Conectar
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.Sleep problems are an escalating global health concern, with prevalence estimates ranging from 8.3% to 45%. Physicians are disproportionately affected, with rates around 44% compared with 36% in the general population. In Bangladesh, reported rates range from 32% to 58%, with physicians being particularly vulnerable. Poor sleep among physicians is strongly linked to burnout, medical errors and increased mental health risks. Despite these serious implications, existing evidence from Bangladesh remains fragmented and inconsistent, limiting its utility for health policy and workforce interventions. This review therefore seeks to generate reliable pooled prevalence estimates and identify key determinants of sleep problems among Bangladeshi physicians.
The research team will search the PubMed, Scopus, Web of Science, EMBASE, PsycInfo, ProQuest Medical, CINAHL, Google Scholar and BanglaJOL electronic and regional databases following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines for published studies from inception until 1 August 2025, using truncated and phrase-searched keywords, relevant medical subject headings and citation chaining from grey literature. Observational cross-sectional studies published within the predefined timeframe, using validated assessment tools, and published in English or other major international languages will be prioritised for inclusion. Review papers, case reports, case series, intervention studies, commentaries, preprints, meeting abstracts, protocols, unpublished articles and letters will be excluded. Two independent reviewers will screen the retrieved papers using the Rayyan web-based application, with any disagreements resolved by a third reviewer. Quantitative estimates of sleep problems, including prevalence, duration, quality and associated risk factors among Bangladeshi physicians will be extracted. A narrative synthesis and meta-analysis will be performed to assess the pooled prevalence using a random effects meta-analysis model. Forest and funnel plots will be generated for visualisation. Heterogeneity will be assessed using the I2 statistic, with sensitivity or subgroup analysis conducted as required. The quality of included studies will be evaluated using Joanna Briggs Institute critical appraisal tools for observational study designs. All statistical analysis will be conducted using Jamovi V2.7.6, R V4.3.2 ‘meta’ packages and GraphPad Prism V9.0.2.
This review will synthesise evidence from existing published literature. While completing the findings, the findings will be submitted to an international peer-reviewed journal and disseminated through conferences, policy forums and stakeholders’ networks to inform future research and interventions.
CRD420251123294.
We hypothesise that women with type 2 diabetes and hypertension are less likely than comparable men to receive renin–angiotensin system (RAS)-inhibiting antihypertensive treatment, particularly as first-line therapy. This study’s main aim is to investigate the delivery of RAS inhibitor treatments by sex and number of antihypertensive treatments used.
Cross-sectional study in a cohort.
Constances cohort, France, 2012–2019.
2541 participants with type 2 diabetes among the 196 477 individuals aged 18–69 included in the Constances cohort.
Proportion of individuals treated with RAS inhibitors by sex and number of antihypertensive treatments dispensed. Factors associated with the use of RAS inhibitors.
Among 2541 diabetics, 1742 (68.6%) had received at least one antihypertensive treatment during the year preceding inclusion—a percentage that did not differ significantly between men and women (p=0.07). In analyses stratified by the number of antihypertensive classes, RAS inhibitors were delivered significantly less often to women than men for single-drug therapy (OR 0.46, 95% CI 0.25 to 0.81; p=0.008) and two-drug therapy (0.35, 95% CI 0.16 to 0.75, p=0.007) but not in regimens of three or more drugs (0.29, 95% CI 0.05 to 1.56; p=0.15). In the multivariate analysis, women received RAS inhibitors significantly less often than men (0.41, 95% CI 0.27 to 0.62; p
Women with type 2 diabetes are less likely than men to receive a prescription for RAS inhibitors, although this drug class is recommended as first-line therapy in this population.
Ebola disease stigma hinders outbreak control and recovery by deterring care-seeking and driving social exclusion. Although this phenomenon is well recognised, gaps remain in understanding how stigma emerges and operates in outbreak settings, limiting the development of effective reduction strategies. The objective of this study was to examine the drivers, manifestations and public health impacts of stigma following the 2022–2023 Sudan ebolavirus outbreak in central Uganda.
We conducted a cross-sectional, mixed-methods survey to assess Ebola disease stigma in June 2024.
The study was conducted in the Ugandan districts of Mubende, Kassanda and Kyegegwa, which were heavily affected by the outbreak.
A total of 302 respondents completed the survey. Respondents included all 51 eligible adult Ebola survivors in the districts known to the research team, as well as household members, healthcare workers, outbreak support staff and the general public.
The interviewer-administered survey explored personal experiences of stigma, community attitudes and impacts on outbreak control. We used a pillar integration process to identify themes across quantitative and qualitative data in three domains (drivers, manifestations and impacts of stigma).
Participants identified several perceived drivers of stigma, including fear, hygiene-focused public health messaging, distrust in public services and criminal connotations inferred from the outbreak response. Manifestations, including self-stigma and associative stigma, endured beyond the outbreak and across contexts. Nearly all survivors interviewed (n=48, 94%) reported multiple experiences of stigmatisation since discharge, with almost half (n=25, 49%) reporting physical harm or threats. Stigma was reported to affect care-seeking, healthcare worker morale and community socioeconomic well-being.
Stigma remains a major barrier to Ebola disease outbreak control and recovery. The high levels of stigma reported by survivors and anticipated by community members highlight the urgent need for targeted interventions in future outbreaks. We specifically show there are opportunities to address misinformation, avoid criminal connotations in outbreak control efforts and enable peer support.
To investigate the relationship between a quality of life (QOL) score and clinical parameters in patients with hypertrophic cardiomyopathy (HCM).
A multicentre cross-sectional study.
We analysed data from the Searching for Atrial Fibrillation and Early Recruitment of Heart Failure in HCM registry, collected between 2018 and 2023.
Patients with HCM (n=499) aged ≥18 years from 12 institutions (Shizuoka Prefecture, Japan) were consecutively enrolled.
Clinical parameters, along with data from a short form of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), were collected. The association between each clinical parameter and the KCCQ-12 score was analysed. Clinical parameters with a significant univariable association (p
In the univariable analysis, KCCQ-12 scores exhibited significant associations with 21 clinical parameters, including sex, left ventricular morphology and the Pittsburgh Sleep Quality Index (PSQI). The multiple regression model with 12 parameters that had a significant univariable association exhibited an adjusted R2 of 0.48. In this model, the PSQI (standardised coefficient –0.39; p
In patients with HCM, we investigated the association between the KCCQ-12 score and various clinical parameters. PSQI, as well as known heart failure-related clinical parameters, was significantly associated with the KCCQ-12 score. Visualising the associations of various clinical parameters with the KCCQ-12 score will help physicians to consider factors linked to the decline in QOL in patients with HCM.
To pilot a culturally tailored, peer-led, co-produced asset-based intervention workshop to encourage early diagnosis of prostate cancer for Black men.
Mixed-methods pilot study.
Community centres in the North-East of England and Scotland.
The intervention was delivered in November 2023 with Black African and Caribbean men (n=21), and again in February 2024 (n=41). Participants were highly educated and aged between 42 and 63 years. The intervention was qualitatively evaluated with 40 of the intervention participants.
Underpinned by the Integrated Screening Action Model (I-SAM), we co-produced a culturally tailored, peer-led 2-hour workshop consisting of multiple components, including small group discussions about barriers to accessing prostate cancer care, general practitioner (GP) health education, activities to facilitate effective communication with the GP and reception staff and videos with testimonials from survivors, women and religious leaders.
Knowledge, attitudes and intention to engage in prostate cancer testing were examined through a pre- and post-survey design. Intervention acceptability was qualitatively explored through focus groups.
Participants (n=41) reported that the workshop increased their confidence in engaging with healthcare providers to discuss prostate cancer testing (I-SAM component: psychological capability). Knowledge (I-SAM component: psychological capability: Z=4.939, p
Asset-based strategies, focusing on community strengths, including faith-based health promotion, can promote health behaviours in a culturally and spiritually meaningful way. The PROCAN-B intervention effectively targeted components within the I-SAM and shows potential to increase prostate cancer awareness and build confidence to engage in behaviours conducive to early diagnosis. However, the sample was small, and more robust effectiveness testing is needed.
The study aims to understand the changing context of RACFs and the role of RACF managers in preparing to confront the COVID-19 pandemic and to provide insights into how the use of visual telehealth consultation might be incorporated to assist with managing whatever might arise.
An interpretive descriptive study design was employed, and data were collected using semi-structured interviews conducted via telephone or videoconference. Purposive recruitment targeted clinical managers responsible for the COVID-19 response in RACFs.
RACF clinical managers were invited to discuss their responses to COVID-19 including the management of RACF and staff. Semi-structured interviews explored the COVID-19-related challenges, the response to these challenges and how telehealth might assist in overcoming some of these challenges. This study followed Thorne's (2008) three-stage process of interpretive description. The COREQ checklist was used in preparing this manuscript.
Two main themes were identified. The first theme ‘keeping people safe’ was comprised of three subthemes; fear and uncertainty, managing the risks and retaining and recruiting staff. The second theme was ‘keeping people connected’, had two subthemes; being disconnected and isolated and embracing technology.
Findings from this study provide valuable insight into understanding the context and the challenges for RACFs and the staff as they attempt to keep residents safe and connected with healthcare providers and the outside world.
Understanding the experiences of RACF managers in preparing to respond to the pandemic will better inform practice development in aged care in particular the use of telehealth and safe practices during COVID-19. Increased awareness of the challenges faced by RACFs during a pandemic provides policymakers with valuable insights for future planning of pandemic responses.
The study focuses on the effects of workplace violence on certain organisational outcomes, such as job performance, burnout, turnover, and work alienation.
The study is a cross-sectional study. The study was conducted with 400 nurses between June 2025 and July 2025 across Turkey.
Verbal violence was the most common form of violence experienced both in the first year of professional experience and throughout the career, with the number of reported incidents increasing over the years. In the first month following the violence, nurses commonly reported experiencing stress, anger, frustration, fear, and headaches; in the last 5 years, they reported experiencing frustration, alarmism, stress, anger, and sleep problems. Nurses reported sharing workplace stress with colleagues, managers, and their families, but received support primarily from colleagues and personal friends. Finally, workplace violence decreased nurse performance and increased work alienation, burnout, and intention to leave.
It provides basic data for the development of preventive and supportive social and managerial plans by determining the workplace violence to which nurses are exposed and its impact on organisational outcomes.
Workplace violence against nurses is widespread, and its impacts are not limited to the results of this study. Therefore, legal regulations should be developed to prevent workplace violence, social and administrative support should be provided to nurses who are victims of violence, and the prevalence of workplace violence against nurses and its effects should be evaluated periodically.
In this study, workplace violence against nurses and its effects on some organisational outcomes were evaluated. The findings provide baseline data for implementing social and managerial interventions to reduce workplace violence to which nurses are exposed and its effects.
This study adheres to the STROBE guideline of reporting.
This study did not include patient or public involvement in its design, conduct, or reporting.
The study sought to understand the characteristics of community deaths due to cholera in Zambia. We sought to examine the drivers of mortality from cholera among communities in Zambia’s 2023–2024 outbreak.
This is a descriptive study of the characteristics of community deaths due to cholera in three provinces in Zambia. Routine surveillance data collected between 14 October 2023 and 16 April 2024, comprising a national line list of cholera deaths, were used for this study.
178 participants were included in the study and completed it. All community deaths on the line list were eligible for inclusion. This comprised: deceased individuals whose death was associated with cholera or who met the national cholera case definition (suspected or confirmed); death occurring in the community, en route or on arrival to a health facility prior to admission; and death must have occurred between 14 October 2023 and 16 April 2024. Deceased individuals whose family members could not be traced or did not consent to participate in the interview were excluded.
The primary outcome was identifying characteristics of cholera-related community deaths. There were no secondary outcomes measured.
Among 178 community deaths due to cholera, the majority were males (61.8%), with the highest mortality in adults aged 35–49 years (22.5%). Over half of the deaths occurred on arrival at healthcare facilities due to delays influenced by socioeconomic barriers. Comorbidities such as HIV/AIDS and hypertension were present in 23% of cases.
The study found that males, death on arrival at healthcare facilities, delays in seeking healthcare and comorbidities such as HIV/AIDS and hypertension were more frequently observed among those who died due to cholera in the community. These findings highlight the need for enhanced early care-seeking behaviours, improved access to timely treatment and targeted interventions for individuals with comorbidities to potentially reduce cholera mortality.
To explore the acceptability and feasibility of using a trauma-informed communication tool to convey client needs to health professionals; and to understand the barriers and enablers for clients using the tool.
Mixed methods design pilot study conducted by nurses from a regional community health service in Victoria, Australia, of purposively sampled clients who have a history of sexual assault and/or family violence and clinicians from a primary care service.
The investigators developed a pocket-sized communication card to convey clients' history of trauma and the clients' emotional and physical needs to health care providers.
Pre-intervention and post-intervention surveys using validated scales (‘Acceptability of Intervention Measure’ and ‘Intervention Appropriateness Measure’) were administered via anonymous online or paper-based survey.
Sixteen clients completed the pre-intervention survey and 12 clients completed the post-intervention client survey. Seven Nurses and three Social Workers completed the clinician survey.
Both clients and clinicians reported high rates of acceptability and appropriateness of the tool on the outcome measures. The most commonly reported barriers to using the tool were clients forgetting to use the card and concern about how health professionals may respond.
Content analysis of qualitative data revealed themes categorised as positive impacts (prevention of re-traumatisation), negative impacts (negative response from health professionals) and suggestions for improvement of the tool (developing a digital version, raising clinicians' awareness of the tool).
This novel tool has demonstrated a high degree of acceptability and applicability in a sample of clients with a history of trauma secondary to sexual assault and/or family violence, and community health clinicians, and several positive and negative impacts have been identified. Further research should focus on larger participant numbers and include developing a digital version and a clinician education component.
Use of a tool to communicate impacts of trauma may prevent re-telling of traumatic stories by clients and enhance quality of care delivery.
The Good Reporting of a Mixed Methods Study (GRAMMS) has been used to report the results of this study.
During development of the tool, it was reviewed by a lived experience consumer representative, the health organisations' consumer advisory panel, and a small sample of clients.
This study examined the relationship between mobbing and quiet quitting attitudes among nursing and midwifery academics.
A descriptive cross-sectional design was used, and data were collected online between June and December 2024 from 209 academics via social media platforms.
The instruments included a Data Collection Form, the Quiet Quitting Attitude Scale (QQAS) and the Academicians Mobbing Scale (AMS). Statistical analyses were applied to assess group differences and relationships.
Academics at private universities reported higher mobbing exposure. Nurse academics had higher overall QQAS and ‘Personal Thought’ scores, whereas midwife academics scored higher in the ‘Positive Attitude’ subdimension. Doctoral students experienced more professional attacks. Mobbing exposure varied significantly by academic status and was notably linked to deteriorations in social relationships and psychological well-being. A strong positive correlation was found between mobbing and quiet quitting attitudes (t = 24.239, p < 0.001).
Midwifery academics reported greater mobbing, while nurse academics showed stronger quiet quitting tendencies. Findings suggest that early-career academics are especially at risk. Institutions should prioritise anti-mobbing strategies and foster academic engagement to promote a healthier work environment.
This study highlights that mobbing is strongly associated with quiet quitting attitudes among nursing and midwifery academics, particularly affecting early-career professionals. Implementing anti-mobbing strategies and fostering academic engagement are essential to support well-being and productivity in academic settings.
The study's online survey was conducted and reported following the CHERRIES guidelines to ensure transparency, completeness and quality of web-based research data.
This study did not involve any direct patient or public contribution in its design, data collection or analysis.
by Mohammad K. Siddiqui, Shagufta Khan, Rinchenla Bhutia, Vivek Nair, Ashok Rai, Nirmal Gurung, Tseten Yamphel, Peggy K. Dadul, Debya S. Kerongi, Karma Doma Bhutia, Jagat Pradhan, Kabita Khati, Sreenivas A. Nair, Shamim Mannan, Kiran K. Rade, Dinesh Gupta, Pawan Malhotra, L. Masae Kawamura, Shikha Dhawan, Asif Mohmmed
BackgroundMonasteries in India house individuals from childhood to advanced age. These congregate settings amplify tuberculosis (TB) transmission and exposure when the disease is present, especially in the high burden areas like Sikkim, India. However, the prevalence of active-TB disease (ATB), tuberculosis infection (TBI), and their associated risk factors have not been studied. The diagnosis and treatment of TBI remain a major bottleneck in eradicating TB. ATB and TBI risk among residents living in the congregate setting of monasteries in Sikkim, India, a high-TB burden area, may be high due to high-density living quarters, public interaction and their frequent travel history but has never been illustrated.
MethodA cross-sectional screening of the monks and residents of Rumtek Monastery (Sikkim, India) was carried out to assess extent of ATB and TBI in a congregate setting. TrueNat MTB and GeneXpert MTB/Rif systems were utilized for ATB diagnosis, whereas QuantiFERON-TB Gold Plus (QFT-plus) Interferon-gamma release assay (IGRA) analysis was used for TBI detection. Follow-up sputum testing by TrueNat MTB was performed on IGRA-positive individuals to exclude ATB.
ResultsAmong the 350 inhabitants of the monastery, 7% (25/350) were found to be symptomatic for TB, whereas 93% (325/350) were asymptomatic. Out of them, 189 participants, including symptomatic cases, agreed to participate in the study and were screened for TBI; however, 15 participants were excluded from the study due to result discrepancies. None of the participant were diagnosed with active tuberculosis (ATB), although, 44.2% (77/174) were found to be positive for TBI; however, none of those with TBI progressed to ATB during one year follow-up. Risk factors for TBI included: advancing age, frequent travel history, family history of TB or having contacts with TB patients and abnormal Body Mass Index (BMI) ≤18.5- ≥ 25.
ConclusionThis study confirms the high prevalence of TBI among residents in the congregate setting of monasteries, and justify TB prevention strategies by targeted screening, TBI testing and preventive treatment in congregate settings of high TB burden areas.
Interprofessional socialisation can contribute to collaborative patient care. Although there is research regarding interprofessional socialisation of healthcare students and frontline staff, there is limited literature regarding healthcare educators in practice settings. Our aim was to examine interprofessional socialisation of healthcare educators in the practice setting following an interprofessional simulation facilitator training programme.
Explanatory sequential mixed methods study.
Quantitative provincial simulation programme evaluation data from 2022 and 2023 (n = 87) were analysed and used to inform qualitative interviews (n = 17). Qualitative and quantitative data were integrated following independent analysis.
There was a statistically significant increase in attitudes toward interprofessional socialisation following the simulation facilitator training programme. Qualitative findings revealed themes regarding interprofessional socialisation: (a) benefits gained through interprofessional socialisation, (b) interprofessional, uniprofessional or both, (c) facilitators to interprofessional socialisation, (d) barriers to interprofessional socialisation and (e) opportunities to strengthen interprofessional socialisation.
Despite positive views of interprofessional socialisation, socialisation behaviours may not be consistent in a variety of contexts. Interprofessional education may increase interprofessional socialisation among educators.
It is important to provide interprofessional socialisation opportunities for educators to promote more interprofessional education initiatives.
The findings of this study provided insights into how to foster interprofessional socialisation in existing structures and how new pathways might be built to connect educators.
This study is reported in congruence with the Journal Article Reporting Standards—Mixed Methods, Quantitative, and Qualitative Standards provided on the Equator Network.
Members of the provincial simulation team were consulted regarding study design and data collection to optimise participation.
The co-occurrence of multiple long-term conditions, that is, multimorbidity, is increasing globally and is associated with lower quality of life and increased risk of death. The risk and prevalence of multimorbidity are higher among women compared with men, but currently, evidence focusing on women’s multiple long-term conditions during the perinatal period is limited. Existing evidence needs to be examined to determine the extent to which maternal multimorbidity or women’s multiple health needs related to pregnancy have been addressed, especially for women living in low-income and middle-income countries (LMICs) where this burden of disease is the highest. The objective of this scoping review is to map existing evidence in LMICs on (a) Study designs and data sources, (b) Context-relevant definitions and descriptions, (c) Associated risk and protective factors, (d) Relevant maternal and infant health outcomes and (e) Treatments and interventions used to manage multiple long-term conditions before, during and after pregnancy.
This scoping review will be conducted using Joanna Briggs Institute methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement extension for scoping reviews. This review will include observational, experimental or quasi-experimental studies, as well as systematic or umbrella reviews, on multimorbidity in women of reproductive age (15–49 years) in prepregnancy, pregnancy or up to 6 weeks after childbirth in LMICs. The studies will focus on definitions, risk and protective factors and management strategies for multiple long-term conditions before, during and after pregnancy. Studies of morbidity in women with a single index condition or conditions that are not related to pregnancy or childbirth will be excluded. A search strategy will be developed using thesaurus (including MeSH) and free-text terms for ‘maternal morbidity’ or ‘multiple long-term conditions’ and associated keywords such as multimorbidity, co-morbidity and unmet health needs related to pregnancy and/or childbirth for women living in LMICs. Electronic (EBSCOhost (CINAHL Ultimate, STM Source, Medline Ultimate), Cochrane Library, Web of Science or Scopus and Google Scholar) and grey literature databases will be searched from database inception. Reference lists and bibliographies of key topic articles will also be searched, and any additional papers that meet the inclusion criteria will be obtained. There will be no limitations on dates or languages. Records will be independently screened, selected and extracted by two researchers. Data will be presented in tables and narrative summaries.
Ethics approval is not required as this scoping review will summarise previously published data. Findings from the review will be disseminated through various platforms, including peer-reviewed journals, conferences and community meetings.
Open Science Framework (https://doi.org/10.17605/OSF.IO/FYCR8).
by Connie Nait, Simple Ouma, Saadick Mugerwa Ssentongo, Boniface Oryokot, Abraham Ignatius Oluka, Raymond Kusiima, Victoria Nankabirwa, John Bosco Isunju
BackgroundDespite advances in HIV care, viral load suppression (VLS) among adolescents living with HIV (ALHIV) in Uganda continue to lag behind that of adults, even with the introduction of dolutegravir (DTG)-based regimens, the Youth and Adolescent Peer Supporter (YAPS) model, and community-based approaches. Understanding factors associated with HIV viral load non-suppression in this population is critical to inform HIV treatment policy. This study assessed the prevalence and predictors of viral load non-suppression among ALHIV aged 10–19 years on DTG-based ART in Soroti City, Uganda.
MethodsWe conducted a cross-sectional study among 447 ALHIV attending three urban HIV clinics in Soroti City. Data were abstracted using a structured questionnaire and analyzed in STATA 15.0. Modified Poisson regression with robust error variance was used to identify predictors of viral load non-suppression. Adjusted relative risks (aRR) and 95% confidence intervals (CIs) were reported, with statistical significance set at p ≤ 0.05.
ResultsOf the 447 participants, 53.5% were female, with a median age of 16 years (IQR: 14.0–17.6). The majority (72.9%) were from Soroti district and had been on DTG-based ART for a median of 42.5 months (IQR: 37.0–48.0). Most were receiving multi-month dispensing (MMD) (75.2%) and were active in care (98%). The prevalence of viral load non-suppression was 19.2% (86/447). Independent predictors of non-suppression included older age (15–19 vs. 10–14 years) (aRR: 1.69; 95% CI: 1.08–2.67), male sex (aRR: 1.48; 95% CI: 1.05–2.11), prior non-suppression before switching to DTG (aRR: 1.76; 95% CI: 1.19–2.59), use of non-fixed dose DTG regimens (aRR: 2.03; 95% CI: 1.23–3.33), history of poor adherence (aRR: 4.36; 95% CI: 2.05–9.26), and not receiving MMD (aRR: 2.83; 95% CI: 1.93–4.15).
ConclusionNearly one in five adolescents on DTG-based ART in Soroti City had viral non-suppression, despite optimized treatment regimens. Targeted interventions−particularly enhanced adherence counseling for older and male adolescents, expanding MMD coverage, and provision of fixed-dose regimens−are urgently needed to improve VLS among ALHIV. These findings underscore the need for adolescent-centered HIV care strategies to close the viral suppression gap and advance progress towards epidemic control.
Sexually transmitted infections (STIs) pose a huge public health challenge in sub-Saharan Africa, where prevalence rates are among the highest globally. Barriers such as limited healthcare access, stigma and inadequate diagnostic facilities impede timely detection and treatment. Self-sampling for STI testing offers a potential solution to these challenges. This scoping review will systematically map the available evidence on self-sampling for STIs in sub-Saharan Africa, focusing on its feasibility, acceptability, implementation and outcomes.
The scoping review will be guided by the Arksey and O’Malley framework. The review will include a comprehensive search of peer-reviewed and grey literature from various repositories and databases. The following databases will be searched: PubMed, Scopus and Global Health. Studies that will be included will meet specific criteria. The results of the review will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.
The methodology used for this study is a scoping review of existing literature; therefore, ethical approval is not required. Findings of this study will be shared at national, regional and international conferences and published in a peer-reviewed journal.
We registered the protocol with the Open Science Framework.
This study aimed to investigate the relationship between coping strategies and compassion fatigue among healthcare professionals in Central Uganda.
A facility-based cross-sectional study conducted between June and July 2023. Three tools were used for data collection: a socio-demographic survey, the Professional Quality of Life Scale (ProQOL-5) and the Brief-Coping, Orientation to Problem Experienced tool. Participants were asked to recall experiences from the previous 30 days.
The study was conducted in five prominent hospitals in Central Uganda.
A total of 548 healthcare providers, including 191 physicians, 256 nurses and 103 technicians.
Compassion fatigue scores.
Most participants were under 29 years old (50.9%) and women (62.0%). High levels of compassion fatigue were reported by 37.8% of participants. Active coping, self-distraction and denial were associated with higher compassion fatigue, while informational support, positive reframing and venting were linked to lower fatigue levels. Seeking social support effectively reduced compassion fatigue.
The findings highlight significant compassion fatigue among healthcare providers in Central Uganda, impacting their well-being and patient care. Coping strategies like active problem-solving and social support are promising in mitigating compassion fatigue. Interventions should focus on reducing self-distraction, enhancing problem-solving skills and fostering supportive work environments to improve healthcare workers’ well-being and patient care quality.
The study evaluated healthcare professionals’ adherence to guidelines on quality neonatal resuscitation practices in Ghana.
This study employed an observational design. A validated observational checklist for neonatal resuscitation was used to assess the adherence to quality neonatal resuscitation guidelines among healthcare professionals.
The study was conducted among healthcare professionals in six healthcare facilities, consisting of five government-owned healthcare facilities and a private non-profit health facility across the northern, middle and coastal belts of Ghana.
The study participants were 75 healthcare professionals across the six sampled healthcare facilities.
Outcome measures of interest are: initial preparation prior to resuscitation; stimulation and airway maintenance; positive pressure ventilation; coordinated positive pressure ventilation with chest compression and postresuscitation infection prevention and control measures.
The results revealed that 53% of the healthcare professionals demonstrated good (scored 80%–100%) adherence to guidelines on quality neonatal resuscitation practices; the remaining scored moderate 36% (scored 50%–79%) and 11% (scored 0%–49%) poor adherence. Binary logistic regression analysis revealed that increased staffing levels and a bachelor’s degree or higher were positively associated with the performance of positive pressure ventilation (adjusted OR (aOR) 19.3 (95% CI 2.430799, 152.8657), p=0.005) and (aOR 9.9 (95% CI 1.070278, 92.38303), p=0.043), respectively. Furthermore, professional nurses and medical practitioners were more likely to adhere to coordinated positive pressure ventilation with chest compressions than auxiliary nursing staff (aOR 13.2 (95% CI 1.917858, 92.61999), p=0.009) and (aOR 15.7 (95% CI 1.227859, 200.1105), p=0.034).
The results showed that 53% of healthcare professionals demonstrated good adherence for neonatal resuscitation practices. Addressing the identified gaps and inequalities in neonatal resuscitation practice will improve healthcare professionals’ knowledge and skills in neonatal resuscitation, which ultimately helps to reduce neonatal deaths among babies in Ghana.
Many people with psychosis find the world very frightening. It can be difficult for them to do everyday things—for example, walking down a busy street, travelling on a bus or going to the shops. Sometimes, the fears are so great that individuals rarely leave their homes. gameChange virtual reality therapy is designed to reduce this agoraphobic avoidance. In gameChange, users practise going into computerised immersive versions of ordinary situations. A virtual therapist guides users through the programme. A mental health worker also supports people. People normally do six sessions of gameChange, but now they can do more as headsets can be left with many people. We originally tested gameChange with 346 patients with psychosis. People saw a significant reduction in their fears. People with the most severe problems made the biggest improvements. This led to gameChange receiving National Institute for Health and Care Excellence (NICE) Early Value Assessment (EVA) approval for its use with patients with psychosis who have severe agoraphobic avoidance. NICE EVA approval is conditional on further evidence generation. We aim to carry out a real-world trial of gameChange used in the NHS. The overall aim is to gather evidence on the four essential areas (clinical benefits on agoraphobia, level of engagement and adherence, healthcare resource use, adverse effects) and the two further supporting areas (health-related quality of life, generalisability) identified in the NICE evidence generation plan for gameChange.
200 patients with psychosis and severe agoraphobic avoidance will be randomised (1:1) to receive gameChange in addition to treatment as usual (TAU) or to a waitlist control group receiving TAU. Assessments will be conducted blind to group allocation at baseline, 8 weeks (end of treatment) and 26 weeks (follow-up). The trial will be embedded in services in at least seven National Health Service (NHS) trusts across England. The primary outcome is agoraphobic avoidance at 26 weeks assessed with the Oxford Agoraphobic Avoidance Scale. The secondary clinical outcomes are agoraphobic distress, paranoia and social contacts. There will be tests of moderation of the main clinical outcome. Treatment acceptability, adverse effects and cost-effectiveness will also be assessed. The target estimand is the treatment policy estimand and all primary and secondary analyses will be carried out incorporating data from all participants including those who do not complete treatment.
The trial has received ethical approval from the NHS Health Research Authority and Health and Care Research Wales (25/WA/0081). A key output will be the evidence needed for a NICE guidance update on gameChange and a clear recommendation concerning future routine use in the NHS.
The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. In this study, we present the cohort’s sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades.
Since February 2023, community health worker (CHWs) supported by a clinical decision support and data collection application have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in Northeast Lesotho. As of 31 May 2024, the cohort includes 5008 households with 14 735 participants (55% female, median age 19 years). The cohort’s socioeconomic status is low with an International Wealth Index of 26, a monthly household income of US$42.4 and low levels of formal education. Among the 7917 adult participants, 42.5% are overweight or obese, with higher rates among women, and 33.1% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1% with a 98.4% treatment rate. Hypertension prevalence is 17% with a 56% control rate and diabetes prevalence is 4% with a 39% control rate.
The cohort’s low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets.
Ongoing cluster-randomised TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions.
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