Conectar
by Abdulmujeeb Opeyemi Muhammad-Olodo, Laura Asher
IntroductionHuman papillomavirus (HPV) vaccine prevents over 90% of cervical cancers. In October 2023, Nigeria launched a free HPV vaccination campaign targeting girls aged 9–14 years. Despite removing cost barriers, misinformation about fertility impacts and population control contributed to variable uptake across states. Understanding caregiver decision-making is crucial for improving coverage. This study aimed to explore factors influencing caregivers’ HPV vaccination decisions during Nigeria’s 2023 campaign in Ilorin East Local Government Area, Kwara State.
MethodsA qualitative study using focus group discussions (FGDs) was conducted using purposive and snowball sampling. We recruited 41 caregivers (mean age 47 years; 71% female) of eligible girls from urban and rural communities. Five FGDs were conducted: four with vaccine acceptors (n = 35) and one with decliners (n = 6). Discussions were conducted in Yoruba, audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s reflexive thematic analysis. Ethical approval was obtained from two institutional review boards.
ResultsFour themes emerged from the analysis. Trust operated at multiple levels: institutional (government programmes), interpersonal (healthcare worker competence), and community (religious/traditional leader endorsement). Historical medical mistrust, intensified by COVID-19 experiences, may have manifested as fertility and population control fears. Personal cancer experiences strongly motivated acceptance, whilst concerns about childhood sexuality influenced timing preferences. Despite free provision, barriers included geographic inequities (remote Fulani-Hausa communities were excluded), language barriers (no Hausa translators), school-based delivery gaps, and indirect costs (transport, time). Caregivers recommended house-to-house campaigns, multilingual services, traditional leader engagement, and permanent vaccination centres.
ConclusionFree vaccine provision is necessary but not sufficient to ensure uptake. Successful HPV vaccination requires rebuilding trust through community engagement, addressing historical medical exploitation concerns, and ensuring equitable access. Integrating these findings into Nigeria’s National Programme on Immunisation could improve coverage from current estimates of 54% to targeted 90%, protecting more girls from cervical cancer whilst respecting community values.
by Sara Grafenauer, Belinda Durey, Kevin Norton
Barbie and Ken dolls have been criticized over time for their overt misalignment of body shape in comparison with the average adult, and the possibility that this impacts the formative minds of children, particularly girls. Updating a previous examination of the original Barbie and Ken dolls from 1996, this study compared the body measures of the 2016 “Fashionista” range—including Curvy, Petite, Tall, and Standard Barbie models, and new Malibu Ken—with representative population data of young adult females and males using anthropometric techniques. A range of anthropometric girth measures plus height were taken from each doll, and body proportions were calculated. The rules of allometry were used to scale the dolls to a standardized adult height of 170.18 cm to determine the dimensions the dolls at this adjusted size. The dimensions were then compared to the same height-adjusted reference population norms used in the original study. The comparison revealed significant alterations in the dolls’ morphology compared with the original Barbie and Ken, with key measures of waist-to-hip and chest-to-waist ratios becoming more realistic and falling within the 95% confidence range of the population. According to z-score deviation data, Curvy Barbie fell closest to the mean for most of the scaled girth measures, while new Ken was closer to the mean for all girths except ankle. Design changes reflect a shift toward greater body diversity, with potential benefits for children’s health behaviours through the production of a broader range of more diverse, human-like dolls. Importantly, key measurements and body proportions were generally closer to the respective reference populations.Active learning strategies, including case-based learning (CBL), problem-based learning (PBL) and team-based learning (TBL), have been extensively studied in clinical and basic science education; however, their application in public health programmes remains under-explored. Public health professionals address population-level challenges that differ substantially from clinical practice, making it necessary to evaluate whether these pedagogies are effective in this field. This review examines how CBL, PBL and TBL have been used in public health education and what outcomes have been reported.
Scoping review was conducted using the Levac and Colquhoun framework, an adaptation of Arksey and O’Malley’s approach.
PubMed, Scopus and Google Scholar were searched for studies published between 2000 and 2025. Eligible studies included those involving students enrolled in undergraduate or postgraduate public health programmes, such as bachelor’s or master’s programmes in public health, epidemiology and biostatistics, global health, community medicine or health policy as well as employees working in public health-related fields. Data were extracted using a predefined template capturing study characteristics, population characteristics, student satisfaction and study objectives. All articles were thematically analysed.
Results
Overall, 22 studies were included. Of these, 11 focused on PBL, 2 on CBL, 3 on both CBL and PBL and 6 on TBL. Public health topics addressed included general public health practice (n=5), global health (n=3), health literacy or education (n=3) and occupational health or medicine (n=2); remaining studies covered leadership, nutrition, health behaviour, climate and health, ageing and mental health. Six themes emerged: skill development, real-world relevance, diversity and inclusion, blended learning, innovative approaches and challenges. Key challenges for PBL included cognitive overload and implementation constraints; for CBL, inequitable participation and resource-intensive implementation; and for TBL, increased student time burden and difficulty adapting to complex simulations.
Active learning methods enhance critical thinking and problem-solving in public health education but face implementation barriers, including faculty training requirements and resource constraints. Future research should examine long-term outcomes and the integration of emerging technologies.
by Taotao Peng, Yu Li, Yukun Ren, Mi Yang, Zonghong Long, Dukun Zuo, Lu Huang, Huawei Liu, Zhenxin Duan, Hong Li
Pulmonary complications in non-pulmonary sepsis (PC-NPS) are the leading cause of morbidity and mortality in the intensive care unit. Early prevention and monitoring are paramount since the prevention strategies remain limited yet. Magnesium, an essential electrolyte involved in inflammation and vascular regulation, may influence the development of such complications. This retrospective cohort study used data from the MIMIC-IV database to explore the relationship between baseline serum magnesium levels and PC-NPS among 4,836 patients with non-pulmonary sepsis. Survival analysis demonstrated that patients who developed PC-NPS had significantly higher 90-day mortality compared with those without lung injury. When stratified by baseline serum magnesium quartiles, patients in the highest quartile (>2.1 mg/dL) showed the poorest survival. Multivariable logistic regression confirmed that elevated magnesium was independently associated with increased risk of PC-NPS, and restricted cubic spline modeling revealed a U-shaped, nonlinear association between baseline magnesium concentration and PC-NPS risk. Inflection points at 1.26 and 1.91 mg/dL identified a range of relatively lower risk. These findings suggest that baseline serum magnesium levels exhibit a U-shaped relationship with the risk of PC-NPS. Evaluating these levels may aid in clinical prognostication and the exploration of underlying mechanisms.by Julian Kylies, Fabian Haas, Anna Duprée, Tobias B. Huber, Karl-Heinz Frosch, Matthias Priemel, Dominik Kylies
BackgroundLiposarcomas (LS) of the extremities and trunk are aggressive soft-tissue sarcomas and surgical resection combined with multimodal therapy represents the cornerstone of curative treatment. Despite advances in surgical and medical management patients are still at risk of developing medical complications that negatively affect morbidity and mortality. Kidney dysfunction, sarcopenia and progressive loss of visceral adipose tissue have emerged as prognostically relevant and potentially treatable complications in surgical oncology. However, despite their growing relevance, little is known about their frequency and impact on survival and morbidity in the context of LS.
MethodsWe conducted a retrospective study of 47 adult patients with localized LS of the extremities and trunk who underwent curative-intent surgery. Kidney function, CT morphometry of muscle (skeletal muscle index, SMI) and visceral adipose tissue (VAT) as well as clinical assessments including ECOG score were recorded at diagnosis (t1) and after a median follow-up (t2) of 11 months. Kidney dysfunction, defined as a decrease in eGFR of ≥ 25% between time points, was analyzed in relation to survival, sequentially assessed CT-morphometry of muscle and adipose tissue as well as functional status assessed by ECOG scores.
ResultsAll patients underwent curative-intent surgical treatment with or without additional multimodal treatment (surgery only: 51.1%, additional radiation: 31.9%, additional chemotherapy: 38.3%). Kidney dysfunction was frequent in our cohort (53.2% of all patients) and significantly associated reduced overall survival in Kaplan–Meier, uni- and multivariate Cox proportional hazards regression models (multivariate hazard ratio: 6.7; p = 0.03). In addition, patients with kidney dysfunction experienced a significantly accelerated loss of SMI (p Conclusions
To our knowledge, this is among the first studies to investigate kidney dysfunction and its consequences in adult LS patients. In our cohort of surgically treated adult patients with LS of the extremities and trunk, kidney dysfunction was a frequent and clinically impactful complication. It was significantly associated with decreased overall survival, loss of muscle and adipose tissue in sequential CT morphometry assessments and progressive functional decline. Off note, CT-morphometry enabled objective, high-resolution tracking of body composition decline and may serve as a promising additional tool for risk stratification. Nonetheless, given the limited cohort size and retrospective single-center design, the generalizability of our findings is limited and the results should therefore be interpreted with caution. Despite these limitations, our findings call for future prospective studies and an awareness for heightened renal surveillance and integrated body composition assessments in the multimodal management of sarcoma patients.
Emerging evidence supports a role for interleukin 6 (IL-6), a pro-inflammatory cytokine, in the pathogenesis of treatment-resistant major depressive disorder (TRD). However, interventional studies targeting IL-6 in this population remain scarce. Tocilizumab is a humanised monoclonal antibody that inhibits IL-6 signalling and is approved for the treatment of autoimmune conditions such as rheumatoid arthritis. The primary objective of this study is to examine whether IL-6 inhibition via tocilizumab can impact depressive symptoms, inflammation-related biomarkers and cognition in patients with TRD. A secondary objective is to compare the biological profiles of patients with TRD with elevated inflammation to those of healthy controls.
This is a proof-of-concept, randomised, parallel-group, triple-blind, placebo-controlled clinical trial. 22 adult outpatients diagnosed with TRD and evidence of low-grade inflammation (serum C reactive protein≥3 mg/L) will be randomised (1:1) to receive either one intravenous infusion of tocilizumab (8 mg/kg; maximum 800 mg) or normal saline, administered as an add-on to their ongoing treatment. Psychiatric, cognitive and biomarker assessments will be performed at baseline and at follow-up visits on days 7, 14 and 28 post-infusion. Additionally, 10 healthy controls with no psychiatric history will undergo the same baseline assessments for biomarker comparison.
The study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (Project number: 2025-0245, CAAE: 88904825.7.0000.5327). Findings will be disseminated through peer-reviewed publications, scientific meetings and, on request, lay summaries for participants.
Postextubation swallowing disorders (SD) are common in the intensive care unit (ICU) and are associated with severe complications, including aspiration pneumonia, a three-fold increase in reintubation risk and higher mortality. While fibreoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy are gold standards for diagnosis, they are often impractical or impossible to perform on intubated patients. The use of ultrasound offers a non-invasive, bedside alternative to evaluate the musculoskeletal structures involved in swallowing. The Echographie Identifier les troubles de Déglutition Acquis en Réanimation (EIDAR) study aims to evaluate the diagnostic performance of pre-extubation ultrasound in identifying patients at risk of SD following mechanical ventilation.
This prospective, monocentric diagnostic study conducted at the Dijon University Hospital ICU will include 100 adult patients ventilated for ≥48 hours. The primary outcome is the presence of SD, defined as a Penetration-Aspiration Scale score >2 during a FEES procedure performed 3 to 24 hours postextubation and independently assessed by an otolaryngologist blinded to index test results. Pre-extubation cervical ultrasound (Index Test) will be performed within 3 hours prior to extubation and measure hyoid bone ascension (primary variable of interest), geniohyoid muscle surface area and digastric muscle cross-sectional area. The diagnostic performance of cervical ultrasonographic parameters will be assessed using their discriminative capacity via a receiver operating characteristic curve. The feasibility of the ultrasound procedure in a critical care setting will also be assessed.
The study received a favourable opinion from the independent ethics committee CPP Ouest III and is registered with the French health authority ANSM (national agency on safety in medicine and health products). It is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Participants or their proxies provide free and informed oral consent. Results will be submitted for publication in peer-reviewed medical journals and presented at international conferences.
RCB 2023-A00461-44 and NCT05922085
This study explored the lived experiences, challenges and coping strategies of Arab male patients with spinal cord injury (SCI) who rely on intermittent catheterisation (IC) to manage neurogenic bladder.
A descriptive qualitative approach was employed, with data analysed using a phenomenological framework.
Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
Male patients with SCI undergoing rehabilitation and performing IC were included in the study. Although both male and female patients were approached to participate, all eligible female patients declined participation. During the recruitment process, some female patients informally expressed privacy concerns and discomfort related to discussing bladder management issues and genital care, which may have contributed to their decision to decline participation.
10 male participants with SCI were recruited after eligible female patients declined participation. Three main themes, each with associated subthemes, emerged to reflect the participants’ experiences. Theme 1: Frequent use of IC in daily life, comprised four subthemes: (1) frequency of practice, (2) environmental and health-related challenges, (3) privacy during IC and (4) fluid intake and output. Theme 2: Cleanliness and general care included two subthemes: (1) catheter cleaning and (2) incontinence. Theme 3 focused on body image and sexuality. Cultural and social norms, including privacy concerns and sensitivities surrounding intimate care in the local context, played a significant role in shaping participants’ experiences and coping strategies.
IC was associated with challenges affecting multiple aspects of daily life among patients with SCI, including social interactions and body image. Participants described various coping strategies used to manage the physical and psychological demands associated with IC. These experiences appeared to be influenced by cultural considerations, including privacy, modesty and sensitivity surrounding urinary care within the local Saudi context.
School-aged children frequently experience psychological distress due to academic pressures, a challenge that is often more severe for those from underserved and minority communities. This study aims to evaluate the effectiveness of mental health interventions implemented in school and community settings for children aged 5 to 19. It also seeks to compare the outcomes between children from minority and underserved populations and their peers.
This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant studies. Major databases will be searched using a structured search strategy developed by the research team. The review will include randomised controlled trials (RCTs) that assess the impact of interventions conducted in school or community settings to prevent psychological distress—specifically depression, anxiety and stress. To minimise bias, two reviewers will independently select studies and extract data at various stages. The quality of included studies will be assessed. A meta-analysis will be conducted to compare intervention outcomes between children from underserved/minority communities and other children. Pooled prevalence rates and subgroup analyses will be used to explore differences in effectiveness. Heterogeneity among studies and publication bias will also be assessed. Meta-analyses of proportions, ORs and relative risks will be conducted using a random-effects model to estimate effect sizes from multivariate analyses.
Ethical approval was not required, as this study involved secondary analysis of published literature and did not involve human participants. To date, no systematic review has comprehensively compared school-based and community-based interventions in terms of their effectiveness in addressing anxiety, depression and stress among school-aged children. This review aims to fill that gap by providing clinical insights into the comparative effectiveness of various intervention types and settings.
CRD42023479389.
To estimate the global, regional and national burden of maternal haemorrhage (2000–2021) and its 2050 projections in 204 countries and territories.
This study systematic analysis of the burden of maternal haemorrhage sourced data from the Global Burden of Disease (GBD) 2021 study. We estimated the incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) due to maternal haemorrhage. Changes in the burden from 2000 to 2021 were computed using AAPC. To detect statistically notable changes in the trends of maternal haemorrhage metrics between 2000 and 2021, Joinpoint regression analysis using the Joinpoint Regression Programme was conducted. We also projected mortality rates, YLDs and YLLs through to 2050 using maps and trends generated by the GBD Foresight visualisation tool.
Globally, the incidence of maternal haemorrhage among women aged 15–49 years declined from 881.98 per 100 000 reproductive aged women (95% uncertainty interval (UI) 687.01 to –1150.23) in 2000 to 714.00 (95% UI 556.97 o t908.54) in 2021, with an average annual percentage change (AAPC) of –0.91 (–1.37 to –0.49). Similar downward trends were observed for maternal deaths, DALYs, YLDs and YLLs attributable to maternal haemorrhage, with AAPCs of –3.78 (–4.39 to –3.18), –4.68 (–4.83 to –4.55), –1.21 (–1.54 to –0.89) and –4.80 (–5.10 to –4.52), respectively. Sub-Saharan Africa, particularly Western Sub-Saharan Africa, recorded the highest burden in 2021, which is almost 300 times higher than in Western Europe. Elevated rates of mortality, DALYs and YLDs were also evident in Sierra Leone, Chad, Niger, Mali, Nigeria, Burkina Faso, Central African Republic, Somalia and South Sudan in 2021 and projections for 2050. However, the high-income Asia Pacific region had the lowest incidence, DALYs and YLDs at 151.32 (109.63–203.68), 2.21 (1.72–2.86) and 0.87 (0.46–1.38) per 1 00 000 women, respectively. Australasia recorded the lowest maternal death count and YLLs attributed to maternal haemorrhage at 0.69 (0.50–0.90) and 0.56 (0.41–0.74) per 1 00 000 women, respectively.
While the global burden of maternal haemorrhage has declined over time, significant regional and national inequities persist. Even though the 2050 projections show improvement in the burden of maternal haemorrhage, there is also regional and national variation in the rate of decrease in maternal haemorrhage burden. Targeted, context-specific interventions are urgently needed to reduce maternal haemorrhage-related mortality and morbidity.
The Mental health care: Adverse Sequelae of COVID-19 study aimed to (1) compare the consequences of the COVID-19 pandemic for mental health services and people with pre-existing mental health conditions (MHCs) in six low- and middle-income countries and (2) identify good practice to mitigate these impacts.
An observational study, using a mixed-methods convergent design triangulating data from (1) semistructured interviews or focus groups and/or a self-completed survey, (2) routine service utilisation data, (3) local grey literature and (4) expert consultation.
The study was conducted in Chile, Ethiopia, Georgia, Nigeria, South Africa and Sri Lanka.
121 key informants.
We found clear evidence in all sites that the pandemic exacerbated pre-existing disadvantages experienced by people with MHCs and led to a deterioration in the availability and quality of care, especially psychosocial care. Alongside increased vulnerability to COVID-19, people with MHCs faced additional barriers to accessing prevention and treatment interventions compared with the general population. To varying extents, sites showed accelerated implementation of digital technologies, but with evidence of worsening inequities in access. In sites where primary care-based mental healthcare was more developed or prioritised, systems seemed more resilient and adaptive.
Our findings have the following implications. First, these mental health service reductions are clear examples of ‘structural stigma’, namely policy level decisions in healthcare which place a low priority upon services for people with MHCs. Second, integration of mental healthcare into all general healthcare settings is key to ensuring accessibility and parity of physical and mental healthcare. Third, digital innovations should be designed to strengthen and not fragment health systems. We discuss these findings in terms of anticipating such challenges for future pandemics and preparing layers of resilience.
To identify profiles of compositional movement behaviour patterns among children and examine cross-sectional and 12-month associations with adiposity markers and health-related quality of life (HRQoL).
Secondary analysis of data from the TransformUs cluster randomised controlled trial with cross-sectional and 12-month follow-up analyses.
Primary schools in metropolitan and regional areas of Victoria, Australia.
Children aged 7–11 years with valid accelerometer at baseline, regardless of demographic, adiposity and HRQoL data available (n=792), were included in the analytical sample for the latent profile analysis.
Sedentary time, light-intensity physical activity (LPA) and moderate- to vigorous-intensity physical activity (MVPA) along with their respective mean bout lengths were derived from raw acceleration data. Latent profile analysis used these measures (total times, as isometric log ratios and mean bout lengths) as input variables to classify distinct profiles for us as a categorical exposure variable in regression models. Primary outcomes were age- and sex-standardised body mass index, waist circumference and parent-reported HRQoL at baseline. Secondary outcomes were the same measures assessed at 12-month follow-up.
Four distinct profiles were identified. The high MVPA-short sedentary bout profile (n=184) was characterised by the highest levels of MVPA, moderate sedentary time and the shortest mean sedentary bout duration. The low sedentary-high LPA profile (n=54) had the lowest sedentary time, the highest LPA and the longest mean LPA bout duration. Two profiles were characterised by high sedentary time: the high sedentary-long sedentary bout profile (n=149), which had the longest mean sedentary bout durations, and the high sedentary-shorter bouts profile (n=405), which also had high sedentary time but shorter bout durations for all intensities. While the omnibus Wald test for differences across profiles indicated uncertainty in the overall profile effect, the high MVPA-short sedentary bout profile had favourable adiposity levels cross-sectionally compared with the high sedentary-long sedentary bout reference profile in pairwise comparisons. No longitudinal associations were detected.
Four distinct movement profiles were identified. Few pairwise differences between health outcomes were observed. While MVPA remains a key factor for promoting healthy body weight, our findings suggest that a variety of movement patterns - including those characterised by lower sedentary time and higher LPA - may also support health in children.
This study is a secondary analysis of the TransformUs effectiveness-implementation trial, registered with the Australian Clinical Trials Registry (ACTRN12617000204347; 1 April 2017).
by Patricia Fiorino, Luigi Fernandes Rosa Cauduro, Danielle Silberspitz Konig, Leonardo Fernandes Rosa Cauduro, Caio de Araujo Santos, Juliana Alves Kavai, Isadora Durigan Duarte, Anna Laura Viacava Américo
Zebrafish (Danio rerio) are widely used as models in cardiovascular research due to their rapid development, optical transparency, and genetic similarity to humans. However, the lack of standardized experimental conditions, particularly regarding developmental stage and microenvironmental parameters, limits reproducibility across studies. This study aimed to characterize cardiovascular function in Zebrafish larvae and evaluate the impact of developmental stage and environmental factors. Wild-type AB embryos were maintained under standard conditions, and heart rate (HR), cardiac output (CO), and ejection fraction (EF) were measured at 24, 30, 48, 52, 56, 72, 78, and 80 hours post-fertilization (hpf). The effects of variations in temperature (27.0, 27.5, and 28.0 °C) and pH (7.0, 7.4, and 8.0) were also assessed. Results showed a progressive increase in HR from 24 to 72 hpf, stabilizing thereafter. CO exhibited two phases of elevation: an early rise between 24–48 hpf and a stronger increase between 48–56 hpf. EF remained generally stable, with a transient reduction at 48 hpf. Cardiovascular performance reached a physiologically stable state after 72 hpf, defining a reliable window for functional studies. Environmental conditions modulated these parameters: temperature variation induced approximately 20% difference in HR and reduced EF, while CO was minimally affected. In contrast, pH variations within the physiological range had no significant impact on HR, CO, or EF. These findings highlight developmental and environmental variables that may influence cardiovascular measurements in Zebrafish larvae and support the development of more consistent experimental approaches in cardiovascular and toxicological research.by Ifeoma Jovita Nduka, Charles Ebuka Okafor, Obinna Ikechukwu Ekwunife
Mammography still remains the gold standard for breast cancer screening, considering its impact on breast cancer mortality. However, it has a relatively low utilization rate in Nigeria. Although the National Strategic Cancer Control Plan (NSCCP) has a goal of making screening services and early detection of cancer available for all Nigerians, there is currently no national breast cancer screening program implemented in Nigeria. The modelling study aimed to evaluate the cost-effectiveness of mammography screening from the healthcare provider’s perspective and to determine the appropriate screening interval for Nigerian women, aiming to enhance the efficiency and effectiveness of breast cancer detection programs. A state-transition Markov model was adapted to simulate annual and biennial mammography, breast cancer diagnosis, and treatment in a cohort of cancer-free Nigerian women aged 40 years and followed them for a lifetime. The study was conducted from the healthcare provider’s perspective. Disability-adjusted life year (DALY) averted, representing the health outcomes, was used to estimate the incremental cost-effectiveness ratio (ICER). Costs and outcomes were discounted at an annual rate of 5%. Annual mammography screening costs US$238.60, averted a DALY of 1.060, and was the most cost-effective intervention with an ICER of US$207.24 (95% CI US$213.31 – US$216.88)/DALY averted, which was below the willingness-to-pay threshold of $1074. Mammography screening strategies were estimated to be cost-effective from the healthcare payer’s perspective under the model assumptions. Annual screening showed the most favorable cost-effectiveness profile among the strategies evaluated, but this finding is model-dependent and should be interpreted as comparative economic evidence rather than a definitive screening recommendation. These results can inform future research, policy discussions, and consideration of sustainable financing for breast cancer screening in Nigeria.by Ligabaw Worku, Amha Kebede, Ayalew Jejaw Zeleke, Saron Fekadu, Melat Abdo, Tigist Atele, Netsanet Worku, Mulugeta Aemero
BackgroundAnopheles mosquitoes are the main vectors of malaria. Effective vector control depends on understanding their species composition, behavior, distribution, and insecticide resistance. This study investigated Anopheles species composition, susceptibility to deltamethrin, and the frequency of knockdown resistance (kdr) mutations in Maksegnit and Gendawuha, Northwest Ethiopia.
MethodsAnopheles larvae and pupae were collected from breeding sites during the rainy and post-rainy seasons and reared to adults under field insectary conditions following WHO guidelines. In addition, adult mosquitoes were collected from houses near larval habitats. Only field-derived mosquito populations were used in this study. Adult females (3–5 days old) reared from field-collected larvae were tested for susceptibility to 0.05% deltamethrin using WHO bioassays. Based on bioassay outcomes, mosquitoes were classified as phenotypically susceptible (died after exposure) or resistant (survived exposure), while field-collected adults represented an unexposed group. A total of 480 mosquitoes (160 resistant, 160 susceptible, and 160 field-collected unexposed adults) were subjected to genomic DNA extraction. Species identification and detection of knockdown resistance (kdr) mutations (L1014F and L1014S) were performed using PCR.
ResultsWHO bioassays conducted on 776 mosquitoes revealed confirmed resistance to deltamethrin, with mortality rates ranging from 48.5% to 72.5% (overall resistance: 37.5%). Resistance intensity exhibited significant variation, peaking after the rainy season and showing a higher prevalence in Maksegnit compared to Gendawuha (p Anopheles arabiensis was the predominant species (93%, 446/480), followed by An. pharoensis (6%, 29/480) and An. stephensi (1%, z/480), with the latter detected for the first time in Gendawuha. Regarding kdr mutation status, genotypic analysis showed that the L1014F mutation was the predominant allele, particularly among phenotypically resistant mosquitoes (67.8%), while lower frequencies were observed in susceptible (45.8%) and unexposed field-collected groups (61.4%). Conversely, the L1014S mutation was detected at low frequency (≤12.3%) and was restricted exclusively to the Maksegnit population.
ConclusionAnopheles arabiensis predominated, with confirmed resistance to deltamethrin, particularly in the post-rainy season. The L1014F kdr mutation was prevalent, while L1014S kdr mutation was rare. Detection of Anopheles stephensi highlights emerging risks, underscoring the need for season-specific resistance monitoring and integrated control strategies.
Early detection of sacral pressure injuries (PIs) in immobilised polytrauma patients remains challenging. This study evaluated ultrahigh-frequency (UHF) ultrasound combining structural and haemodynamic parameters for early PI diagnosis. In a prospective cohort of 73 polytrauma patients (Injury Severity Score 16–25), daily sacrococcygeal assessments were performed over 15 days using UHF ultrasound (Mindray Resona 11; L20-5 s probe). Parameters included 2D morphology, perfusion (colour power angiography [CPA]), flow metrics (peak systolic velocity [PSV]), Braden Scale and inflammatory markers. PI incidence was 27.4% (n = 20; all stage I/II). Haemodynamic markers outperformed 2D ultrasound: CPA grade ≥ 1 (AUC = 0.858, 80.0% sensitivity) and PSV > 5.55 cm/s (AUC = 0.841, 95.0% sensitivity). Combined CPA + PSV achieved superior accuracy (AUC = 0.922). Systemic inflammation showed no intergroup differences. UHF ultrasound detects early PIs by capturing ischaemia-reperfusion changes. The CPA + PSV protocol provides nurses with a rapid (< 5 min), sensitive bedside tool to guide proactive interventions.
The diagnosis of cancer results in psychophysiological distress in patients, significantly reducing quality of life (QoL). Currently, self-management interventions based on e-health have been used to improve QoL among cancer patients, but the overall effects remain inconsistent.
To assess the impact of self-management interventions based on e-health on the QoL of cancer patients.
Studies were retrieved from six databases up to November 6, 2024. The methodological quality assessment was performed via ROB 2. Data synthesis and subgroup analyses were performed in Review Manager 5.3. Meta-regression was conducted using Stata 15.0.
Thirty RCTs were included. The results of meta-analysis revealed self-management interventions based on e-health significantly improved QoL (SMD = 0.18, 95% CI: 0.08 to 0.28, p < 0.01). Subgroup analyses showed that long-term, mixed-mode, theory-supported, or facilitator-supervised interventions were more effective, with greater improvements in QoL observed among patients with breast cancer than among other types.
Self-management interventions based on e-health were valuable supplements for enhancing the QoL of cancer patients. Intervention duration, delivery modes, cancer types, theoretical frameworks, and facilitators' involvement should be considered in the design of future interventions. However, additional high-quality studies are needed to confirm these findings.
The protocol was registered on PROSPERO (Registration number: CRD420251017709)
Area-based measures of socioeconomic status (SES) are increasingly used to study health disparities among people living with HIV (PLWH), with wide variation in how they are defined and applied across studies and settings. This study synthesises the types of area-based measures of SES used in Canada and the USA, the domains captured and their associations with health outcomes among PLWH.
A scoping review of studies published in English between 2012 and 2025 was conducted using PubMed and Web of Science. The search combined ‘HIV’ with terms related to area-based SES measures. Eligible studies included PLWH, were based in Canada or the USA, used area-based SES measures and assessed health outcomes.
We screened 3470 studies: 56 met inclusion criteria. Most were US-based (n=53) and focused solely on PLWH (n=46). Area-based SES was measured using composite (n=34), single (n=16) or both types of indicators (n=6), all drawn from census data. The most common SES domain was income/poverty (n=56), the most common geographic unit was census tract (n=19) and the most common health outcome assessed was viral load/suppression (n=29). Most studies linked lower area-based SES with poorer health outcomes among PLWH (n=46).
Our findings highlight the utility of area-based SES as an individual-level SES proxy and tool for capturing broader social determinants of health when assessing a range of health outcomes across studies including PLWH. This review contributes to strengthening methodological approaches and supports future work focused on addressing social determinants and advancing health equity for PLWH.
FreshRSS 