Conectar
To identify behavioural and household factors associated with poor oral hygiene among Japanese kindergarten children in a population with high health awareness, using the Debris Index-Simplified (DI-S) as a clinical proxy for early oral hygiene deterioration.
Cross-sectional study.
Seven kindergartens in Sapporo city, Japan.
Of the 1229 kindergarten children invited, 871 provided parental consent (consent rate: 70.9%). Among them, 675 children aged 1–6 years who completed both the questionnaire and oral examination (completion rate: 54.9%). Most post-consent losses were due to logistical and staffing constraints. Children were stratified into ≤3 year and ≥4 year academic classes.
The primary outcome was oral hygiene status based on the DI-S scores (categorised as good (DI-S=0) or poor (DI-S>0). The secondary outcome was the presence of dental caries, defined as decayed, missing and filled primary teeth: dmft≥1. Multivariable logistic regression was used to estimate associations between poor oral hygiene and behavioural and household factors.
Among the 675 children, 168 children (24.9%) exhibited poor oral hygiene (DI-S>0) and 89 children (13.2%) had dental caries (dmft≥1). In multivariable analysis adjusted for demographic, dental and dietary variables, poor oral hygiene was significantly associated with being from a multiple-child household (OR 1.67, 95% CI 1.16 to 2.42) and irregular juice consumption (OR 1.60, 95% CI 1.07 to 2.38). Age-stratified analysis revealed that these associations persisted among those in the ≥4 year class, with additional significance for infrequent tooth brushing (
In a high health awareness Japanese preschool population, poor oral hygiene was independently associated with household composition and juice consumption, rather than traditional dental behaviours. These findings suggest the need to broaden preventive strategies beyond routine dental guidance to include family structure and dietary patterns, particularly in low-prevalence settings. Differential associations between DI-S and caries experience emphasise the utility of early clinical indices in oral health promotion.
Patient-reported experience measures (PREMs) are measures of patients’ perceptions of care they receive. PREMs are critical in developing and evaluating programmes that aim to improve patient healthcare experiences and quality of care (QoC) according to patient-defined needs. This review aims to map key domains of PREMs across distinct healthcare technical areas and life stages from globally available literature.
A scoping review adapting Arksey and O’Malley’s framework and Joanna Briggs Institute’s guidelines for the conduct of scoping reviews.
Google Scholar, PubMed, WHO, US Academy of Medicine and USAID Momentum.
PREMs literature from electronic repositories of grey and peer-reviewed publications, published in English historically up to September 2023.
Two lead reviewers with support from the technical working group co-created a review framework of healthcare technical areas, life stages and PREMs domains. We screened eligible articles, prioritising reviews except for technical areas with no reviews, where we then selected individual studies. We charted, analysed and synthesised data from 52 eligible articles.
PREMs literature has recently increased, especially in low-income and middle-income countries (LMICs), although studies in high-income countries (HICs) dominate in proportion (n=38; 73.1%). Out of 52 eligible articles, technical areas with most publications were sexual and reproductive health (n=21; 40.4%) and general outpatient care (n=11; 21.2%). Studies in adulthood (n=24; 46.2%) and from pregnancy and birth to postnatal (n=16; 30.8%) were most represented. PREMs studies reported mostly on communication and rapport (n=33; 63.5%) and respect and dignity (n=42; 80.8%) domains. Nearly a quarter (n=12; 23.1%) of the articles included only validated tools; the rest included a combination of validated and unvalidated measures. Of the tools relating to life stages of babies, younger children and older adults, the majority (n=17; 94.4%) included patient proxies.
PREMs, as an important component of QoC measurement, are increasing across several healthcare technical areas and life stages with commonalities and notable distinctions in measurement domains and tools. Evidence on PREMs largely comes from HICs. Evidence on critical, yet sometimes overlooked domains, highlights key QoC implementation gaps. The adaptation and utilisation of PREMs in programmes, especially in LMICs and under-represented technical areas, present opportunities to close the QoC disparities in those settings. Strategic, concerted efforts towards the harmonisation of PREMs tools across multiple life course stages and technical areas are critically needed in high-level quality improvement efforts.
Nurse practitioner-sensitive outcomes (NPSOs) are critical indicators of the quality and effectiveness of nursing care provided to older adults. These outcomes, which include metrics such as falls, pressure ulcers, infection rates, frailty, delirium, length of stay, hospital readmissions, and quality of life (QoL), are essential for assessing the impact of nurse practitioners (NPs) and enhancing patient safety. Despite their importance, the current literature on NPSOs in services for older adults remains limited. This scoping review aims to address this gap by systematically mapping the existing research, identifying key themes, and uncovering areas needing further exploration. By doing so, the authors seek to provide a comprehensive overview that will inform future research directions and contribute to the enhancement of clinical practice in older person services (OPS). This review is important for healthcare providers, policymakers, and researchers who are committed to improving the quality of nursing care and outcomes for older people.
The aim of this scoping review is to map the existing research on NPSOs in services for older adults. This review seeks to identify key themes and gaps in the current literature to guide future research and enhance clinical practice in this area.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were utilised to structure this scoping review.
From initial screening of 3593 manuscripts drawn from seven databases, 66 were deemed eligible for full screen. Five studies met the inclusion criteria and were ultimately selected for data extraction and analysis. The most common outcome measures reported were complications and comorbidities, and QoL.
This review highlights that the reporting of NPSOs in older person care is lacking and requires further attention.
Huntington's disease has a disruptive effect on entire families. While previous reviews have examined lived experiences of individuals with Huntington's Disease, their informal caregivers, or their offspring, none have provided a comprehensive overview that integrates these three perspectives.
A scoping review.
Providing an integrated view and a holistic understanding of the multifaceted challenges faced by families affected by Huntington's disease.
We operationalised the lived experiences using the keywords: “barriers”, “facilitators” and “needs”. We extracted and thematically analysed data from 35 articles searched from 1993 to 2023.
Twelve themes were identified, organised into three dimensions: (1) Having the Disease: encompassing the symptoms and progression of the disease; (2) Family Dynamics: reflecting the challenges of living in a household affected by Huntington's disease; and (3) Outside World: describing relationships and interactions with relatives, friends, health services and wider social structures.
The dimensions and related experiences of all three perspectives are intertwined. These experiences are mutually reinforcing, with fluid shifts in perspective occurring between family members. While the needs of family members overlap, they also diverge, highlighting the need for a systemic, family-centred approach to address the evolving challenges faced by all family members.
No Patient or Public Contribution.
To synthesise and critically analyse existing reviews of evidence on mentorship in nursing and midwifery, providing a comprehensive overview of current knowledge.
A scoping meta-review.
The review was conducted using the scoping meta-review framework outlined by Sarrami-Foroushani et al. (2015), alongside the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to ensure rigour and transparency. The following steps were included: (i) defining the problem, (ii) literature search and criteria, (iii) study selection and data extraction, (iv) data synthesis, (v) presentation of results and (vi) interpretation and recommendations.
A comprehensive search strategy was designed, utilising Boolean operators, truncation and predefined keywords across seven databases including MEDLINE, CINAHL, Embase, PsycINFO, Epistemonikos, ERIC and Google Scholar.
Following double-blind screening of 269 papers, 14 literature reviews were included. The findings provided a detailed overview of mentorship programme types (formal and informal), outcome measures used to evaluate mentorship effectiveness and recommendations for future programmes. Identified themes included skill development, job satisfaction, career progression and retention outcomes, together with challenges including time constraints and balancing clinical responsibilities with mentorship roles. Formal mentorship programmes that are adequately supported and integrated into the organisational culture can improve healthcare systems, workforce stability and patient outcomes. Informal mentorship continues to offer valuable, flexible support, particularly when used alongside formal structures. Implementation challenges exist, such as time constraints, limited organisational support, and mismatched mentor-mentee pairings.
This review highlights the critical role of mentorship in nursing and midwifery, offering insights into effective practices, challenges and potential areas for further research. The findings suggest that formal, structured mentorship programmes produce consistent benefits, including enhanced clinical skills, confidence and satisfaction among mentees, as well as leadership development and professional fulfilment for mentors, while positively impacting organisational efficiency and patient outcomes. Successful mentorship programmes require organisational commitment, with protected time, resources, and ongoing mentor training.
Mentorship programmes in nursing and midwifery enhance professional development, job satisfaction, and retention, enabling a stable healthcare workforce. Mentorship for mentors and mentees is linked to increased confidence, competency and readiness for advanced roles among nurses and midwives. Fostering mentorship in healthcare can lead to improved quality and continuity of care as mentees grow into more competent and confident practitioners.
Formal mentorship programmes that are adequately supported and integrated into the organisational culture can improve healthcare systems, workforce stability and patient outcomes. Policymakers responsible for healthcare workforce development can use these findings to advocate for mentorship as a strategic investment, potentially influencing policies related to nurse retention, professional development and funding allocations for mentorship initiatives. Structured mentorship improves job satisfaction, reduces turnover and fosters professional growth, thus reducing costs associated with recruitment and training.
The findings are reported in line with the PRISMA guidelines (Page et al., 2021) and through a narrative synthesis, summarising and analysing the results of various reviews to present a cohesive understanding of mentorship practices in nursing and midwifery. This method allowed for the integration of qualitative and quantitative findings and the identification of common themes and patterns across studies.
Patients or members of the public did not directly contribute to this review. However, by focusing on mentorship practices that support nurses and midwives, the study indirectly addresses public interests, as improved mentoring contributes to the quality of patient care. Future studies could benefit from patient or public feedback on desired qualities in care providers, further informing the development of mentorship programmes aligned with patient-centred care outcomes.
To test the feasibility and acceptability of a newly developed model of neonatal nurse-controlled analgesia to manage pain in the post-operative infant.
The study utilised a single-centre two-arm parallel, unblinded randomised controlled external pilot trial design.
The pilot trial was conducted in a surgical neonatal tertiary intensive care unit in Brisbane, Australia. Eligible infants were randomised to receive either post-operative pain management care via a model of neonatal nurse-controlled analgesia or standard care. Feasibility and acceptability were the primary outcomes. Seven feasibility outcomes were assessed by a traffic light system to delineate progression to a larger trial. Acceptability and clinical utility of the model of care by staff were assessed by feedback from an anonymous questionnaire that was administered at the completion of the trial period. Secondary outcomes included parental attitudes and perceptions of post-operative pain management to help establish primary outcomes for a larger randomised controlled trial.
Overall staff found the formalised model beneficial for managing post-operative pain but found the complexity of the model and ability to titrate analgesia based only on documented pain scores barriers requiring further consideration. Three of the seven feasibility outcomes failed to reach ‘greenlight’ targets to progress to a larger trial with adherence to the model, and the proportion of eligible infants not recruited was allocated a ‘redlight’. Secondary outcomes were comparable and support future study.
This pilot feasibility study has shown that a model of neonatal nurse-controlled analgesia can be safely implemented and utilised in the post-operative care of the surgical neonate. Further exploration of the barriers to model adherence and recruitment is warranted before a future larger trial is undertaken.
Though not all primary outcomes reached an acceptable range for further progression, this pilot feasibility study provided invaluable learning and has provided direction for future research into the provision of a family integrated and responsive model of analgesia.
This study is reported in line with the Consolidated Standards of Reporting Trials (CONSORT): Extension to randomised pilot and feasibility trial and the TIDieR Checklist (Template for Intervention, Description and Replication).
No patient or public contribution was utilised for this study.
Trial Registration: ACTRN12623000643673—the trial was prospectively registered
To explore current evidence regarding the provision of palliative care for individuals with very severe to extreme behavioural and psychological symptoms of dementia (BPSD) in a hospital setting.
Scoping review.
The PRISMA-ScR reporting guideline.
The JBI guidelines for scoping reviews were followed. A data extraction form assisted in the identification of key findings via a process of content analysis.
Studies were obtained from bibliographic databases of PubMed, CINAHL, and PsycINFO.
This review included six articles, and nine categories emerged from the findings. Symptom assessment and management, pain assessment challenges, atypical presentation of end-stage dementia, complex prescribing and treatment practices, principles of person-centred care, collaboration; training for health care professionals; emotional impact on staff; and family and caregivers.
This scoping review highlighted a significant gap in the literature regarding palliative care for people living with very severe to extreme BPSD in hospital settings. This review highlighted key differences in the presentation of people with BPSD needing palliative care. There is a need for tailored models of care, specialised training and education for health professionals, families, and carers, and recognition of dementia as a terminal illness.
The results of this review provide valuable insights into the level of understanding about the unique palliative care needs for people experiencing very severe to extreme BPSD, making an important contribution to the planning and development of future models of care.
Mapping the available literature highlights a paucity of research in palliative care for people with very severe to extreme BPSD in hospital settings. There is a need for rigorous research studies and models of care developed and informed by the evidence for this small population necessitating unique care needs.
No patient or public contribution.
by Yasutaka Tanaka, Daiki Mizushima, Yoshimitsu Izawa, Tomohiro Matsumura, Chikara Yonekawa, Hirotomo Kato, Takashi Mato
BackgroundIn tropical to subtropical regions, centipede bites may prompt medical attention, with manifestations largely reflecting venom-related discomfort, although infections, including rare fatal necrotizing soft tissue infection (NSTI), have been reported. However, no reports are available on the commensal bacteria on centipede forcipules.
ObjectivesThis study aimed to investigate bacterial species residing on and in centipede forcipules and their potential role in post-bite infections.
MethodsNine Scolopendra mutilans, three Scolopendra japonica, and two Bothropolys rugosus were collected from three regions in Japan. The bacterial composition of their forcipules was analyzed using 16S ribosomal ribonucleic acid gene sequencing and microbiome analysis.
FindingsA diverse bacterial community was observed on the centipede forcipules. Among the NSTI-associated genera examined (Escherichia, Staphylococcus, and Streptococcus), only Staphylococcus was identified as a minor population.
ConclusionThis study provides the first evidence that some bacteria found on centipede forcipules have been previously isolated from centipede bite infections. The risk of infection from bacteria on centipede forcipules during a centipede bite appears low. However, the presence of diverse bacterial species emphasizes the importance of thoroughly cleaning centipede bite wounds to prevent secondary infection.
by Nasrin Akter, Farhana Faruque Zerin, Bilkis Banu, Fatema Afrin Kanta, Shahnaz Begam, Sarder Mahmud Hossain
BackgroundTo combat growing prevalence of hypertension in Bangladesh, it is critical to have an in-depth understanding about quality of life (QOL) among people living with hypertension and related factors. In the recent COVID-19 pandemic the QOL of hypertensive people got downsized. This study aimed to measure QOL among hypertensive people in a selected tertiary hospital in Dhaka city, and its association with the basic characteristics of the patients.
MethodsThis study was conducted among randomly selected 300 hypertensive patients from two departments of Square Hospitals Limited, using the patient register record. Data were collected through face-to-face interview methods. The WHOQOL-BREF questionnaire was used to assess the QOL of the subjects. Descriptive statistics were used to examine mean scores of quality of life. Cronbach’s alpha coefficient and Pearson’s correlation coefficient were applied to estimate the internal consistency, and the level of agreement among different domains of WHOQOL-BREF, respectively. Chi-square test followed by binary regression analysis was used to measure the association between QOL domains and independent variables.
ResultsBoth overall WHOQOL-BREF and each domain had a good internal consistency, (r = 0.13–0.77, p Conclusion
The results revealed low QOL in psychological and social domain, including significant factors associated with the poor QOL in all domains. Planning and implementation of effective interventions are needed to improve QOL among hypertensive patients targeted towards aged, diabetic, lower income group who had positive COVID-19 infection and poor lifestyle through health system strengthening.
by Michelle Lauge Quaade, Mikael Leijon, Mikhayil Hakhverdyan, Thomas Bruun Rasmussen, Charlotte Kristiane Hjulsager, Lars Andresen, Karin Mundbjerg, Anne Sofie Vedsted Hammer
Diarrhea outbreaks significantly affect the health and growth of farmed mink, posing economic and welfare challenges. While various pathogens have been linked to mink diarrhea, the causes during the weaning period remain unclear. Sporadic associations of mink coronavirus (MCoV), Campylobacter, and gastrointestinal disease in mink have been suggested. This study investigates the occurrence and levels of MCoV and Campylobacter in fecal samples from Danish farm mink (Neogale vison) and their potential association with post-weaning anorexia diarrhea syndrome (PADS), growth-period diarrhea (GPD), or pre-weaning diarrhea (PWD). The focus of the study is on PADS, studied through two case-control setups where case farms had known problems with PADS and control farms without such problems. Animals were also diagnosed based on necropsy pathological findings. Seventeen MCoV genomes were determined from five Danish farms. This data facilitated the development of an MCoV RT-qPCR and was applied across three study groups. Results showed high prevalence of both MCoV and Campylobacter spp. in all groups. No link was found between MCoV presence or levels and PADS diagnosis on the individual level; however, farm-level analysis revealed that MCoV was 2.35 times more likely (95% CI 1.027; 5.056) on PADS case farms than controls. Mink with PWD exhibited higher MCoV levels compared to GPD cases, suggesting a role at this developmental stage. Phylogenetic analysis revealed diverse and farm-specific MCoV strains, with sequences from healthy controls forming a distinct subclade, hinting at strain-specific pathogenicity. Campylobacter spp. presence was not significantly associated with PADS, but higher levels were observed in mink with PADS versus those without (not tested for PWD). These findings highlight the importance of surveillance and rigorous hygiene practices on mink farms to address risks from MCoV and Campylobacter spp., calling for further research to clarify their roles in PADS and overall mink health.
by Nilavro Das Kabya, MD Shaifullah Sharafat, Rahimul Islam Emu, Mehrab Karim Opee, Riasat Khan
Malabar spinach is a nutrient-dense leafy vegetable widely cultivated and consumed in Bangladesh. Its productivity is often compromised by Alternaria leaf spot and straw mite infestations. This work proposes an efficient and interpretable deep learning framework for automatic Malabar spinach leaf disease classification. A curated dataset of Malabar spinach images collected from Habiganj Agricultural University and supplemented with public samples was categorized into three classes: Alternaria, straw mite, and healthy leaves. A lightweight SpinachCNN established a strong baseline, while Spinach-ResSENet, enhanced with squeeze-and-excitation modules, improved channel-wise attention and feature discrimination. A customized Vision Transformer (SpinachViT) and SwinV2-Base were further investigated to assess the benefits of transformer-based architectures under limited data. To mitigate annotation scarcity, we employed SimSiam-based self-supervised pretraining on unlabeled images, followed by supervised fine-tuning with cross-entropy or a hybrid objective combining cross-entropy and supervised contrastive loss. The best-performing domain-optimized model, SimSiam-CBAM-ResNet-50, incorporated Convolutional Block Attention Modules and achieved 97.31% test accuracy, 0.9983 macro ROC-AUC, and low calibration error, while maintaining robustness to Gaussian and salt-and-pepper noise. Although a SwinV2-Base benchmark pretrained on ImageNet-22k reached slightly higher accuracy (97.98%, 98.99% with test-time augmentation), its 86.9M parameters and reliance on large-scale pretraining reduce feasibility for edge deployment. In contrast, the SimSiam-CBAM model offers a more parameter-efficient and deployment-friendly solution for real-world agricultural applications. Model decisions are interpretable via Grad-CAM, Grad-CAM++, and LayerCAM, which consistently highlight biologically relevant lesion regions. The spinach dataset used in this study is publicly available on: https://huggingface.co/datasets/saifullah03/malabar_spinach_leaf_disease_dataset.
Persons with serious mental illness (SMI) often have coexisting medical conditions and experience a significantly reduced life expectancy compared with the general population. Peer support is considered an effective care approach for this population, and with rapid technological advancements, digital peer support, such as the DigiPer mobile application, can be a feasible self-management tool for persons with SMI. The study aims to assess the feasibility of DigiPer for persons with SMI in the Norwegian community mental health service settings.
This feasibility study will incorporate both qualitative and quantitative methods. The study consists of three phases: (1) simulation-based training among peer support workers using qualitative individual interviews; (2) pre–post study of DigiPer among peer support workers and service users using quantitative questionnaires and (3) process evaluation for peer support workers and service users using qualitative individual interviews. Peer support workers (n=5) and service users with SMI (n=15) will be recruited to evaluate the feasibility of DigiPer.
Ethics approval was granted from the Regional Committee for Medical Research Ethics (reference no. 853041), along with an assessment of processing of personal data by the Norwegian Agency for Shared Services in Education and Research (reference no. 810990). Findings will be disseminated through peer-reviewed publications and presentations at relevant national and international scientific conferences.
Gestational weight gain (GWG) is an important indicator of maternal nutrition to be monitored during pregnancy. However, there is no evidence-based tool that can be used to monitor it across all geographic locations and pre-pregnancy body mass index (BMI) categories. The WHO is undertaking a project to develop GWG charts by pre-pregnancy BMI category, and to identify GWG ranges associated with the lowest risks of adverse maternal and infant outcomes. This protocol describes all the steps that will be used to accomplish the development of these GWG charts.
This project will involve the analysis of individual participant data (researcher-collected or administrative). To identify eligible datasets with GWG data, a literature review will be conducted and a global call for data will be launched by the WHO. Eligible individual datasets obtained from multiple sources will be harmonised into a pooled database. The database will undergo steps of cleaning, data quality assessment and application of individual-level inclusion criteria. Heterogeneity of maternal weight and GWG will be assessed to verify the possibility of combining datasets from multiple sources and regions into a single database. Generalized Additive Models for Location, Scale and Shape will be applied for the construction of the centile curves. Diagnostic measures, internal and external validation procedures will also be performed.
This project will include an analysis of existing study de-identified data. To be included in the pooled database, each included study should have received ethics approvals from relevant committees. Manuscripts will be submitted to open-access journals and a WHO document will be published, including the GWG charts and cut-offs for application in antenatal care.
Treatment failure remains a major challenge in tuberculosis (TB) management. Rapid and objective assessment of treatment response is essential, as existing tools have limited accuracy and slow turnaround times. The PATHFAST TB LAM Ag assay (PATHFAST-LAM), an automated chemiluminescent enzyme immunoassay, was developed to quantify lipoarabinomannan (LAM) in sputum within 1 hour. Previous studies have shown a strong correlation between sputum LAM concentration and culture-based bacterial load. However, its clinical utility for predicting poor outcomes during treatment has not been prospectively evaluated.
We will conduct a prospective longitudinal study enrolling newly diagnosed, bacteriologically confirmed patients with pulmonary TB at Rhodes Chest Clinic and Mbagathi County Referral Hospital in Nairobi, Kenya. We will follow participants throughout the 6-month treatment course, attempting to collect sputum weekly during weeks 1–4, biweekly during weeks 5–12 and monthly during months 3–6. We will measure LAM concentrations at these time points using the PATHFAST-LAM assay. The primary outcome is to assess whether changes in sputum LAM concentration during the intensive phase (baseline to week 4 and/or week 8) predict a composite poor outcome, defined as positive sputum culture at month 6, treatment failure, death during treatment or relapse within 3 months after treatment completion. The primary endpoint is the area under the curve from the receiver operating characteristic analysis, representing the predictive performance of changes in sputum LAM concentration for the composite poor outcome. We will identify the optimal cut-off value for LAM change and estimate sensitivity and specificity with 95% CIs using 2x2 tables. We will apply an adaptive design that allows sample-size re-estimation after interim analysis.
The study was approved by the Kenya Medical Research Institute (KEMRI/SERU/CRDR/124/5241) and Nagasaki University (250619327). Findings will be disseminated through peer-reviewed publications and scientific meetings.
Salivary gland carcinomas (SGC) are rare tumours. The term SGC is not more than an umbrella for a variety of histogenetically, morphologically and biologically distinct entities. Accordingly, SGCs have not been sufficiently investigated to date. Their rarity makes it difficult to reach high patient numbers for individual entities in clinical studies, leading to pooling patients with different histological subtypes to attain sufficient participants. The different histological subtypes of SGC differ significantly in their clinicopathological features, such as their grading, their occurrence and their outcome. SGCs are usually stratified into low-grade, intermediate-grade or high-grade tumours. In most kinds of SGC, specific targetable molecular markers are lacking. The inclusion of immunotherapy (IT), however, might improve the outcome of patients suffering from high-grade SGCs. In order to integrate IT as a therapeutic option for SGC and to facilitate therapeutic decisions based on tumour (immune) biology, predictive and prognostic immunological biomarkers are indispensable.
In this prospective study, 500 patients will be enrolled, who are distributed in three arms. The observational cohort includes patients with malignant salivary gland tumours, whereas patients with benign tumours of a salivary gland are grouped in the control group 1. In the control cohort, 2 patients do not have a salivary gland tumour but have a planned functional surgery of the nose or ear or a maxillofacial surgery. The local immune status from the tumour tissue and the microbiome will be sampled before treatment. In addition, the systemic immune status from peripheral blood will be analysed before and after surgery and after the adjuvant and definitive chemoradiotherapy, if applicable. Clinical baseline characteristics and outcome parameters will additionally be collected. Data mining and modelling approaches will finally be applied to identify interactions of local and systemic immune parameters and to define predictive and prognostic immune signatures based on the evaluated immune markers.
Approval from the institutional review board of the Friedrich-Alexander-Universität Erlangen-Nürnberg was granted in September 2023 (application number 23-292-B). The results will be disseminated to the scientific audience and the general public via presentations at conferences and publication in peer-reviewed journals.
by Donato Koyalta, Zita Aleyo Nodjikouambaye, Jonathan Muwonga Tukisadila, Hachim Djamal Abdoulaye Bargo, Suitombaye Noubaramadji Yamti, Amine Akouya, Ralph-Sydney Mboumba Bouassa, Laurent Belec
BackgroundHigh-risk (HR) human papillomavirus (HPV) infection remains a great concern in sub-Saharan Africa in men who have sex with men (MSM). The prevalence of anal shedding of HPV and associated risk factors was estimated for the first time in a cross-sectional observational study covering MSM living in N’Djamena, the capital city of Chad.
MethodsMSM were recruited from the community in 21 sites in neighborhoods of 5 districts randomly selected in N’Djamena by respondent-driven sampling (RDS) method. Anal Collector V-Veil UP2™ device was used for anal canal self-sampling. Manual silica-extracted DNA was subjected for HPV detection and genotyping using BMRT Human Papillomavirus Genotyping Real Time PCR assay (Jiangsu Bioperfectus Technologies Co., Ltd., Taizhou, China). HIV serostatus was assessed using two rapid tests in series.
ResultsA total of 70 MSM (mean age: 29.9 years; range, 18–50) were included. The overall acceptability to practice veil-based anal self-sampling was 95.9%. The usability of the veil collector device was high (92.3%), with easy understandable instructions for use and correct placement in the anal canal. Satisfaction questionnaire reported high overall feeling, intimacy respect and lack of shame. The majority of MSM (44/70, 62.8%) showed anal shedding of HPV DNA, with HR-HPV frequently detected (38,70, 54.3%), including HPV-33 (30/70, 42.9%) HPV-68 (16/70, 22.9%), HPV-18 (4/70, 5.7%), HPV-35 (3/70, 4.3%), HPV-58 (2/70, 2.9%), and HPV-45 (1/70, 1.4%). The distribution of genotypes in HR-HPV DNA-positive MSM revealed that HPV-33 (30/70; 42.9%) was the predominant genotype, followed by the HPV-68 (16/70; 22.9%), HPV-18 (4/70; 5.7%), HPV-35 (3/70; 4.3%), HPV-58 (2/70; 2.9%), and HPV-45, HPV-51 and HPV-56 (each type, 1/70;1.4%).Among all HPV detected, only 42 HPV (36.8%) were covered by Gardasil-9® vaccine, including the HR-HPV-33, −18, −58 and −45, and the low risk-HPV-6 (5.7%) and HPV-11 (1.4%). The majority of detected HPV were non-covered by Gardasil-9® vaccine (63.1%). Overall HIV prevalence was 5.7%.
ConclusionsTaken together, these observations point the MSM population in N’Djamena as a very particular core group of HIV and HPV transmission. HIV prevalence was higher than that of general adult population, but limited to only one MSM of twenty. The RDS method of recruitment allowed to include MSM likely belonging to the same sexual network of HPV transmission leading to the selection of an atypical and specific profile of anal HPV distribution. The potential efficacy of HPV prophylactic vaccination in this population can be estimated at relatively weak.
Patients with combat wounds and injuries, presented as extensive infected and purulent defects with antibiotic-resistant microflora, were treated in a surgical inpatient setting. Closure of extensive soft tissue defects of the limbs is possible using methods of plastic and reconstructive surgery and requires preoperative infection control. The lack of effect from preoperative treatment for purulent limb defects with antibiotic-resistant microflora leads to limb amputation. This clinical study proposes a method of treatment by hyperbaric oxygenation with an ozone-containing steam–water mixture as an anti-bacterial agent. Eighteen male patients, aged between 20 and 60 years, were categorised into three groups based on the time elapsed since the injury. All patients were treated using the proposed method. The high effectiveness of the proposed method was demonstrated in all groups and resulted in saving limbs from amputation, establishing suitable conditions for closing the soft tissue defects of the limbs and achieving significant progress in the recovery.
by Yuto Kimura, Takahiro Kozuka
This study examined the association between event-related disclosure and posttraumatic growth (PTG). Specifically, it targeted the Japanese adult, assessed attitudes toward event-related disclosure, and examined event-related rumination as a mediating variable. A cross-sectional online survey was conducted among Japanese adults aged 20–59. Participants completed measures of demographic characteristics, stressful life events attributes, attitudes toward disclosure, event-related rumination, and PTG. Analysis of data from 480 individuals revealed that neither willingness to disclose nor resistance to disclose was directly associated with PTG. However, both willingness to disclose and resistance to disclose were positively associated with PTG through deliberate rumination and negatively associated with PTG through intrusive rumination. The effect sizes for willingness to disclose were approximately three times greater than those for resistance to disclose. These findings suggest that event-related disclosure may enhance PTG by promoting deliberate meaning-making processes, while also potentially hindering it by reinforcing involuntary negative thinking. Furthermore, these effects may be stronger when individuals are more proactive and disclose more frequently. These results have important implications for interventions aimed at enhancing PTG through event-related disclosure.
To understand how reductions in resource allocation affect food safety services in England.
This longitudinal ecological study analysed secondary observational data.
England, data at the local authority level.
Ecological study, without human participants.
The primary outcome measures were the number of staff, represented by the number of full-time equivalents per capita, number of interventions per establishment, and proportion of hygiene-compliant establishments.
A £1 decrease in food safety expenditure per capita was associated with a 2% (–3.3 to –0.7) decrease in staffing levels and a 1.6% (–3.2 to –0.1) decrease in the number of interventions achieved per establishment. A one-unit reduction in staff was associated with a 42.2% (–80.5 to –11.9) decrease in the number of interventions achieved. No evidence of an association was found between expenditure or staff levels and the proportion of compliant establishments.
Spending reductions negatively affected the capacity of food safety teams to provide key services. Reductions in food safety expenditure significantly affected food hygiene staff levels and service provision. This finding raises concerns about the capacity of food safety teams to operate and the potential for increased public risk of gastrointestinal infections.
Pre-exposure prophylaxis (PrEP) use among cisgender female sex workers (FSWs), a population at disproportionately high HIV acquisition risk in Uganda, remains suboptimal. Uptake and continued use are constrained by barriers, such as limited clinical hours, long distances to access facility-based PrEP services, and high mobility among FSWs. Community pharmacies may offer a more accessible PrEP delivery model due to extended operating hours and convenient locations. This study aims to evaluate the accessibility and capacity of pharmacies in Kampala, Uganda, to serve as potential sites for PrEP delivery.
We will conduct a concurrent mixed-methods study combining geospatial mapping, structured surveys, a discrete choice experiment (DCE), and in-depth interviews (IDIs). First, the study will compare the reach and accessibility of PrEP services through community pharmacies versus public healthcare facilities. To highlight PrEP service reach, we will use geospatial analysis to map pharmacies, PrEP clinics, FSW hotspots (i.e., areas where sex is exchanged), and HIV incidence. We will also calculate a PrEP facility needs ratio (number of PrEP facilities/HIV incidence) for each of Kampala’s administrative divisions and estimate travel distance and time to access PrEP services using cost–distance analysis. Perceived accessibility of PrEP services will be assessed through FSW surveys (n=50) and IDIs (n=20–30), guided by Levesque’s framework. Then, we will evaluate pharmacy capacity via surveys (n=274) and IDIs (n=20–30), exploring infrastructure, resources, and staff perspectives, informed by the Consolidated Framework for Implementation Research. Additionally, a DCE will be embedded in the pharmacy survey to elicit staff preferences for delivery approaches and analysed using mixed logit models. Finally, we will integrate quantitative and qualitative findings to provide a broad assessment of whether pharmacies are suitable venues for PrEP delivery to FSWs in Kampala. Enrolment will begin by April 2026 for FSWs and July 2026 for pharmacy staff.
Ethical approval has been obtained from the Infectious Diseases Institute Research Ethics Committee (IDI-REC-2025-175) and the Uganda National Council for Science and Technology (HS6178ES). Written informed consent will be obtained from all participants. We will disseminate study findings through stakeholder meetings, scientific conferences, and peer-reviewed publications.
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