Conectar
by Tatsuya Yoshihara, So Owada, Harumasa Arita, Akiko Nakagomi, Kota Tanaka, Yosuke Ono, Osamu Yoshino
BackgroundTo investigate the association between menstrual-related disorders and sexually transmitted infections (STI) among young women in Japan, and to examine differences according to disorder type and hormonal therapy use.
MethodsThis cross-sectional study used the Japan Medical Data Center Claims Database and included women younger than 40 years who had at least one healthcare visit in 2023. Menstrual-related disorders were defined as endometriosis or dysmenorrhea based on ICD-10 codes. The prevalence of five STIs—gonorrhea, genital chlamydia infection, trichomoniasis, genital herpes, and other sexually transmitted conditions—was compared between women with and without menstrual-related disorders. Subgroup analyses were conducted for endometriosis, dysmenorrhea, and hormonal therapy (low-dose estrogen–progestin combinations or dienogest). Prevalence ratios (PR) and prevalence differences (PD) with 95% confidence intervals (CI) were estimated.
ResultsAmong 3,440,929 women, 257,897 (7.5%) had menstrual-related disorders. All STI were substantially more prevalent in this group than in women without menstrual-related disorders, with PRs ranging from 4.31 to 5.29. Endometriosis showed the highest prevalence, particularly for genital chlamydia infection (4.98%; PR 7.44). Dysmenorrhea was also associated with consistently elevated STI prevalence. Among women with menstrual-related disorders, STI prevalence differed only slightly according to hormonal therapy use, with differences generally within one percentage point.
ConclusionMenstrual-related disorders were strongly associated with increased diagnosis of STI in Japanese young women. These findings highlight the importance of integrating STI screening and reproductive health education into routine gynecologic care for women with endometriosis or dysmenorrhea. The influence of healthcare-seeking behavior and diagnostic patterns should be considered when interpreting claims-based STI data.
by Qian Li, Yilun Huang, Samuel Yeung-Shan Wong, Winnie W. S. Mak, Xue Yang
Background and objectiveA well-established link exists between depression and Internet gaming disorder (IGD) at the individual level, while it remains unexplored within the family system. This study aims to investigate the interdependent relationship between parent and adolescent depression and IGD, and to identify the potential mechanisms.
MethodsA cross-sectional dyadic study was conducted with adolescents and their parents (primary caregiver) in Hong Kong. Adolescents completed anonymous surveys in classrooms, and parents completed online surveys via WhatsApp or phone interviews. The Actor-Partner Interdependence Model (APIM) and Actor-Partner Interdependence Mediation Model (APIMeM) were utilized to test the interdependence and mediators between depression and IGD in parent-child dyads, respectively.
ResultsA total of 1,277 parent-child dyads were included. Depressive symptoms in parents (β = 0.072) and adolescents (β = 0.273, both p Conclusions
Adolescent depressive symptoms were positively associated with their own and parental IGD symptoms, which were mediated by adolescent-reported family relationships and adolescent gaming time. The influence of adolescents’ mental health problems on parents’ problematic behaviors within the family system should not be overlooked.
Genitourinary syndrome of menopause (GSM) is a chronic, oestrogen-deficient condition that is frequently underdiagnosed and undertreated. Although low-dose vaginal estriol improves epithelial trophism and microbial balance, a substantial proportion of women report persistent symptoms. High-quality randomised evidence evaluating combined therapeutic strategies remains scarce. Energy-based modalities, including the erbium:YAG (Er:YAG) laser (=2940 nm), have been proposed as adjunctive treatments. This trial aims to assess the efficacy of Er:YAG laser therapy combined with vaginal estriol compared with estriol alone in postmenopausal women with GSM.
This is a single-centre, randomised, double-blind, controlled clinical trial. Postmenopausal women aged 45–70 years with vaginal pH ≥5.0 and at least one moderate GSM symptom (Visual Analogue Scale ≥4) will be eligible. Exclusion criteria include current systemic or local hormone therapy, previous vaginal energy-based treatment, abnormal cervical cytology and body mass index ≥35 kg/m2. All participants will receive vaginal estriol cream (0.5 mg per dose) daily for 14 days, followed by twice-weekly administration for 16 weeks. Participants will be randomised (1:1) to receive either estriol plus sham Er:YAG laser or estriol plus active Er:YAG laser. Three laser sessions will be delivered at approximately 4-week intervals. Assessments will occur at baseline, monthly during treatment and 4 months after the final session. The primary outcome is the Vulvovaginal Health Index, with the primary endpoint defined as the change from baseline to 4 months post-treatment, reflecting sustained effect. Secondary outcomes include GSM symptom severity, vaginal microbiome composition (16S rRNA sequencing), quality of life (Menopause Rating Scale) and sexual function (Female Sexual Function Index). Data will be analysed using repeated-measures analysis of variance or appropriate non-parametric tests, with significance set at p
Ethical approval has been obtained from the Human Research Ethics Committee of UNINOVE. Written informed consent will be obtained. Findings will be disseminated via peer-reviewed journals and scientific meetings.
by Elias Chane, Yilkal Amlaku, Amare Mekuanint, Abebaw Worede, Habtamu Wondifraw Baynes, Getnet Fetene
BackgroundMetabolic syndrome (MetS) is a group of interrelated metabolic aberrations that significantly elevates the risk of poor cardiovascular outcomes and type 2 diabetes mellitus. Healthcare professionals, particularly those working long shifts, may have elevated risk due to the demanding nature of their work, irregular lifestyles, and associated stress. This study aimed to assess the prevalence and associated factors of MetS among healthcare professionals working long shifts in primary hospitals in the Central Gondar Zone, Northwest Ethiopia.
MethodsAn institutional-based cross-sectional study was conducted among a total of 271 healthcare professionals working in three primary hospitals (from September to December 2023). Study data were collected using structured questionairs, anthropometric measurements, and biochemical assessments. Five mililiters of fasting blood sample was collected from each participant; and serum lipid profile and glucose analyzed on Beckman Coulter DXC 700 AU chemistry analyzer. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Independent ttest and one-way ANOVA were used for intra and inter group comparison; and Logistic regression model was fitted to identify factors associated with MetS, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported to determine the strength of associations.
ResultsThe prevalence of MetS among healthcare professionals was 11.44% (95% CI 8.14–15.83). Dyslipidemias were observed to be the most common forms of metabolic derangement with 145 (53.51%) of study subjects having at least one lipid profile abnormality; whereas, hyperglycemias was the least common 27 (9.96%) form of metabolic abnormalities. Age ≥ 35 years (AOR = 6.75; 95% CI: 2.34–19.46), a family history of diabetes among first-degree relatives (AOR = 7.78; 95% CI: 2.57–23.53), and short sleep duration ( Conclusion and recommondation
Metabolic syndrome is prevalent among healthcare professionals particularily those working long shifts; with age, family history of diabetes, and insufficient sleep identified as key risk factors. Hospital administrators and occupational health units should implement routine metabolic screening, optimized shift scheduling, and sleep hygiene support programs specifically for healthcare professionals working prolonged shifts, with particular attention to high-risk staff groups. Further workplace-based research is also needed to evaluate the effectiveness of these targeted interventions.
Asthma is one of the most prevalent long-term health conditions affecting pregnant women. Poorly controlled asthma during pregnancy is associated with adverse maternal and fetal outcomes and may predispose offspring to long-term respiratory morbidity. The current ‘one size fits all’ approach to asthma management during pregnancy is not optimally effective for approximately half of the pregnant women with asthma. A personalised medicine approach to managing airways disease is required. The treatable traits approach focuses on the identification and treatment of traits in the pulmonary, extra-pulmonary and behavioural domains, which are identifiable, measurable, clinically relevant (linked to exacerbation risk or poor asthma control) and treatable. This manuscript outlines the protocol for the Treatable Traits for Asthma Management in Pregnancy (TTAP) study. The purpose of the TTAP study is to prospectively determine the prevalence of a range of treatable traits from these three domains in pregnant women with asthma and determine which traits are associated with exacerbation risk, poor asthma control and poor asthma-related quality of life. Additionally, this study will assess differences in trait prevalence and clinical relevance in pregnant women from regional versus metropolitan hospitals in Australia and in different antenatal models of care.
The TTAP study is a multicentre, prospective observational cohort study. Study participants are pregnant women with asthma attending antenatal clinics at 10 metropolitan and regional hospitals (public and private) in NSW and Victoria, Australia. Assessment of traits from the pulmonary, extrapulmonary and behavioural domains as well as asthma outcomes is conducted at three gestational timepoints: 12–16 weeks, 22–26 weeks and 32–36 weeks of pregnancy. A follow-up assessment of asthma outcomes is conducted at 2–4 weeks postpartum. The outcomes assessed are asthma exacerbations requiring medical intervention (primary outcome), asthma symptom control and asthma-related quality of life. Traits and outcomes will be assessed using questionnaires, direct questioning, measurement of biomarkers, physical measurements and assessment of routinely collected data from medical records.
The Hunter New England Human Ethics Committee (2024/ETH01289) has approved the TTAP study protocol. Outcomes will be published in peer-reviewed journals, presented at scientific conferences and disseminated online to participants, clinicians and other pregnant women with asthma and their families via the Asthma in Pregnancy Toolkit website https://asthmapregnancytoolkit.org.au/.
The establishment of an effective strategy for recurrence prevention following curative treatment for hepatocellular carcinoma (HCC), including radiotherapy, remains a critical unmet clinical need. Despite favourable local control and safety profiles, recurrence after particle therapy remains a major challenge, highlighting the need for effective adjuvant strategies to improve long-term outcomes. The present phase Ib/II trial is designed to evaluate the safety and efficacy of atezolizumab plus bevacizumab (Atezo+Bev) administered after carbon-ion radiotherapy (C-ion RT) in patients with unresectable non-metastatic large HCC. This study aims to explore the potential of this multimodal approach as a novel adjuvant strategy to improve outcomes in patients at high risk of recurrence.
This is a phase Ib/II, single-arm clinical trial designed to evaluate the safety and efficacy of adjuvant Atezo+Bev following C-ion RT in patients with HCC. Eligible patients will be enrolled in the first registration phase. C-ion RT (60 Gy) will be administered over four consecutive treatment days ideally within one calendar week. Patients will receive a combination of atezolizumab (1200 mg) and bevacizumab (15 mg/kg) administered intravenously every 21 days for one treatment cycle. The primary endpoint of the phase Ib part is the proportion of patients with dose-limiting toxicity (DLT). DLT is defined as prespecified toxicities associated with the investigational drug among the adverse events that occurred from the start date of the investigational drug (Day 1) to Day 21. If there is one or fewer cases of DLT out of six cases, the trial will proceed to the phase II part. The primary endpoint of the phase II part is the 1-year recurrence-free survival rate.
This study was approved by the ethics committee of two participating institutions (Chiba University Hospital (approval No. 2024021) and National Institute for Quantum and Radiological Science and Technology, QST Hospital (approval No. C24-001)). Trial results will be reported in a peer-reviewed journal publication.
jRCT2031240284.
Chronic diabetic foot ulcers and venous leg ulcers remain difficult to treat due to delayed healing and high complication rates. Biologic skin allografts derived from living or amniotic tissue provide extracellular matrix components, cytokines, growth factors and viable cells that facilitate tissue repair. This investigation systematically reviewed randomised controlled trials comparing Apligraf, Theraskin, Amnioband, Amnioexcel, EpiCord and Epifix for chronic lower extremity wounds. Searches were conducted in PubMed, Embase and Cochrane databases. Primary outcomes included complete wound closure at 12 weeks, time to healing and percent area reduction. Secondary outcomes included infection, amputation and recurrence rates. Nineteen trials with a total of 1303 participants met inclusion criteria. Analysis demonstrated statistical significance in 12-week wound closure (p = 0.0394), with Theraskin achieving the highest mean closure (84.7%) and Amnioexcel the lowest (37.5%). Epifix and Amnioband showed faster healing trends and greater closure advantages compared with standard care. Reported complications were uncommon and inconsistently defined. While no single graft demonstrated statistically superior outcomes, descriptive trends suggest Theraskin, Epifix and Amnioband may offer greater clinical benefit. These findings provide comparative insight to guide clinical selection of skin substitutes and highlight the need for large-scale head-to-head trials to establish relative efficacy.
Live attenuated vaccines (LAVs) are recommended during moderate corticosteroid therapy (
To test the safety and immunogenicity of LAVs in NS in children on moderate dose corticosteroid therapy (1.5 mg/kg alternate day dose with maximum 40 mg alternate day dose; early arm) vs those off corticosteroid therapy for 4 weeks (standard arm), we are conducting a single-centre, open-label, non-inferiority RCT at a tertiary care centre in South India (VACCINES trial: Vaccines in Children on Corticosteroids for NEphrotic Syndrome). Eligible children (after inclusion and exclusion criteria) will be enrolled after obtaining written informed consent (from a legally accepted representative/parents) as well as assent for children aged >12 years. Two doses of measles, mumps, rubella (MMR) and/or varicella vaccines will be administered 12 weeks apart, after the initial assessment of seroprotection. Immunological assessment of humoral and cellular immunity will be evaluated in eligible participants. Randomisation into the standard and early arms will be performed during the last 2 weeks of alternate-day therapy (stratified into first episode and relapse patients). Seroconversion assessments will be made at 4, 12, 16 and 52 weeks into the study. The primary objective is to compare the proportion of participants who demonstrate seroconversion after 4 weeks of the first intervention. The secondary outcomes are the antibody geometric mean titres and adverse event profiles including serious events. With a non-inferiority margin of 15% (assuming 86% seroconversion in healthy controls), power of 85% and an alpha error of 5%, 100 patients (including 10% attrition) will be randomised (1:1). Comparisons with 50 healthy children will also be made. The occurrence of three serious adverse events directly attributable to the intervention constitutes a stopping rule. An interim analysis after recruitment of 50% is planned to be presented to an institutional Data Safety Monitoring Board. The first patient was enrolled on 30 June 2025, and enrolment is expected to be completed by February 2028.
The trial has been approved by the Institutional Review Board (IRB) of the Christian Medical College, Vellore (IRB min 2411130, dated 20 November 2024). Results will be published in a peer-reviewed journal and may be presented at medical conferences.
Clinical Trials Registry – India, CTRI/2025/01/078854 (Jan 16, 2025).
by Omar Muhumed Maidhane, Omran Salih, Abdisalam Hassan Muse, Abdirahman Omer Osman, Muse H. Abdi, Mahdi Hashi Hassan, Nur Mohamud Ali, Shacban Abdilahi Elmi
BackgroundAccess to adequate sanitation remains a critical public health challenge in Somalia, where a large portion of the population relies on unimproved facilities due to persistent conflict, climate shocks, and political instability. This reliance contributes to a high burden of waterborne diseases. This study aimed to assess the spatial distribution of unimproved sanitation and identify its individual and community-level determinants using recent national data to inform targeted interventions.
MethodsThis study is a secondary analysis of the 2022 Somalia Integrated Household Budget Survey (SIHBS), which included 7,212 households. The primary outcome was the use of unimproved sanitation facilities, categorized according to the WHO/UNICEF Joint Monitoring Programme (JMP) definitions. We employed a multilevel logistic regression model to identify individual and community-level determinants associated with unimproved sanitation. To analyze the spatial patterns of unimproved sanitation, we used Global Moran’s I for spatial autocorrelation and the Getis-Ord Gi* statistic for hotspot analysis.
ResultsOverall, 36.87% of Somali households use unimproved sanitation facilities. There are significant disparities across residence types, with the highest prevalence among nomadic populations (83.28%), followed by rural (51.10%) and urban (23.88%) residents. The multilevel analysis revealed that households in permanent/formal housing (AOR: 3.42) and those with IDP status (AOR: 3.18) had significantly higher odds of using unimproved sanitation. At the community level, urban residence was paradoxically associated with higher odds of unimproved sanitation (AOR: 7.99) compared to rural areas, while nomadic populations had significantly lower odds (AOR: 0.04), likely reflecting a high prevalence of open defecation not captured as a “facility.” Spatial analysis identified significant hotspots of unimproved sanitation in the Hiraan (90.65%) and Bay (80.39%) regions, and cold spots in Banadir (5.37%) and Lower Shabelle (3.70%).
ConclusionThe findings highlight deep inequalities in sanitation access across Somalia, driven by geographic location, socioeconomic status, and population group. The high prevalence of unimproved sanitation, especially among nomadic, rural, and displaced populations, calls for urgent, geographically-targeted interventions. A multi-pronged approach is necessary, focusing on the specific needs of different communities and addressing the underlying structural and individual-level drivers of poor sanitation to advance public health and sustainable development goals in the region.
by Mequanent Dessie Bitewa, Thomas Kidanemariam Yewodiaw, Aysheshim Asnake Abneh, Mikias Getahun Molla, Mulat Belay Simegn, Tadele Sinishaw Jemere, Mequannt Alemu Endayehu, Aysheshim Belaineh Haimanot, Werkneh Melkie Tilahun, Atirsaw Assefa Melikamu, Tadele Derbew Kassie
BackgroundCervical cancer is preventable, yet it remains a leading cause of cancer death in women. About 90% of cases and 94% of deaths occur in low- and middle-income countries (LMICs). Limited access to screening drives high incidence and mortality. Screening is central to secondary prevention and global elimination efforts.
ObjectiveThis study aimed to assess determinants of cervical cancer screening among women aged 30–49 years in low- and middle-income countries: a multilevel analysis.
MethodsA cross-sectional study used nationally representative data from 148,605 weighted women aged 30–49 years in 20 LMICs (2019–2024). Multilevel logistic regression identified factors associated with cervical cancer screening while accounting for cluster-level variation. Statistical significance was set at p Result
Overall cervical cancer screening uptake was 14.03% (95% CI: 13.63–14.45%), ranging from 0.92% in Mauritania to 42.98% in Zambia. Higher screening was associated with older age 40–49 years (AOR = 1.48; 95% CI: 1.41–1.54), occupation (AOR = 1.15; 95% CI: 1.10–1.21), contraceptive use (AOR = 1.38; 95% CI: 1.31–1.44), recent health-facility visit (AOR = 1.93; 95% CI: 1.84–2.02), prior abortion (AOR = 1.28; 95% CI: 1.22–1.34), female-headed households (AOR = 1.11; 95% CI: 1.05–1.18), high community education (AOR = 1.63; 95% CI: 1.49–1.79), and high media exposure (AOR = 2.54; 95% CI: 2.30–2.80). Lower uptake was observed among individuals in high-poverty communities (AOR = 0.63; 95% CI: 0.57–0.68), higher parity (1–4 birth) (AOR = 0.86; 95% CI: 0.78–0.94); (five or more births) (AOR=0.66 95% CI: 59–0.73), and those residing in rural areas (AOR = 0.89; 95% CI: 0.82–0.97).
ConclusionCervical cancer screening uptake in LMICs is far below the WHO 2030 target, with wide country disparities. Socio-demographic factors, health-facility contact, and community education increase uptake, while poverty and geographic barriers reduce it. Integrating screening into routine reproductive and maternal care, strengthening community and media education, and addressing structural barriers to access are essential to improving coverage.
by Sosina Workineh Tilahun, Adiam Nega, Lealem Wagaw, Adamu Addissie
BackgroundShared decision-making is crucial for alignment of treatment options with patient values and preferences. However, currently in Ethiopia, shared decision-making in clinical care of cancer, in which cervical cancer is not exceptional, is not well understood.
AimThis study aimed to assess the perceived level of shared decision-making and its predictors in cervical cancer care at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.
MethodsWe employed a convergent parallel mixed-methods study design from February 18 to May 23, 2025, at Tikur Anbessa Specialized Hospital. The study used interviewer-administered questionnaires for 203 cervical cancer patients and in-depth interviews for 15 cervical cancer patients and 10 clinical oncologists. Using SPSS v26, multiple linear regression analysis was used to determine significant predictors of the perceived level of shared decision-making, with statistical significance set at P Results
The overall mean score for the perceived level of shared decision-making was 24.94 (± 9.12), with a range of 7–44, and the standardized mean score was 2.77 (± 1.01). The perceived level of shared decision-making had positive linear associations with increased trust in oncologists (0.32, 95% CI (0.21, 0.44); p Conclusions
The study emphasized the complex interplay of factors influencing the practice of shared decision-making in clinical care of cervical cancer. Therefore, understanding these dynamics may help to enhance the practice of shared decision-making in clinical cervical cancer care.
Extrapulmonary tuberculosis (EPTB) poses a significant diagnostic and economic challenge in HIV endemic, low-resource settings due to its complex presentation and current diagnostic tools limitations. While accurate and timely diagnosis is critical for reducing morbidity, mortality and health system costs, economic evaluations of EPTB diagnostics remain sparse and fragmented. This protocol aims to map existing evidence on the economic evaluation of diagnostic innovations for EPTB in low-resource settings.
This scoping review protocol follows the Joanna Briggs Institute (JBI) methodological framework and registered on the Open Science Framework. Peer-reviewed articles, grey literature and official reports published between 2000 and 2025 will be searched in PubMed, MEDLINE, Google Scholar, Scopus and Science Direct. The search strategy is structured using the Population, Intervention, Comparator, Outcome, Time, Study design and Setting (PICOTSS) framework, and will be peer-reviewed using the Peer Review of Electronic Search Strategies (PRESS) guideline. Study selection, data charting and extraction will be performed independently by two reviewers. Data will be charted iteratively, and the methodological quality of selected economic evaluations will be appraised using the Drummond checklist. Results will be synthesised in narrative summaries and tabular formats. Final reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline.
For review of previously published data, ethical approval is not required. Findings will be disseminated in professional networks, stakeholder meetings and a peer-reviewed journal.
OSF Registration DOI 10.17605/OSF.IO/BTCPG
by Osamuedeme J. Odiase, April J. Bell, Alison M. El Ayadi, KaSelah Crockett, Malini A. Nijagal, Patience A. Afulani
IntroductionComfort is a key factor in physical and mental health, influencing overall well-being. Though once seen as peripheral to the patient care experience, it is now recognized as a critical outcome. For Black and other historically minoritized birthing individuals—who face racism, disproportionally higher morbidities, and unequal care—comfort is key to a safe, positive pregnancy experience. Innovative, community-driven models designed to improve comfort are therefore needed. San Francisco’s Pregnancy Village (PV) is a novel, cross-sector care delivery model providing a one-stop shop for clinical, city government, and wraparound services in a dignified and uplifting environment for Black and other minoritized pregnant individuals and their families. This study aims to examine comfort at PV and its key predictors.
MethodsWe surveyed 114 participants (57 pregnant/postpartum individuals and 57 family members) between July 10, 2021 and June 30, 2022. Comfort was measured using a 3-item scale capturing the affective dimension of comfort, with scores standardized to 0–100 scale. Additionally, two individual items assessed situational aspects of comfort: (1) discomfort being seen at PV and (2) feeling out of place at PV. We performed univariate, bivariate, and multivariate analyses.
ResultsThe mean comfort score was 96.2/100 (SD = 11.4). Pregnant and postpartum participants, as well as those with limited social support, felt significantly less comfortable with the idea of being seen by friends at PV compared to family members and those with strong social support, respectively. Participants with some higher education and those reporting occasional everyday discrimination felt significantly less out of place at PV than those with a high school diploma or no discrimination experiences.
ConclusionsThe Pregnancy Village model fostered generally high levels of comfort among Black and other minoritized pregnant individuals and their families in San Francisco, California. However, lower comfort levels among pregnant and postpartum individuals, those with lower educational attainment, and individuals lacking social support underscore the need for greater investment in co-led community-institutional, culturally responsive, and trauma-informed care approaches to foster comfort, particularly for those who face the severest inequities.
by Gen Tsujio, Masakazu Yashiro, Yuichiro Miki, Kohei Matsuoka, Koji Maruo, Mami Yoshii, Tatsuro Tamura, Katsunobu Sakurai, Takahiro Toyokawa, Naoshi Kubo, Shigeru Lee, Tomohisa Okuno, Kishu Kitayama, Go Masuda, Masaichi Ohira, Kiyoshi Maeda
BackgroundOur group revealed that the combination of intra-operative stamp cytology and peritoneal lavage cytology (CY) improved the identification of individuals with high risk of peritoneal metastasis. In this exploratory Phase II study, we aimed to evaluate the effect on relapse-free survival (RFS) of extensive intraoperative peritoneal lavage (EIPL) for gastric cancer with positive peritoneal cytology (CY1) and/or stamp cytology positive (stamp+).
Materials and methodsThis study was a single arm, multi-institutional, exploratory phase 2 trial to assess the effects of EIPL after open gastrectomy for gastric cancer with CY1 and/ or stamp+. The primary endpoint was RFS. Secondary endpoints were overall survival (OS), postoperative recurrence site and incidence of postoperative adverse events.
ResultsBetween 2017 and 2021, 13 patients from 2 institutions were enrolled in this study. Because of the recent decline in open abdominal surgery, the number of cases did not increase and the trial was closed due to lack of applicants at 13 cases. Median 3-year RFS was 14.5 months (95% CI 5.4-NA), median 3-year OS was not reached (95% CI 14.5-NA) and median3-year peritoneal RFS was 16.0 months (95% CI 5.4-NA). Median 3-year peritoneal RFS rate was 83% in CY0 and stamp+ cases (n=6), and 0% in CY1 and stamp+/- cases (n=7). (Log-rank p=0.015).
ConclusionBecause of the slow accrual pace and early stop of the trial, we were not able to evaluate the prespecified endpoints thoroughly. However, EIPL might be effective to prevent perineal recurrence, especially in CY0 and stamp+ case.
Over 50% of patients participating in cardiac rehabilitation (CR) experience poor sleep and/or, closely related, psychological stress. Although stress management interventions are generally available, they are typically underutilised in CR, and sleep remains an underaddressed component within CR. This is concerning, as poor sleep and stress not only reinforce each other but are also associated with poorer cardiovascular health and lower quality of life. Therefore, the primary aim of the OPtimising CArdiac REhabilitation by REfining Sleep and STress (RESST) study is to investigate the (cost-)effectiveness of adding a behavioural intervention targeted at improving sleep and managing stress during CR (RESST intervention) on sleep and psychological stress. Furthermore, the study aims to explore the (bidirectional) associations between sleep, stress and lifestyle behaviours.
This parallel-arm multicentre randomised controlled trial will include 200 CR patients across 3 major CR centres in the Netherlands who experience poor sleep and/or stress. Patients will be randomised in a 1:1 ratio to standard CR or standard CR with the RESST intervention. Standard CR is a structured programme combining exercise, lifestyle guidance and risk management. On top of standard CR, the RESST intervention consists of 5 in-person group sessions targeting sleep and stress and is based on Acceptance and Commitment Therapy and Cognitive Behavioural Therapy. Primary outcomes are accelerometer-assessed and self-reported sleep and perceived stress. Secondary outcomes include quality of life, psychosocial well-being, chronic stress biomarkers (hair cortisol and cortisone), momentary fatigue, momentary stress and physical activity. Linear mixed models will be used to assess changes in outcomes at 3-month (after intervention and/or CR completed) and 6-month follow-up. The momentary data collected with ecological momentary assessment and accelerometry will be analysed using multilevel linear mixed models to explore the (bidirectional) relationship between sleep, stress and other lifestyle components such as physical activity.
This study was approved by the ethics committee of Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands (MEC-2024-0238). The findings will be disseminated through publications in peer-reviewed journals, presentations at academic conferences and professional and patient publications.
Diabetes is a chronic disease characterised by elevated blood sugar levels, which can lead to damage across various body systems. Bangladesh has the second highest number of adults with diabetes in South Asia and faces a significant economic burden from this condition. The objective of this study was to investigate the economic burden of diabetes and its associated factors among patients with diabetes registered at a tertiary-level diabetes hospital in the Rajshahi region of Bangladesh.
This was a cross-sectional hospital-based study.
Primary data were collected from patients with diabetes at a tertiary-level diabetes hospital in Bangladesh.
The study recruited 400 patientswith diabetes, who were randomly selected. The economic burden was assessed using the Catastrophic Health Expenditure (CHE) threshold of ≥10% of household income. Descriptive statistics, 2 tests, t-tests, linear regression and binary logistic regression were employed for analysis, with statistical significance set at p
The proportion of diabetes-related burden among patients with diabetes was 50.7%. 95.8% of patients had type 2 diabetes, and over half (52.5%) were overweight or obese. Treatment costs were significantly associated with diabetes duration, insulin use and age (35–55 vs ≥56 years). The economic burden was strongly associated with lower income levels (poor income and middle income vs high income) and longer diabetes duration. Participants not adhering to a healthy diet had 43% lower odds of experiencing economic burden than those following a healthy diet.
Approximately half of the patients experienced catastrophic health expenditure due to diabetes, indicating a substantial economic burden in the Rajshahi region of Bangladesh. This burden was significantly higher among lower-income and middle-income groups and patients with longer disease duration, and treatment-related factors such as insulin use were associated with greater financial strain. These findings emphasise the need for targeted financial protection strategies, including subsidised care and preventive interventions.
Non-communicable diseases, particularly cardiovascular diseases (CVDs), have become major contributors to morbidity and mortality in sub-Saharan Africa (SSA) and are projected to surpass infectious diseases as the leading cause of death among adults by 2030. Although CVDs have traditionally been associated with older age and obesity, adverse cardiovascular phenotypes are increasingly being observed in younger and leaner individuals in SSA. This pattern suggests that pathways to CVD risk in SSA may differ from those described in high-income countries. Early-life infectious exposures, undernutrition and socio-demographic conditions common in many SSA settings have been proposed as potential risk factors. Still, empirical evidence linking these exposures to cardiovascular risk in early adulthood remains limited due to a scarcity of long-running birth cohorts in the region.
This protocol describes a new round of data collection nested within the Entebbe Mother and Baby Study (EMaBS), a population-based Ugandan birth cohort established originally as a clinical trial (ISRCTN32849447) between 2003 and 2006 with prospective follow-up from pregnancy through adolescence. All participants currently under follow-up will be invited to participate at approximately 21 years of age. Primary outcomes are physiological determinants of CVD measured in early adulthood, including blood pressure, blood lipid levels, body mass index, body composition and markers of glucose metabolism. Secondary outcomes include behavioural CVD risk factors (diet, physical inactivity, alcohol use and tobacco use) and qualitative measures of CVD knowledge and risk perception. Key exposures of interest include prospectively collected early-life and childhood infectious exposures (malaria and helminth infections), markers of growth and undernutrition, micronutrient status, inflammatory markers, socio-demographic factors and selected genetic variants. Quantitative analyses will use multivariable regression and causal modelling approaches and will be complemented by qualitative interviews and focus group discussions.
The study protocol has been reviewed and approved by the Uganda Virus Research Institute Research and Ethics Committee (UVRI REC Ref: GC/127/35), the Uganda National Council for Science and Technology (UNCST Ref: MV625), and the London School of Hygiene & Tropical Medicine Research Ethics Committee (LSHTM Ethics Ref: 8811). Written informed consent will be obtained from all participants before study activities. Study findings will be shared and discussed with participants and community stakeholders through established engagement platforms. Results will be disseminated to the scientific community through peer-reviewed publications and conference presentations, and data will be made available to other researchers via established data-sharing platforms. We will engage policymakers at the district, national and international levels to facilitate the translation of findings into policy-relevant outputs.
by Samuel M. Schut, Zachary A. Cupler, Brian C. Coleman
BackgroundAlthough student loans have made health professional education accessible for a greater proportion of the US population, rising student indebtedness has incited considerable discourse. This study aimed to characterize US chiropractors’ self-reported student loan debt, student loan relief opportunities, and perceived value of chiropractic training.
MethodsA 38-item cross-sectional, anonymous, electronic survey was developed. Chiropractors who graduated from a US-based, Council on Chiropractic Education-accredited Doctor of Chiropractic program (DCP) were recruited. The survey was conducted between February 2025 to March 2025. Survey domains included (1) demographics, (2) financial characteristics, (3) loan relief, and (4) educational and career value. Descriptive statistics and visualizations were used for analysis.
ResultsA total of 1,455 responses were collected. The mean (SD) and median (Q1-Q3) student loan debt at graduation was $176,297 ($89,460) and $185,000 ($120,000–$240,000). At survey completion, 85% retained student loan debt, averaging $232,062 ($102,691) with a median of $240,000 ($177,500–$290,000). Mean (SD) gross income in 2023 was $99,068 ($100,349); median (Q1-Q3) was $76,000 ($50,000-$115,000). Approximately 87% of respondents reported being ineligible or unsure about eligibility for loan relief programs. Over half (53.3%) disagreed or strongly disagreed that their DCP provided a positive return on investment (ROI), and approximately 70% rated the financial ROI of DCP training as low or very low. Perceptions of non-financial ROI were more favorable. Overall, 65% would not choose a chiropractic career again; among them, 67.3% would pursue a career in another healthcare field.
ConclusionsUS chiropractors are burdened with considerable student loan debt that outpaces gross income. The findings of this study are commensurate with prior studies investigating chiropractic educational debt, yet likely are not unique to the profession and represent larger challenges faced by many modern US health professions. Innovation is likely needed to support the sustainability of the chiropractic profession given tension between educational debt and income.
by Tamar Zurashvili, Maia Kajaia, Oluwabusayomi Akeju, Jack DeHovitz, Mamuka Djibuti
People who inject drugs (PWID) are at a heightened risk of contracting and transmitting HIV due to shared needles and unsafe sexual practices. Evidence on what shapes condom use among PWID in Georgia is limited. We conducted qualitative study among PWID recruited from two harm-reduction organizations in Tbilisi and Samegrelo between June-August 2025. Interviews were guided by the COM-B framework and analyzed thematically. Reduced sexual pleasure emerged as a dominant capability-related barrier to condom use. Knowledge of risks, benefits, and where to obtain condoms supported condom use, although participants noted that some community members lacked such knowledge. Opportunity factors were mixed. The convenient access to condoms, whether purchased at pharmacies or available for free at harm-reduction centers, created opportunity for condom access, and facilitated condom use; the factors impeding the use included the cost of purchase as well as long distance to and restricted hours of outlets, and occasional stock-outs and concerns about quality of condoms at harm-reduction centers. Social dynamics emerged as essential factors. Partner pressure, coercion, and persuasion, often intensified by alcohol or drug use, limited condom negotiation, whereas partner support, preparedness, and peer information sharing facilitated condom use. Motivation-related barriers included being under the influence of alcohol or stimulants and “heat of the moment” impulsivity, alongside low perceived risk with regular partners. Motivators included a strong desire for self and partner protection, heightened risk perception with casual or commercial partners, fear of infection, and past negative experiences including infections or unintended pregnancy. Findings indicate that condom use among PWID in Georgia is shaped by interplay of capability, opportunity, and motivation factors. Culturally sensitive, locally adapted strategies addressing pleasure-related concerns through education, strengthening negotiation and refusal skills, including couple-focused approaches can improve consistent condom use in Georgia and may benefit other countries in Eastern Europe and Central Asia.
FreshRSS 