Conectar
Catastrophic health expenditure (CHE) and impoverishment due to out-of-pocket (OOP) expenditure are the most widely used metrics to assess financial protection in health. This study aimed to investigate the impact of OOP expenditure on CHE and impoverishment in Bangladesh and identify their determinants.
A national cross-sectional survey.
We used data from the latest Household Income and Expenditure Survey 2022 in Bangladesh.
14 395 households from eight administrative divisions in Bangladesh.
The well-known methodology developed by Wagstaff and Doorslaer was used in this study to estimate the prevalence of CHE and the effect of OOP spending on impoverishment. We used a generalised linear model with a log link and a gam ma distribution to assess the association between the explanatory variables and annual OOP expenditure.
The prevalence of CHE was estimated to be 17.72% (95% CI 17.71% to 17.73%) and 7.07% (95% CI 7.06% to 7.08%) using 10% and 25% of the total consumption expenditure as thresholds, respectively. Given the 40% of non-food expenditure threshold level, about 9.46% (95% CI 9.45% to 9.47%) of households faced CHE due to OOP expenditure in Bangladesh. In 2022, approximately 3.7% (95% CI 3.7% to 3.71%) of the population (6.13 million people) fell into poverty in Bangladesh. The prevalence of CHE was higher among male-headed households, larger families, households with elderly members, households with members suffering from chronic illnesses, those using hospital care and individuals in the poorest wealth quintiles.
Our study indicated that the financial burden due to OOP expenditure was substantial in Bangladesh. Findings stress the need for prepayment schemes such as national health insurance for safeguarding households against falling into poverty.
by Md. Golam Rabby, Md. Nayim Hossain, Maymuna Islam Keya, Md. Ashrafuzzaman Zahid, Rashida Parvin, Md Syduzzaman
This study evaluated how Monkey jack pulp extract (MJPE) impacted the raw Pangasius (Pangasianodon hypophthalmus) fish balls physicochemical quality, microbiological safety, oxidative, and storage stability while being refrigerated. Fish balls were made with several antioxidants, including control (T0), butylated hydroxytoluene (BHT, T1), ascorbic acid (AA, T2), and MJPE at increasing concentrations (T3 and T4), and kept for 10 days at 4°C. On days 1, 5, and 10, changes in pH, cooking loss, color characteristics (L*, a*, b*, chroma, and hue angle), heme iron content, antioxidant activity (DPPH), lipid oxidation (TBARS), and total viable count (TVC) were assessed. All samples showed quality decrease with increasing storage time. However, antioxidants treated samples showed significantly (P < 0.05) higher stability than the control treated samples in every storage day. T4 successfully inhibited pH rise, decreased cooking loss, maintained higher heme iron levels, and preserved color characteristics rather than other treatments. Additionally, T4 showed higher DPPH scavenging capacity (ranged 72.44% to 65.79%), whereas the control showed the lower DPPH value (ranged 56.57% to 33.39%). TBARS value showed the lowest (0.31 to 0.41 mg MDA/kg sample) in T4 and the highest (0.49 to 0.67 mg MDA/kg sample) in the control. MJPE considerably reduced bacterial growth (0.80 to1.68 Log10 CFU/mL) compared to control and synthetic antioxidants treated samples. In terms of keeping the quality and enhancing the shelf life, MJPE demonstrated significantly improved antioxidant and antimicrobial effects compared to BHT and AA (P < 0.05). MJPE showed significant potential as a natural preservative for fish-based products by improving their physicochemical, microbiological, and oxidative stability during refrigerated storage.by Md. Naziur Rahman, Abu Yousuf Hossin, Shahriar Mannan Imon Talukder, Mt. Sumaiya Siddika, Md. Harun-Ur-Rashid, Shahanaz Parveen, Md. Ridwanul Islam, Md. Yeamin Hossain, Mahfuj Ahmed, Brototi Chakraborty Dyuti, Zarin Tabassum, Ajoy Kumer
Non-small-cell lung cancer (NSCLC) remains the leading cause of lung cancer–related mortality, largely driven by aberrant activation of the epidermal growth factor receptor (EGFR). Despite the clinical success of EGFR tyrosine kinase inhibitors (TKIs), intrinsic and acquired resistance, coupled with safety concerns, highlight the need for novel, safer inhibitors. Natural products represent an underexplored source of structurally diverse bioactive compounds with favorable biocompatibility. In this study, a comprehensive in silico approach is used to evaluate phytochemicals from Adenium obesum as potential candidate EGFR-targeting compound. Initially, sixteen phytochemicals were first assessed for predicted antineoplastic activity using PASS. High-scoring molecules were docked against the EGFR kinase domain (PDB ID: 1M17), besides performed detailed protein–ligand interaction analysis, drug-likeness and ADMET profiling, toxicity prediction and 100-ns molecular dynamics (MD) simulations. PASS-based bioactivity prediction revealed strong anticancer potential among the sixteen screened compounds, with consistently high antineoplastic and antiproliferative activity probabilities (Pa > 0.79) and low inactivity scores, supporting their selection for subsequent docking, ADMET, and molecular dynamics analyses. Next, several phytochemicals exhibited strong docking affinities, with Cardenolide achieving the highest binding score (–9.9 kcal/mol) and forming stable interactions with key catalytic residues. A 100-ns MD simulation confirmed the structural stability, persistent binding, and dynamic integrity of the EGFR–Cardenolide complex under physiological conditions. Importantly, interaction mapping revealed that Cardenolide engages conserved and functionally critical regions of the EGFR kinase domain associated with catalytic activity and structural stability, supporting its mechanistic relevance as an ATP-competitive scaffold. Additionally, predicted pharmacokinetic and toxicity profiles further supported Cardenolide’s suitability as a drug-like candidate. Collectively, these results identify Cardenolide as a computationally prioritized candidate with favorable predicted EGFR-binding characteristics, structural stability, and physicochemical and toxicity profiles. However, as the present study is based entirely on computational analyses, these findings should be considered hypothesis-generating and do not establish EGFR inhibitory activity or therapeutic efficacy. Experimental validation, including biochemical kinase inhibition and cellular assays, is therefore required to determine the actual EGFR inhibitory potential and anticancer activity of Cardenolide. Nevertheless, the findings provide a rational basis for prioritizing Cardenolide for further experimental investigation and illustrate the potential of Adenium obesum phytochemicals as a source of candidate EGFR-targeting compounds for future NSCLC drug discovery.Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy manifested by progressive limb weakness. Anxiety and depression are significant yet under-recognised complications of GBS, particularly in low- and middle-income countries (LMICs). This study examined the proportion and progression of anxiety and depression in Bangladeshi GBS patients and their associations with clinical features, outcomes and quality of life (QoL).
A prospective cohort study.
National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.
A total of 148 GBS patients aged ≥18 years diagnosed by National Institute of Neurological Disorders and Stroke criteria for GBS, were recruited within 2 weeks of symptom onset.
Anxiety and depression were evaluated as the primary outcome using the Hospital Anxiety and Depression Scale (HADS) at week 13 and week 26 post-GBS. Secondary outcomes included Medical Research Council sum score, GBS Disability Score, fatigue severity, pain intensity and EuroQol 5-Dimension 5-Level. Statistical analyses involved descriptive summaries, group comparisons, correlation tests and longitudinal assessments by analysis of variance.
A total of 111 patients with complete HADS data were analysed (median age 36 years; 71% male). At week 13, 45% had anxiety reducing to 36% at week 26. Depression was 53% at week 13 and 41% at week 26. Baseline bulbar involvement was significantly associated with week 13 depression and week 26 anxiety. Between week 13 and week 26, 27%–30% of patients had persistent symptoms and 13%–16% experienced worsening. Anxiety and depression mostly followed concordant patterns, though 28 patients showed discordant patterns. Elevated mood symptoms were associated with greater fatigue, pain and reduced QoL.
Anxiety and depression are common and persistent in GBS adversely affecting recovery and QoL. Mental health monitoring and targeted support should be integrated into GBS management, especially in LMIC settings.
Modern healthcare systems are experiencing a rapid state of change, and it is evidence-based practice (EBP) that is playing a key role in ensuring safe and quality patient care. While EBP has been correlated with favorable patient outcomes, its predictive association with the quality of nursing work life (QNWL) has not been explored, especially in the Middle East region like Jordan.
This study evaluated EBP knowledge, attitudes, practices, and barriers among Jordanian nurses and factors that predict QNWL.
Descriptive, correlational, and cross-sectional research designs have been used. A convenience sample of 198 nurses in five Jordanian hospitals was completed in EBPQ, EBP Barriers Scale, and Brooks' QNWL Scale.
Participants (mean age 29.99; 58.1% female) reported a moderate level of EBP (M = 111.30) or QNWL (M = 153.45). Organizational issues were the greatest challenge to EBP implementation. Higher levels of QNWL had significant relationships with being female, having a bachelor's degree, and working in private hospitals. Of interest, EBP knowledge was one of the predictors of QNWL, followed by educational level.
Findings indicate that strengthening the knowledge of nurses on EBP can improve QNWL. Structured skill-based EBP training and skills development through mentorship should be given priority. Managers should encourage conducive environments with time and resource protection. Policymakers should make EBP competencies part of continuing professional development as well as licensure standards. Future studies should use longitudinal and intervention designs to investigate mechanisms of causal influence and test EBP-oriented workforce strategies.
To preserve the validity and reliability of health instruments like patient-reported outcome measures across linguistic and cultural contexts, translation, cross-cultural adaptation and psychometric validation must be conducted using standardised, rigorous methodologies. Although international standards proposed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) are available, adherence to these guidelines in Bangla-language instrument studies has not been systematically evaluated. This systematic review aims to identify, synthesise and critically appraise Bangla-language translation, cross-cultural adaptation and psychometric validation studies of health instruments for adherence to recommended methodological approaches, translation and cross-cultural adaptation guidelines and psychometric properties.
In this study, we will search three databases, including Ovid MEDLINE, PubMed and EMBASE via Ovid, from 1 February 2026 to 1 March 2026 to retrieve published articles on translation, adaptation and psychometric validation of health-related instruments into Bangla. Two reviewers will independently conduct title and abstract screening, full-text eligibility assessment, data extraction, evaluation of translation and cross-cultural adaptation quality and assessment of psychometric properties. The certainty of evidence will be graded. Disagreements will be resolved by consensus, with the consultation of a third reviewer when necessary. Methodological quality and psychometric properties will be assessed based on the COSMIN Risk of Bias (RoB) checklist and COSMIN standards. Evaluation of translation and cross-cultural adaptation will be based on the extended ISPOR guideline. COSMIN-Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to rate the certainty of evidence.
This study is a systematic review protocol, exclusively on published literature and publicly available data, and does not involve direct interaction with human participants or the collection of individual participant-level data. Therefore, ethical approval is not applicable. We expect to share our findings through national and/or international platforms. Moreover, the results will be published in a peer-reviewed journal. We anticipate that the result of this study will contribute to recommending a standardised roadmap for researchers, especially for conducting translation, validation and cross-cultural adaptation studies of health-related instruments in Bangla.
CRD420251250949.
by Muhammad Kamruzzaman Mozumder, Ummay Kulsum Keya, Fayaza Ahmed, Imtiazuddin Gazi, Konica Gop, Pooja Bhattacharjee, Md. Akramul Islam, Shayla Islam
BackgroundShortage of qualified mental health professionals and limited access to specialized care, coupled with a high burden of mental health problems, particularly anxiety and depression, is a growing public health concern in Bangladesh. A possible solution being tested is the utilization of existing community resources. Availability of a psychometrically valid and reliable screening tool for early detection of mental health problems is of paramount importance. The present study aimed at testing the psychometric properties of the Bangla version of the ultra-brief PHQ-4.
MethodsEmploying practicing mental health professionals as data collectors, this cross-sectional study used data from 357 adults from an urban and two rural communities of Bangladesh.
ResultsConfirmatory factor analysis indicated excellent model fit for the two-factor structure of the Bangla PHQ-4 (χ2 = 0.103 at p > .01, RMSEA = 0.000, CFI = 1.000, TLI = 1.007, and SRMR = .006) for the total sample. The model demonstrated factorial invariance for sex, age, and mental health state. The scale demonstrated high internal consistency (McDonald’s ω = .869) and strong construct validity, evidenced by high correlation with the SRQ-20 (r = .747), K-6 (r = .820), self-rated mental health state (r = −.677), and interviewer-rated mental health state (r = −.680). The scale also demonstrates excellent diagnostic accuracy (AUC = .906), and acceptable sensitivity (82%) and specificity (83%) using a cutoff score ≥ 6.
ConclusionThis study provided evidence of satisfactory psychometric properties of the Bangla PHQ-4 in terms of factor structure, group level invariance, internal consistency, and construct validity in Bangladeshi rural and urban community samples.
Intimate partner violence (IPV) is a major public health concern in Bangladesh, where approximately two-thirds of women report experiencing partner violence and over half of young men admit to perpetrating it. While adverse childhood experiences (ACEs) are among the strongest predictors of IPV, existing research has relied on cumulative ACE scores, overlooking how distinct dimensions of childhood adversity may differentially predict violence. This study examines the relationship between two dimensions of ACEs, threat (eg, exposure to violence) and deprivation (eg, lack of emotional or cognitive support) and IPV perpetration among Bangladeshi young adults.
Cross-sectional survey.
Bangladeshi youths aged 18–35 years across the eight divisions who participated in the national Gender Norms Attitude Study in 2022.
Of the 2790 participants, 2016 (mean age 28.27, SD 5.11) were included in this study as they were either married or in a committed relationship.
The primary outcome measures were IPV perpetration, assessed using the Hurt, Insult, Threaten, Scream scale. The primary exposures were two dimensions of childhood adversity (ACE): threat and deprivation, derived from the nine items commonly used in public health research.
Overall, 59.88% of men and 41.53% of women reported having perpetrated IPV. Both threat (adjusted OR (aOR)=2.57; 95% CI 2.03 to 3.23) and deprivation (aOR=1.75; 95% CI 1.39 to 2.20) ACEs significantly associated higher odds of IPV perpetration. Women had lower odds of perpetration than men (aOR=0.41; 95% CI 0.32 to 0.52), as did those with higher socioeconomic status (aOR=0.83), whereas the odds varied by region (eg, highest in Barisal, aOR=4.40).
Conclusions
The findings highlight the importance of adopting a dimensional approach to ACEs and considering regional and socioeconomic factors in IPV prevention efforts. By integrating these findings into public health interventions and policy frameworks, Bangladesh and other low- and middle-income countries can develop more effective, culturally sensitive strategies to reduce IPV and its devastating consequences.
Cardiovascular disease (CVD) remains a leading cause of global morbidity and mortality, with self-management playing a pivotal role in improving outcomes. Voice-assisted artificial intelligence (AI) technologies such as virtual assistants and voice-controlled applications have emerged as innovative tools for healthcare delivery. While the technologies show promise in areas like primary prevention and chronic disease management, their effectiveness in supporting self-management for patients with CVD remains underexplored. This study aims to evaluate the impact of voice-assisted AI technologies on CVD self-management, specifically focusing on cardiovascular-related mortality, health-related quality of life (HRQoL) and adherence to lifestyle modifications.
A systematic review and meta-analysis will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A comprehensive search will be performed across databases such as MEDLINE, Scopus, Embase and Cochrane Central Register of Controlled Trials (CENTRAL), from 2010 to 2025. The review will include randomised controlled trials (RCTs), non-RCTs and observational studies that evaluate voice-assisted AI interventions (eg, voice-controlled fitness apps, smart health assistants) aimed at CVD self-management. The primary outcome will be cardiovascular-related mortality. Secondary outcomes will include HRQoL, clinical outcomes (eg, high blood pressure), lipid profiles (eg, cholesterol and glucose levels) and lifestyle modifications (eg, dietary habits and levels of physical activity). Data management and analysis will be conducted using Comprehensive Meta-Analysis software V.2.0. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies. The meta-analysis will use random-effects models, with heterogeneity assessed using Q and I² statistics. Subgroup analyses and meta-regression will be conducted to explore potential sources of heterogeneity.
No formal ethical assessment is required, as this study involves analysis of publicly available secondary data. Findings will be disseminated through publications in peer-reviewed scientific journals, conference presentations and media coverage to inform healthcare providers, policymakers and patients.
CRD42024568702.
by Mohammad Nazmol Hasan, Md. Robin Islam, Rafee Shahrier, Md. Bayazid Hossen
Abiotic stressors, such as drought, salinity, and heavy metals, induce physiological changes, nutritional imbalances, molecular alterations, and oxidative stress in plants, which significantly reduce productivity. However, the secondary transporters, multidrug and toxic compound extrusion (MATE) proteins, transport substrates and metabolites. Accordingly, in response to abiotic stressors, these proteins strengthen plants’ immune systems, detoxify toxins, and enhance growth and development. Although the roles of MATE proteins responding to abiotic stresses have been investigated in several plants, their functions in sunflower have not yet been discovered. Therefore, this study identified 74 MATE proteins in sunflower (HanMATE) based on phylogenetic analysis, which were distributed into four subgroups. Their MATE-like properties were then validated using the domain, motif, gene structure, gene duplication, and physicochemical analysis. The HanMATE proteins in various cell organelles play a crucial role in abiotic stress tolerance, scavenging reactive oxygen species (ROS), and regulating transcription. Subsequently, Most HanMATE genes are enriched with biological processes and molecular functions that transport micro- and macro-molecules, drugs, negatively charged ions, organic anions, and citrate. The important Cis-regulatory elements (CREs), abscisic acid-, light-, and MeJA-responsive elements in HanMATE genes regulate plants’ growth and development in stress conditions. The synteny analysis indicated that 41 HanMATE proteins exhibit over 75% sequence similarity with 40 established stress-responsive (SR) MATE proteins from various plant species, suggesting their potential SR characteristics. Furthermore, this study identified 136 microRNAs linked to 58 HanMATE proteins, including 19 major hub microRNAs and 31 hub HanMATE proteins, which may enhance sunflower agronomic traits and abiotic stress resistance. The HanMATE proteins are conserved in other species that contribute to detoxification and have stable binding affinity with flavonoids and citric acid, validated from 3D structural modeling, molecular docking (MD), dynamic simulation, and functional prediction. These findings demonstrate that HanMATE genes are essential for sunflower abiotic stress tolerance (AST), and genetic engineering can be applied to develop more robust sunflower.by Afsana Anwar, Mahmood Parvez, Farhan Azim, Uday Narayan Yadav, Saruna Ghimire, Ateeb Ahmad Parray, Shovon Bhattacharjee, ARM Mehrab Ali, Rashidul Alam Mahumud, Md Irteja Islam, Md Nazmul Huda, Mohammad Enamul Hoque, Probal Kumar Mondal, Abu Ansar Md Rizwan, Suvasish Das Shuvo, Sabuj Kanti Mistry
BackgroundFrailty and disability often emerge with ageing and affect quality of life. Older adults residing in Rohingya refugee camp in Bangladesh are particularly susceptible to frailty and disability due to adverse physical and social environment along with limited health and social care services available in the camp. This study aimed to investigate the prevalence and factors associated with frailty and disability among Rohingya older adults living in Bangladesh.
MethodsThis cross-sectional study was conducted among older adults aged ≥60 years residing in the Rohingya refugee settlement in Bangladesh. The primary outcomes were frailty and disability, explored using the ‘Frail Non-Disabled (FiND) questionnaire. Data were collected face-to-face during November-December 2021, using a semi-structured questionnaire. A multinomial logistic regression model was used to identify the factors associated with frailty and disability.
ResultsThe majority of participants (n = 864) were aged 60–69 years (72.34%), male (56.25%), married (79.05%), and without formal education (89.0%). The study revealed a high prevalence of frailty (36.92%) and disability (55.21%) among the participants. The multinomial regression analysis showed that the likelihood of experiencing disability was significantly higher among participants who were aged 70–79 years (RRR = 2.65, 95% CI: 1.25, 5.66) and ≥80 years (RRR = 8.06, 95% CI: 1.05, 61.80), were female (RRR = 3.93, 95% CI: 1.88, 8.1.9), had no formal education (RRR = 4.34, 95% CI: 2.19, 8.63), were living in a large family (RRR = 1.82, 95% CI: 1.05, 3.18) and were suffering from non-communicable diseases (RRR = 2.36, 95% CI: 1.32, 4.22) compared to their respective counterparts. The regression analysis also revealed that frailty was significantly higher among participants who were female (RRR = 2.82, 95% CI: 1.34, 5.94), were suffering from non-communicable diseases (RRR = 2.28, 95% CI: 1.27, 4.09), and had feeling of loneliness (RRR = 2.16, 95% CI: 1.11, 4.22).
ConclusionsThe findings underscore the need for long-term care and health promotion activities to alleviate the burden of frailty and disability among older adults in humanitarian settings. Efforts should particularly target the most vulnerable groups- older individuals (≥80 years), women, those without formal education, those living in large families, and those with non-communicable diseases.
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.To synthesise the existing literature on effective interventions aligned with the 2015 U.S. Occupational Safety and Health Administration guidelines to address workplace violence against nurses.
An integrative review.
PubMed, Embase, CINAH, and PsycINFO databases were searched for articles published between 2010 and 2023. Articles addressing WPV interventions and published in English were included.
Thirty-seven of 834 articles met the inclusion criteria. The review revealed several strategies to address workplace violence in healthcare settings, with staff training being the most common strategy. However, most interventions were researcher-designed, often excluding input from nurses or other stakeholders. Limited managerial support for nurses following the incidents was another prominent finding.
Although safety training programmes are common, there are critical gaps in managerial support and nurse involvement in intervention development. Further research should focus on incorporating nurse contributions and strengthening managerial support to enhance prevention efforts.
Addressing workplace violence in healthcare settings requires a comprehensive approach beyond safety training. Active nurses' participation in intervention design and enhanced managerial support are essential for creating effective solutions. Healthcare administrators should create environments that empower nurses to contribute to solutions.
This review highlights existing gaps in interventions and emphasises the need for collaborative and nurse-centered approaches to address workplace violence.
The reporting of this review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
No patient or public contribution.
FreshRSS 