Conectar
by Siobhán O’Connor, Sandra M. Malone, Joseph Firnhaber, Sinéad O’Keeffe, John McNamara, Anna Donnla O’Hagan
While mental health literacy is an important component to successful help-seeking, rural populations often face gaps in both knowledge and service provision. Informed by the Theory of Planned Behaviour and Self-Efficacy Theory, we designed the ‘Skills for Resilience’ as a brief, once-off, community-based educational intervention to increase Irish farmers’ mental health literacy and help-seeking intentions. We adopted a quasi-experimental between (group: intervention and control) and within-group design (time: baseline [T1], immediately post-intervention [T2], and ≥ 1 month post-intervention [T3]). A total of 72 participants (intervention n = 37; control n = 35) were recruited from knowledge-sharing discussion groups. Although recruitment was also open to women, all discussion groups consisted of men. A trained facilitator delivered a discussion lasting between 30 and 90 minutes. Five intervention participants also participated in a qualitative interview after T3. Our results identified intervention participants’ mental health literacy increased significantly at T2 and T3 compared to T1, but did not increase between T2 and T3. Mental health literacy was also significantly greater in the intervention group compared to the control group at T2 and T3. Help-seeking intentions and self-efficacy in seeking mental healthcare also increased significantly at T2 compared to T1, but did not increase between T1 and T3 or T2 and T3. There were no significant changes in outcome measures for the control group at any time point. Through reflexive thematic analysis we identified that the intervention also addressed stigma against mental health (Theme 1) and provided important resources for participants and their community’s present and future coping (Theme 2). At T3, 100% of participants enjoyed the discussion and would recommend the intervention to other farmers. This intervention provides a successful example of integrating the Theory of Planned Behaviour and Self-Efficacy Theory to improve mental health literacy in farmers using a brief, educational intervention.by Anni Varjonen, Toni Saari, Sari Aaltonen, Teemu Palviainen, Mia Urjansson, Paula Iso-Markku, Jaakko Kaprio, Eero Vuoksimaa
We examined the associations of midlife and old-age cardiovascular risk factors, education, and midlife dementia risk scores with cognition at 90 + years, using data from a population-based study with 48 years of follow-up. Participants were 96 individuals aged 90–97 from the older Finnish Twin Cohort study. Individual cardiovascular risk factors assessed via questionnaires in 1975, 1981, 1990, and 2021–2023 included blood pressure, body mass index, physical activity, and cholesterol, and self-reported educational attainment. The Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) score and an educational-occupational attainment score were used as midlife dementia risk scores. Cognitive assessments included semantic fluency, immediate and delayed recall from a 10-word list learning task, and a composite cognitive score. Regression analyses were conducted with dementia risk factors predicting cognition at 90 + years, adjusting for age, sex, education, follow-up time, and apolipoprotein E genotype (ε4-carrier vs non-carriers). Results showed that higher education and higher educational-occupational score were associated with better cognitive performance in all cognitive measures. Those with high midlife blood pressure scored significantly higher in all cognitive tests than those with normal blood pressure. Conversely, those with high old-age blood pressure scored lower in semantic fluency and composite cognitive score, but not in immediate or delayed recall. Other cardiovascular risk factors and the CAIDE score did not show consistent associations with cognition. Education appears to have a long-lasting protective effect in cognitive aging, whereas midlife and old-age cardiovascular risk factors were not significantly associated with cognition at 90 + years.by Catarina Simões, Diana S. Vasconcelos, Raquel Xavier, Xavier Santos, Catarina Rato, D. James Harris
Fire has long been recognized as an important ecological and evolutionary force in plant communities, but its influence on vertebrate community ecology, particularly regarding predator-prey interactions, remains understudied. This study reveals the impact of wildfires on the diet of Podarcis lusitanicus, a lizard species inhabiting a fire-prone region in the Iberian Peninsula. In order to explore diet variability associated with different local burn histories, we evaluated P. lusitanicus diet across three types of sites in Northern Portugal: those had not burned since 2016, those burned in 2016, and those more recently burned in 2022. Podarcis lusitanicus is a generalist arthropod predator with dietary flexibility. Given the turnover of arthropod species after fire, it is expected to find variations in diet caused by different fire histories, especially between unburned and recently burned sites. From DNA metabarcoding of faecal samples, our study revealed that while prey richness remained unaffected by wildfire regime, significant shifts occurred in diet composition between more recently burned and unburned areas. Specifically, we found that differences in diet composition between these two fire regimes were due to the presence of Tapinoma ants and jumping spiders (Salticus scenicus). These prey were present in the diets of lizards occupying unburned areas, while these were absent in areas burned in 2022. Interestingly, diets in unburned areas and areas burned in 2016 showed no significant differences, highlighting the lizards’ ecological flexibility and the habitat’s resilience over time. The ant species T. topitotum was found in dominance in both burned areas, suggesting that this species may be fire tolerant. In addition, families such as Cicadellidae and Noctuidae were found to be more associated with more recently burned areas. The use of DNA metabarcoding in this study was essential to provide a more detailed and accurate view of predator-prey interactions in ecosystems susceptible to fire, and therefore a better understanding of changes in prey consumption in this fire-adapted ecosystem.by Sishir Poudel, Laxman Wagle, Tara Prasad Aryal, Binay Adhikari, Sushan Pokharel, Dipendra Adhikari, Kshitiz Bhandari, Kshitiz Rijal, Jyoti Bastola Paudel
BackgroundMultidrug-resistant tuberculosis (MDR-TB) continues to be a major public health concern, especially in high-burden countries like Nepal. While individual risk factors are known, the cumulative impact of cardiometabolic factors on MDR-TB is not well understood.
MethodsA health-facility-based, age- and sex-matched 1:2 case-control study was conducted at MDR-TB treatment centers in Gandaki Province, Nepal. MDR-TB patients (cases) and drug-sensitive tuberculosis (DS-TB) patients (controls) were enrolled. Cases were defined as adults (≥18 years) with confirmed MDR-TB; controls were adults with sputum-positive DS-TB. Data on sociodemographics, cardiometabolic risk factors (alcohol, tobacco, abnormal body mass index, hypertension, diabetes), TB literacy, and treatment history were collected using a structured, pretested questionnaire by trained medical officers. Data were analyzed using Stata v13.0. Binary logistic regression was used to assess associations between risk factors and MDR-TB. Ethical approval was obtained from the Nepal Health Research Council and written informed consent was obtained from all participants.
ResultsA total of 183 participants (61 cases, 122 controls) were included. Mean age of participants was 42.5 years (SD = 18.5); 73.8% were male. Most participants were from urban areas (74.9%), and 66.7% were unemployed. Cardiometabolic risk factors were present in 79.2% of participants. Alcohol and tobacco use were reported by 59.6% and 45.9%, respectively; 9.8% had diabetes and 7.1% had hypertension. Known TB contact and prior TB history were reported by 26.8% and 31.1% respectively. In multivariate analysis, unemployment (AOR: 5.24, 95% CI: 1.33–20.64), and known TB contact (AOR: 8.89, 95% CI: 2.46–32.15) were significantly associated with MDR-TB. Cardiometabolic risk factors were not significantly associated.
ConclusionKnown TB contact and unemployment were significantly associated with MDR-TB, while the cumulative effect of cardiometabolic risk factors showed no significant impact, indicating that interventions should prioritize established TB-related risk factors.
by Simon Knobloch, Philipp Haul, Saskia Rusche, Heiko Paland, Darius Zokai, Moritz Haaf, Jonas Rauh, Christoph Mulert, Gregor Leicht
When confronted with dichotically presented syllables, right-handed healthy individuals tend to consciously perceive syllables presented to the right ear more often. This phenomenon, known as the right-ear advantage, is driven by delayed processing of information from the left ear in left temporal auditory cortex due to its indirect relay through the corpus callosum. In contrast, less is known about about the corresponding mechanisms for stimuli processed in the right temporal hemisphere. In this study, we developed a melody-based dichotic listening paradigm designed to induce a left-ear advantage. This novel paradigm, alongside a classical syllable-based paradigm was tested in 40 healthy right-handed participants. We also examined the influence of musical education on lateralization of auditory processing. Our results revealed a significant left-ear advantage for the perception of dichotically presented melodies and replicated established findings of a right-ear advantage for syllables. No group differences emerged between participants with or without current or past musical practice. However, among those with musical training, a greater number of years of practice was associated with a reduced right-ear advantage for syllables and an increased report of melodies presented to the left-ear. These findings suggest that the left-ear advantage in dichotic perception of melodies reflects right hemispheric processing of musical stimuli. Moreover, monitoring of the left ear seems to be altered by musical practice. Future research using neuroimaging techniques will be necessary to confirm this finding.by Bethelhem Bashe, Desalegn Dawit Assele, Worku Ketema, Mulugeta Sitot Shibeshi
BackgroundCerebral palsy is a frequent physical disability of childhood, causing motor impairment, sensory impairment, cognitive and behavioral issues, and secondary musculoskeletal deformities, with a global incidence of 1–4 per 1,000 children. It significantly impacts children’s quality of life and imposes an economic burden on families and healthcare systems. There is limited evidence of the risk factors of cerebral palsy in Ethiopia, including in the study setting. We investigated factors associated with cerebral palsy among children attending Hawassa University Comprehensive Specialized Hospital.
MethodsAn institution-based, unmatched case-control study was conducted among children who visited Hawassa University Comprehensive Specialized Hospital from January 2019 to December 2023. Consecutive cases were recruited until the required sample size was reached, and controls were randomly selected. Data were extracted from 80 cases and 160 control charts. Binary logistic regression analysis was used to identify risk factors for cerebral palsy. An adjusted odds ratio with a 95% confidence interval was reported to show the strength of the association. The significance of the association was declared at a p-value Results
A total of 240 participants (80 cases and 160 controls) were enrolled in the study. Maternal infection during pregnancy [AOR:4.1; 95%; 1.39, 12.1], low birth weight [AOR:4.1; 95%; 1.49, 11.2], prolonged labor [AOR:3.2; 95%;1.47, 7.00], history of perinatal asphyxia [AOR: 2.65; 95%;1.06, 6.65], and central nervous system infection during infancy [AOR:3.4; 95%; 1.21, 9.64] were risk factors for cerebral palsy.
ConclusionPerinatal asphyxia, maternal infection, low birth weight, prolonged labor, and CNS infection during infancy are significantly associated with cerebral palsy. Public health education should promote awareness about cerebral palsy, encourage antenatal care, and educate healthcare professionals on emergency obstetrics and newborn care. Appropriate measures should be taken to reduce the incidence of CNS infections during infancy.
by Muluken Chanie Agimas, Mekuriaw Nibret Aweke, Berhanu Mengistu, Lemlem Daniel Baffa, Elsa Awoke Fentie, Ever Siyoum Shewarega, Aysheshim Kassahun Belew, Esmael Ali Muhammad
IntroductionMalaria is a global public health problem, particularly in sub-Saharan African countries. It is responsible for 90% of all deaths worldwide. To reduce the impact and complications associated with delayed treatment of malaria among children under five, comprehensive evidence about the magnitude and determinants of delayed treatment for malaria could be the solution. But there are no national-level studies in the Horn of Africa for decision-makers.
ObjectiveTo assess the prevalence and associated factors of delay in seeking malaria treatment among under-five children in the Horn of Africa.
MethodPublished and unpublished papers were searched on Google, Google Scholar, PubMed/Medline, EMBASE, SCOPUS, and the published articles’ reference list. The search mechanism was established using Medical Subject Heading (MeSH) terms by combining the key terms of the title. Joana Brigg’s Institute critical appraisal checklist was used to assess the quality of articles. A sensitivity test was conducted to evaluate the heterogeneity of the studies. The visual funnel plot test and Egger’s and Begg’s statistics in the random effect model were done to evaluate the publication bias and small study effect. The I2 statistics were also used to quantify the amount of heterogeneity between the included studies.
ResultsThe pooled prevalence of delayed treatment for malaria among under-five children in the Horn of Africa was 48% (95% CI: 34%–63%). History of child death (OR =2.5, 95% CI: 1.73–3.59), distance >3000 meters (OR = 2.59, 95% CI: 2.03–3.3), drug side effect (OR = 2.94, 95% CI: 1.86–4.67), formal education (OR = 0.69, 95% CI: 0.49–0.96), middle income (OR = 0.42, 95% CI: 0.28–0.63), expensiveness (OR = 4.39, 95% CI: 2.49–7.76), and affordable cost (OR = 2.13, 95% CI: 1.41–3.2) for transport were factors associated with malaria treatment delay among children.
Conclusion and recommendationsAbout one out of two parents in the Horn of Africa put off getting their kids treated for malaria. High transportation expenses, long travel times (greater than 3,000 meters) to medical facilities, and anxiety about drug side effects were major risk factors that contributed to this delay. On the other hand, a middle-class income was found to be protective of treatment delays. These results highlight how crucial it is to improve access to healthcare services, both financially and physically, to minimize delays in treating malaria in the area’s children.
by Tadesse Tarik Tamir, Berhan Tekeba, Alebachew Ferede Zegeye, Deresse Abebe Gebrehana, Mulugeta Wassie, Gebreeyesus Abera Zeleke, Enyew Getaneh Mekonen
IntroductionSolitary childbirth—giving birth without any form of assistance—remains a serious global public health issue, especially in low-resource settings. It is associated with preventable maternal complications such as hemorrhage and sepsis, and poses significant risks to newborns, including birth asphyxia, infection, and early neonatal death. In Ethiopia, where many births occur outside health facilities, understanding the spatial and socio-demographic patterns of solitary childbirth is vital for informing targeted interventions to improve maternal and child health outcomes. This study aims to identify and map the spatial distribution of solitary childbirth across Ethiopia and to analyze its determinants using data from the 2019 national Interim Demographic and Health Survey.
MethodWe analyzed data from the 2019 Interim Ethiopian Demographic and Health Survey to determine the spatial distribution and factors of solitary birth in Ethiopia. A total weighted sample of 3,884 women was included in the analysis. Spatial analysis was used to determine the regional distribution of solitary birth, and multilevel logistic regression was employed to identify its determinants. ArcGIS 10.8 was used for spatial analysis, and Stata 17 was used for multilevel analysis. The fixed effect was analyzed by determining the adjusted odds ratio with a 95% confidence interval.
ResultThe prevalence of solitary childbirths in Ethiopia was 12.73%, with a 95% confidence interval spanning from 11.71% to 13.81%. The western and southern parts of Oromia, all of Benishangul-Gumuz, most parts of the SNNPR, and the west of Amhara regions were hotspot areas for solitary birth. Having no formal education, not attending ANC visits, and residing in pastoral regions were significantly associated with higher odds of solitary birth in Ethiopia.
CocnlusionA notable proportion of women are experiencing childbirth alone, which highlights a significant aspect of maternal health in the country, reflecting both the challenges and improvements in childbirth practices. The distribution of solitary births exhibited spatial clustering with its hotspot areas located in western and southern parts of Oromia, all of Benishangul-Gumuz, most parts of the SNNPR, and west of Amhara regions. Lack of education, not having an ANC visit, and being a resident of pastoral regions were significant determinants of solitary birth. The implementation of maternal and child health strategies in Ethiopia could benefit from considering the hotspot areas and determinants of solitary birth.
by Chien-Hsien Kitty Yang, Xiu Ting Yiew, Robert G. Hahn, William Muir, Carolyn Kerr, Shane Bateman
This prospective experimental study evaluated the disposition of a crystalloid and a colloid solution in 10 healthy cats under general anesthesia. Each cat was randomly assigned to receive either 20 mL/kg of a balanced isotonic crystalloid solution (PLA) or 5 mL/kg of 6% tetrastarch 130/0.4 solution (T-HES), administered over 15 minutes, in a 2-period, 2-treatment crossover design. Blood samples were collected, and urine output was measured during a 3-hour experimental period. Plasma dilution was calculated using serial hemoglobin concentrations and red blood cell count. Volume kinetics (distribution and elimination) of each fluid were determined using non-linear mixed effects pharmacokinetic modeling software. Data from a previous study with a similar methodology in healthy conscious cats were included in the population kinetic analysis, revealing anesthesia as a significant covariate for k21 (peripheral-to-central intercompartmental rate constant) for PLA and k10 (dilution-dependent first-order elimination rate constant) for T-HES. Cumulative urine output under general anesthesia was approximately 3.5 times lower for PLA and 2.5 times lower for T-HES compared to conscious cats. Overall, our data suggest that the elimination of PLA and T-HES is markedly reduced, and a bolus of PLA produces a short period of plasma expansion with the potential to cause significant peripheral fluid accumulation in cats during general anesthesia.by Ismat Tasnim, Md. Asif Iqbal, Ismat Ara Begum, Mohammad Jahangir Alam, Morten Graversgaard, Paresh Kumar Sarma, Kiril Manevski
Food insecurity and agriculture in South Asia, including Bangladesh, pose significant threats to the well-being and livelihoods of its people. Building adaptive capacities and resilient food systems is crucial for sustainable livelihoods. This study employs the Resilience Index Measurement and Analysis II framework to construct a Resilience Capacity Index (RCI) and analyze its relationship with food security using data from the Bangladesh Integrated Household Survey 2018. The study applies Exploratory Factor Analysis and Structural Equation Modeling to examine the impact of key resilience components such as Access to Basic Services, Adaptive Capacity, and Assets on household resilience. The findings reveal that access to basic services, land assets, and farm equipment positively influences households’ resilience capacity. However, the presence of livestock assets has a negative impact, potentially due to market volatility, climate vulnerability, and disease outbreaks. Additionally, adaptive capacity has a positive but insignificant influence on RCI, suggesting that without enhancing economic opportunities, institutional support, and inclusive development strategies, adaptive capacity could not be enough to foster resilience. However, resilient capacity enhances food security metrics such as the Food Consumption Score and Expenditure. These findings underscore the importance of policies that focus on increasing and maintaining access to basic services, promoting sustainable land management practices, and strengthening social safety nets. This study emphasizes the importance of focusing on livestock assets to ensure their sustainability by stabilizing the livestock market, improving veterinary services, and providing subsidies to reduce maintenance costs.by Nourridine Siewe, Avner Friedman
Osteoarthritis (OA), the most common form of joint disease, involves the progressive degradation of articular cartilage and is a major cause of chronic disability in aging populations. Since OA is associated with severe deficiency of collagen type II, clinical trials considered treatment of OA by injection with undenatured collagen type II (UC-II). Recent studies consider also injection of senolytic drugs, like fisetin, that eliminates senescent chondrocytes in aging patients, to reduce the negative effect of these senescent cells on cartilage structure. In this paper we develop a mathematical model of OA for men and, separately, for women, and use the model to assess the efficacy of treatment by UC-II and by fisetin, alone or in combination. Our computations show the benefits of starting treatment early. They also show that although the effect of treatment by fisetin on slowing the progression of OA is much smaller compared to UC-II treatment, its effect in combination with UC-II is significantly increased.by Pornkamol Tiranaprakij, Sahaphume Srisuma, Krongtong Putthipokin, Sirasa Ruangritchankul
BackgroundAnticholinergic medication use is associated with adverse clinical outcomes, especially in older adults. However, few studies have assessed the anticholinergic burden in the Thai geriatric population. Hence, we aimed to evaluate the impact of anticholinergic burden on clinical outcomes in older patients after discharge from the hospital.
MethodsA prospective cohort study was conducted between January 1 to December 31, 2023. The prescribed medications were assessed at admission and discharge to determine the anticholinergic cognitive burden (ACB) scores. Participants were classified into three groups according to the ACB score at discharge: none (score 0), moderate (score 1–2), and severe (score ≥ 3) anticholinergic burden. The Cox proportional hazard model was used to determine the marker risk of high anticholinergic burden to adverse outcomes.
ResultsThis study involved 290 older patients admitted to general internal medicine wards. At discharge, 37.9% (n = 110) of the patients had a high anticholinergic burden (ACB score ≥ 3), and 50% (n = 145) had a higher ACB score than at admission. The three most commonly prescribed anticholinergics at discharge were benzodiazepines (20.3%), corticosteroids (20.0%), and antihistamines (15.9%). During the one-year follow-up period, 16.6% (n = 48) of the patients died. The incidence rate of all-cause mortality in hospitalized older patients with an ACB score ≥ 3 was 0.65 cases per 1000-person day during a one-year follow-up period. After adjusting for potential factors, an ACB score of ≥ 3 at discharge was marginally associated with one-year mortality post discharge [hazard ratio: 2.98, 95% confidence interval (0.96–9.28)].
ConclusionsThe exposure to high anticholinergic burden (ACB scores ≥ 3) at discharge was slightly associated with an increased risk of one-year mortality post discharge. The cautious use of benzodiazepines may assist to reduce the anticholinergic burden in this vulnerable population.
by Juliana Rodrigues Tovar Garbin, Franciéle Marabotti Costa Leite, Ana Paula Brioschi dos Santos, Larissa Soares Dell’Antonio, Cristiano Soares da Silva Dell’Antonio, Luís Carlos Lopes-Júnior
A comprehensive understanding of the factors influencing the epidemiological dynamics of COVID-19 across the pandemic waves—particularly in terms of disease severity and mortality—is critical for optimizing healthcare services and prioritizing high-risk populations. Here we aim to analyze the factors associated with short-term and prolonged hospitalization for COVID-19 during the first three pandemic waves. We conducted a retrospective observational study using data from individuals reported in the e-SUS-VS system who were hospitalized for COVID-19 in a state in a southeast state of Brazil. Hospitalization duration was classified as short or prolonged based on a 7-day cutoff, corresponding to the median length of hospital stay during the second pandemic wave. Bivariate analyses were performed using the chi-square test for heterogeneity. Logistic regression models were used to estimate odds ratios (ORs) and their respective 95% confidence intervals (CIs), with statistical significance set at 5%. When analyzing hospitalization duration across the three waves, we found that 51.1% (95%CI: 49.3–53) of hospitalizations in the first wave were prolonged. In contrast, short-duration hospitalizations predominated in the second (54.7%; 95% CI: 52.4–57.0) and third (51.7%; 95% CI: 50.2–53.2) waves. Factors associated with prolonged hospitalization varied by wave. During the first wave, older adults (≥60 years) (OR=1.67; 95%CI: 1.35–2.06), individuals with ≥10 symptoms (OR=2.03; 95%CI: 1.04–3.94), obese individuals (OR=2.0; 95%CI: 1.53–2.74), and those with ≥2 comorbidities (OR=2.22; 95%CI: 1.71–2.89) were more likely to experience prolonged hospitalization. In the second wave, he likelihood of extended hospital stays was higher among individuals aged ≥60 years (OR=2.04; 95%CI: 1.58–2.62) and those with ≥2 comorbidities (OR=1.77; 95%CI: 1.29–2.41). In the third wave, prolonged hospitalization was more frequent among older adults (OR=1.89; 95%CI: 1.65–2.17,), individuals with 5–9 symptoms (OR=1.52; 95%CI: 1.20–1.92), obese individuals (OR=2.2; 95%CI: 1.78–2.73), and those with comorbidities (OR=1.45; 95%CI: 1.22–1.72 and OR=2.0; 95%CI: 1.69–2.45). In conclusion, we identified variations in hospitalization patterns across the pandemic waves, although the differences were relatively subtle. These variations likely reflect gradual shifts in the risk factors associated with prolonged hospital stays. Our findings highlight t the importance of implementing targeted public health interventions, particularly those designed to reduce disease severity and improve clinical outcomes among vulnerable populations at greater risk of extended hospitalization.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.
by Bijuan Chen, Zhouwei Zhan, Sisi Yu, Jiali Huang, Chuying Chen, Jie Wang, Jianji Pan, Shaojun Lin, Yun Xu
BackgroundLaryngeal cancer attributable to occupational asbestos exposure remains a significant public health concern, particularly in industrialized regions. This study analyzes the burden, trends, and contributing factors of laryngeal cancer due to asbestos exposure in China from 1990 to 2021.
MethodsData were obtained from the Global Burden of Disease Study (1990–2021). We analyzed age-standardized death rates, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Temporal trends were assessed using joinpoint and decomposition analyses, and an age-period-cohort (APC) model was applied to examine mortality and DALY trends across different cohorts.
ResultsIn 2021, there were 234 deaths and 4,430 DALYs due to laryngeal cancer attributable to occupational asbestos exposure, predominantly affecting males. Mortality rates declined from 1990 to 2008, followed by a rise until 2012, and a subsequent decline. YLDs showed a consistent increase over time. APC analysis revealed higher mortality and DALY rates in older age groups and earlier birth cohorts. Decomposition analysis indicated that epidemiological changes were the largest driver of increased deaths in men, followed by population growth and aging. For DALYs, aging and population growth were key drivers, while epidemiological changes mitigated the burden.
ConclusionsThe burden of laryngeal cancer attributable to asbestos exposure has declined overall, but disability rates continue to rise, particularly among males. Effective strategies targeting prevention, early detection, and management of asbestos exposure are needed to reduce the disease burden in China.
by Yordi Sebastián Tamayo-Molina, Juan Felipe Valdés-López, Geysson J. Fernandez, Silvio Urcuqui-Inchima
Dengue virus (DENV), the etiological agent of dengue fever, remains a global health concern, leading to severe illness and death in the absence of any definitive cure. Research has shown that vitamin D may reduce DENV replication in vitro and that dengue patients with low or deficient vitamin D levels are at higher risk of severe dengue. Studies indicate that viral replication is inhibited in human monocyte-derived macrophages (MDM) differentiated in the presence of vitamin D (D3MDM), suggesting that vitamin D may prevent DENV entry into host cells. However, despite these findings, the role of vitamin D in regulating the temporal expression patterns of genes as early, mid, and late transcriptional profile of DENV-infected macrophages remains unclear. Therefore, utilizing a kinetic transcriptomic profile is crucial. This approach provides detailed insights into the dynamic changes in gene expression over time, helping to clarify how vitamin D can modulate the immune response at critical stages of DENV infection. To address the transcriptional dynamics, we conducted a comprehensive analysis of gene expression patterns in MDM and D3MDM infected with Dengue virus serotype 2 (DENV-2). Utilizing bulk RNA sequencing alongside a standard viral growth curve, we systematically analyzed transcriptional kinetics by selecting key time points: 1.5, 3, 5.5, and 10 hours post-infection (h.p.i.) to monitor early viral entry and replication events and 24 h.p.i. to assess gene expression during peak viral particle production. Our temporal analysis revealed a progressive increase in cellular transcripts within the first hour of infection, with a more pronounced gene expression pattern in DENV-2-infected MDM compared to DENV-2-infected D3MDM at this early stage. Enrichment analysis indicated a reduced inflammatory response in DENV-2-infected D3MDM. Additionally, transcription factor analysis suggested diminished NF-κB signaling, but enhanced IRF5 activity was elevated in the DENV-2-infected D3MDM. High-dimensional clustering analysis identified nine unique gene clusters across both macrophage types, with notable upregulation of genes associated with antiviral activity, including IDO1, ISG20, OASL, IFI44L, RSAD2, IFIT1, MX1, EPSTI1, CXCL10, and CXCL11 in DENV-2-infected D3MDM at 1.5 h.p.i., suggesting an enhanced early antiviral response. These findings indicate that vitamin D modulates the magnitude and diversity of the early transcriptional responses, highlighting its potential as a therapeutic option to mitigate DENV severity.by Qinghua Wen, Xiaoyue Wang, Simin Li, Huanhuan Zhu, Fengyin Zhang, Chao Xue, Juan Li
BackgroundThe glucose disposal rate (eGDR) and a body shape index (ABSI) are predictors strongly associated with cardiovascular disease (CVD) and outcomes. However, whether they have additive effects on CVD risk is unknown. This study aimed to investigate whether combined assessment of eGDR and ABSI could improve prediction of CVD risk.
MethodsThe current study used data from NHANES from 1999 to 2018 and included 14,237 participants. Receiver operating characteristic (ROC) curve was used to evaluate the performance of each indicator in predicting CVD. Machine-learning algorithms were applied to screen variables to adjust the model. Finally, the ROC curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration curve and decision curve analysis (DCA) were used to evaluate the predictive performance of the combination of eGDR and ABSI.
ResultsThe ROC curve showed that eGDR (C-statistics: 0.7255) and ABSI (0.7093) had the highest predictive performance. Among 14,237 participants, multivariate logistic regression showed that lower eGDR (≤6.448) and higher ABSI (≥0.086) significantly increased CVD risk (OR = 11.792, P Conclusion
The eGDR and ABSI have potential additive effects on predicting CVD risk, and have excellent predictive performance, which can evaluate cardiovascular risk more comprehensively.
by Nipaporn Butsing, Nalinrat Thongniran, Jesada Keandoungchun
BackgroundStrokes are the major cause of disability. Functional recovery following an acute stroke is time-dependent and varies depending on several factors. This study aimed to investigate changes in functional outcomes after stroke from discharge to six months post-discharge and to identify factors associated with changes in functional outcomes during this six-month period.
MethodsThe study included 155 consecutive patients with a first stroke and were hospitalized in an acute stroke unit at an advanced tertiary hospital in Bangkok between April 2020 and August 2021. The patients’ functional outcomes were evaluated using the modified Rankin Scale (mRS) and the Barthel Index (BI) before hospital discharge and at one-, three-, and six-month post-discharge. Friedman tests were used to assess changes in mRS scores over six months. Linear mixed effect regression was applied to identify the change in BI scores during the six months post-discharge.
ResultsOf the participants, 62.6% were men, and the mean age was 64.0 (SD = 12.5). The median mRS scores ranged from 3.0 at discharge to 0.0 at six months post-discharge. Significant changes in mRS scores were identified within three months post-discharge, and differences by stroke subtype and severity (P Conclusion
The time after discharge, gender, stroke subtype, and stroke severity are significant factors affecting functional outcomes after a stroke. The most significant improvement in functional outcomes occurred within one month post-discharge.
by Esther Mofiyinfoluwa Ola, Temitope Helen Balogun, Rasheed Olayinka Isijola, Oluwaremilekun Grace Ajakaye
Parasitic infections are a major cause of morbidity and mortality in Nigeria, with malaria and schistosomiasis having the highest burden. This study investigated the prevalence of malaria, urogenital schistosomiasis, and co-infections and their impact on the nutritional status of schoolchildren in two communities in Ondo State. A total of 185 participants from Ipogun and Oke Igbo were screened for malaria and schistosomiasis infection using the ParaHit malaria rapid diagnostic test kit and urine microscopy. Anthropometric measurements were used to assess the nutritional status of the participants. In this study, a higher prevalence of malaria was recorded in Oke Igbo, with 36 individuals (57.1%), compared to 60 individuals (49.2%) in Ipogun. Urogenital schistosomiasis was also more prevalent in Oke Igbo, affecting 18 individuals (28.6%), while only 5 individuals (4.1%) were affected in Ipogun. Co-infection with both diseases was more common in Oke Igbo, with 13 cases (20.6%), compared to 4 cases (3.3%) in Ipogun. However, malnutrition rates were similar between the two communities, with 60 cases (77.9%) in Ipogun and 28 cases (75.5%) in Oke Igbo. Notably, participants with either malaria or urogenital schistosomiasis, as well as those co-infected, exhibited a higher frequency of chronic malnutrition. The likelihood of co-infection was significantly associated with gender and locality, with individuals in Oke Igbo being 0.78 times less likely to be co-infected (P = 0.00; CI = 0.09–0.49), while males were 2.19 times more likely to have co-infections (P = 0.02; CI = 1.13–4.28). This study emphasised the significant health burden posed by malaria and urogenital schistosomiasis co-infections among schoolchildren in Ondo State, highlighting the need for comprehensive health and nutritional interventions to address the challenges associated with these parasitic diseases.by Brooke Allemang, Francine Buchanan, Pranshu Maini, Dalya Kablawi, Lin Li, Linda Nguyen, Kimberly Courtney, Jessie Cunningham, Carla P. Southward, Kristin Cleverley, Sarah Munce, Alene Toulany
BackgroundPediatric patient and family engagement is an active and collaborative process, that involves children, adolescents, and family members with lived experience contributing to the design, implementation, and evaluation of healthcare services. Prior studies have highlighted the patient engagement methods and impact in clinical care, education, and research. However, gaps remain in understanding the commonalities and distinctions of engagement approaches, patient/family partner roles, and outcomes in clinical care, education, and research contexts. Further, research examining the nuances of pediatric patient and family engagement within healthcare delivery, education, and research in pediatric institutions is needed to streamline efforts.
ObjectiveThis scoping review will identify the commonalities of and distinctions between pediatric patient and family engagement in clinical care, education, and research contexts in pediatric healthcare institutions.
MethodsA scoping review, conducted in collaboration with a team of adolescent, young adult, and family partners, will allow us to systematically map out key concepts, evidence, and knowledge gaps regarding pediatric patient and family engagement in clinical care, education, and research. We will follow the Joanna Briggs Institute framework in the design and conduct of the review and guidance on engaging knowledge users within scoping reviews. The protocol for this scoping review has been registered with the Open Science Framework database (https://osf.io/63qx5).
ResultsThis study will describe the engagement types, approaches, and outcomes of pediatric patient and family engagement employed within clinical care, education, and research settings, highlighting commonalities and distinctions across contexts. In doing so, it will identify potential opportunities for collaboration and resource-sharing based on the context of engagement and provide needed clarity on streamlining pediatric patient and family engagement approaches within pediatric institutional settings.
ConclusionsIt is anticipated that the results will produce preliminary evidence of relevance to pediatric institutions seeking to consolidate engagement practices across clinical care, education, and research domains.
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