-era social and political tensions may have accelerated pre-existing trends in gun owner diversification and shifts toward protection from people as a primary reason for gun ownership. Specific ownership motivations may shape storage behaviors, use patterns, policy support, and perceptions of safety. This study's objective was to assess the importance of specific reasons for owning guns, including protection from whom and in what circumstances, among demographic subgroups of new and prior gun owners.
Introduction to the Focused Issue: Identifying and Addressing Health Related Social Risks and Needs: What Is Our Role?
ULTRA-PROCESSED FOOD CONSUMPTION AND RISK OF GALLSTONE DISEASE: ANALYSIS OF THREE PROSPECTIVE COHORTS
Majority of dietary intake in US adults comes from ultra-processed foods (UPFs), which have been linked to several adverse health outcomes. Gallstone disease is highly prevalent and constitutes a significant burden to the US health system but remains understudied.
Associations of sugary beverage consumption with chronic obstructive pulmonary disease (COPD), asthma, and asthma-COPD overlap syndrome: A prospective cohort study
The associations between specific types of sugary beverages and major chronic respiratory diseases remain relatively unexplored.
Prenatal Stress Impacts Foetal Neurodevelopment: Temporal Windows of Gestational Vulnerability
Prenatal maternal stressors ranging in severity from everyday occurrences/hassles to the experience of traumatic events negatively impact neurodevelopment, increasing the risk for the onset of psychopathology in the offspring. Notably, the timing of prenatal stress exposure plays a critical role in determining the nature and severity of subsequent neurodevelopmental outcomes. In this review, we evaluate the empirical evidence regarding temporal windows of heightened vulnerability to prenatal stress with respect to motor, cognitive, language, and behavioural development in both human and animal studies. We also explore potential temporal windows whereby several mechanisms may mediate prenatal stress-induced neurodevelopmental effects, namely, excessive hypothalamic-pituitary-adrenal axis activity, altered serotonin signalling and sympathetic-adrenal-medullary system, changes in placental function, immune system dysregulation, and alterations of the gut microbiota. While broadly defined developmental windows are apparent for specific psychopathological outcomes, inconsistencies arise when more complex cognitive and behavioural outcomes are considered. Novel approaches to track molecular markers reflective of the underlying aetiologies throughout gestation to identify tractable biomolecular signatures corresponding to critical vulnerability periods are urgently required.
Using GPS-defined venue-based affiliation networks among Black sexual minoritized men and transgender women to identify locations for HIV prevention interventions
HIV biomedical intervention uptake is suboptimal among Black sexually minoritized men (SMM) and transgender women (TW). Venues where people meet and interact shape HIV-related risk and prevention behaviors. We aimed to construct GPS-defined venue-based affiliation networks and identify the unique set of venues that could maximize reach of HIV biomedical interventions among Black SMM and TW.
Association of life's essential 8 with risk of recurrent cardiovascular events among patients with coronary heart disease
To examine the association of Life's Essential 8 (LE8) with the risk of recurrent cardiovascular events among patients with CHD.
Association of solid fuel use with cognitive function and the modifying role of lifestyle: a nationwide cohort study in China
Indoor air pollution from solid fuel use might be harmful for cognitive function, while healthy lifestyle is associated with better cognitive function. The extent to which lifestyle modifies the association of solid fuel use with cognitive function remains unknown.
[Society, communication and health: Moving through the Covid-19 pandemic and beyond]
[Balancing drug regulation and health democracy: The role of patient and healthcare professional advisors at the ANSM]
The French National Agency for Health Products (ANSM) is a regulatory and public health agency. Its regulatory, health policing and public health protection activities require a perfect fit with the field and the various people involved in the use of health products. Since 2019, the ANSM has adapted its organisation, procedures and processes to encourage and improve interaction with its stakeholders, as part of its policy of openness towards civil society. To accompany this ambitious change and to support its staff, the Agency has recruited advisors corresponding to the main users of health products: prescribers (doctor's hospital and outpatient), pharmacists and patients. Working as a group or individually, they provide a "lived" user perspective on health products at each stage of the evaluation process. They may be involved in the assessment of dossiers, signals or applications received by the Agency, in the internal validation of reports or in discussions with stakeholders. They are particularly involved when the analysis requires expertise that goes beyond the technical, scientific or regulatory aspects. They may also work with ANSM staff to explain certain processes and difficulties in the field. Advisors help to ensure that regulatory and/or scientific expertise is clear and consistent with user experience. In addition to their scientific and therapeutic aspects, medicines are also economic, social and political issues. Their regulation is therefore particularly affected by the need for health democracy. This requires the active participation of health professionals, patients and, more broadly, civil society in the decision-making process. Civil society is a space occupied by a wide range of actors who exert pressure from different ideological positions to influence the regulation of health products. In this context, taking into account a plurality of viewpoints in the regulation of health products is necessary and complex, but its operation can be facilitated by the collective efforts of the actors and the adaptation of organisations, such as the integration of advisors.
Unravelling the enigma: A rare case of primary gastric squamous cell carcinoma with aggressive metastasis
This report details a rare case of squamous cell carcinoma (SCC) in the stomach, a condition accounting for only a fraction of gastric carcinomas. A 46-year-old male patient with dysphagia, abdominal pain, and haematemesis was diagnosed with primary gastric SCC displaying aggressive metastasis, an exceptionally low-incidence condition affecting mainly males in their sixth decade of life. Primary gastric SCC, though clinically similar to adenocarcinoma, involves a bleaker prognosis, lacking standardized treatment protocols. Histopathology and imaging confirmed the diagnosis, highlighting the challenges in managing advanced cases. Palliative chemotherapy showed partial remission but led to severe neuropathy. The case underscores the urgent need for research to understand the pathogenesis, effective management, and therapeutic targets for primary gastric SCC, emphasizing its scarcity and poor prognosis in medical literature. Increased clinical awareness and ongoing research are crucial for improving outcomes in such rare presentations.
Characterization of spinal hemangioblastomas in patients with and without von Hippel-Lindau, and YAP expression
Hemangioblastoma (HB) is a benign tumor of the central nervous system, associated with von Hippel-Lindau disease (VHL), or sporadic. The aim of this study was to compare and examine the clinical-pathological profile of patients with spinal hemangioblastoma and YAP expression.
Validation of immunohistochemical overexpression of p16 in the histologic diagnosis of cervical intraepithelial neoplasia grade 2
An accurate cytohistologic diagnosis is important to avoid overtreatment of cervical intraepithelial lesions. The three-tiered Cervical Intraepithelial Neoplasia (CIN) classification, grades 1, 2 and 3, despite poor agreement among pathologists in diagnosing CIN2, is still being used. The College of American Pathologists recommended an alternative two-tiered classification that has not yet been universally accepted. We review the diagnostic results of 286 biopsies performed by three pathologists using haematoxylin and eosin (H&E) and p16 to establish the level of agreement among the readers. Agreement between pathologists in diagnosing CIN2 with H&E was around 45% and improved to 86.7% when interpreting p16 stained biopsies without H&E; agreement with pathologist 3 was lower, around 60%. Discrepant results from one pathologist when assessing p16 highlights the decisive influence of individual criteria. P16 has shown to improve agreement between pathologists with previous good agreement, but did not correct it for the third pathologist. In equivocal cases, protein p16 is a useful conjunctive tool for a histologic diagnosis.
Validation of digital image slides for diagnosis in cervico-vaginal cytology
To test the diagnostic concordance between microscopic (MI) and digital (DG) observation of cervico-vaginal (CV) cytology in a validation study of the technique.
