ObjectivesThis study examined the point prevalence of patients with intellectual and developmental disabilities (IDDs) in Ontario forensic inpatient units and compared the demographic, clinical, and system-level profiles of long-stay forensic patients with and without IDD.MethodThis cross-sectional study utilized Ontario administrative health data held at ICES. All patients over 18 years of age who occupied an Ontario forensic inpatient bed on 30th September 2023 were included in the analysis. Focus was given to patients with a length of stay (LOS) of at least 365 days (i.e., "long-stay" patients). Within this group, the prevalence of IDD was assessed, and patients with and without IDD were compared on their demographics, clinical characteristics, LOS, and support needs using standardized differences (StdDiff).ResultsAmong long-stay forensic patients (n = 549), 42.4% had IDD. Long-stay forensic patients with and without IDD had a mean age of 43 years, and the majority of patients in both groups were male (87.6% vs. 90.8%; StdDiff = 0.105). In the 2 years prior to admission, the majority of all long-stay patients were diagnosed with a psychotic disorder, though the proportion was higher among patients without IDD (80.3% vs. 92.1%; StdDiff = 0.348). Long-stay patients with IDD had a substantially longer LOS (mean LOS = 7.2 years vs. 4.9 years; StdDiff = 0.459) and were more likely to be restrained (5.2% vs. 2.2%; StdDiff = 0.156). A higher proportion of long-stay patients with IDD had difficulty with activities of daily living (23.2% vs. 11.7%; StdDiff = 0.306), and severe cognitive impairment (14.6% vs. 6.6%; StdDiff = 0.260).ConclusionsThis study found that almost half of long-stay forensic patients had IDD and this patient group had different demographic and clinical profiles from other patients, which may impact their support needs within the hospital and pose barriers to discharge. A Closer Look at Long-Stay Forensic Patients With Intellectual and Developmental DisabilitiesPlain Language SummaryThe goal of this study was to learn more about patients with intellectual and developmental disabilities (IDDs) in Ontario forensic inpatient units. We looked at how many patients with IDD had been in a forensic bed for at least 1 year and we also compared forensic patients with and without IDD.This study used administrative health data. We started by identifying all patients over 18 years old who were in a forensic inpatient bed in Ontario on 30th September 2023. Then we looked at how many of these patients had been in the hospital for at least 365 days—we call this group “long-stay patients.” We learned that almost half (42.4%) of long-stay forensic patients had IDD. Then we compared long-stay forensic patients with and without IDD. We learned that the 2 groups were a similar age (mean age = 43 years) and that most patients in both groups were male (87.6% vs. 90.8%). Most long-stay patients were diagnosed with a psychotic disorder, but the proportion was higher among patients without IDD (80.3% vs. 92.1%). Compared with patients without IDD, patients with IDD stayed in the hospital longer (mean = 7.2 years vs. 4.9 years). Additionally, more long-stay patients with IDD had difficulty with daily activities (23.2% vs. 11.7%), and severe cognitive impairment (14.6% vs. 6.6%), compared with other patients.Overall, this study found that patients with IDD are over-represented in forensic inpatient settings. They also have different profiles from other patients. This can impact their needs within the hospital as well as their needs in the community, which can lead to barriers to discharge.
Body mass index (BMI) inadequately captures heterogeneity in cardiovascular (CV) risk. We hypothesised that a 'Slow Burn' phenotype, defined as lower-than-expected energy intake relative to BMI, age, and sex, identifies individuals at elevated CV risk across the BMI spectrum. We analysed 160 905 White/European participants from the UK Biobank. Relative caloric intake status was derived using residuals from a linear model predicting energy intake from BMI, age, and sex and categorised as low (LI; the 'Slow Burn' phenotype, < 30th percentile), normal (NI, 30th-70th), or high (HI, > 70th). Nine phenotypes were defined by combining intake groups with BMI categories: normal weight (NW), overweight (OW), and obese (OB). The primary outcome was 3-point major adverse cardiovascular events (3P-MACE: myocardial infarction [MI], stroke, and CV mortality). Compared with the NI group, the LI phenotype was associated with a higher risk of 3P-MACE (adjusted hazard ratio [aHR] 1.07, 95% CI 1.01-1.14) and MI (aHR 1.15, 95% CI 1.06-1.25), while the HI group showed no increased risk. In BMI-stratified analyses, the NW-LI (Normal-Weight Slow Burn) phenotype demonstrated an increased 3P-MACE risk (aHR 1.17; 95% CI 1.04-1.33) versus the NW-NI reference. Mediation analysis revealed that low muscle strength accounted for 5.2% (95% CI 1.6%-17.7%) of the excess risk in the normal-weight stratum, whereas MASLD showed no evidence of mediation. Longitudinally, NW-LI participants were more prone to future weight gain than their NI counterparts. Relative caloric intake identifies a high-risk 'Slow Burn' phenotype, characterised by increased cardiovascular risk despite lower-than-expected caloric intake. These findings highlight the limitations of BMI-based risk assessment and support risk-stratification strategies that incorporate energy balance and functional status.
AIM: To compare the regional tissue oxygen saturation under general, spinal, and epidural anesthesias during the posterior lumbar discectomy procedures performed in the prone position. MATERIAL and METHODS: A total of 90 patients with an American Society of Anesthesiologists score I-III were evaluated. Using the research randomizer program, the patients were split into three groups: group of general anesthesia (GA, Group I), group of spinal anesthesia (SA, Group II), and group of epidural anesthesia (EA, Group III). Each patient received non-invasive peripheral arterial oxygen saturation (SpO2), three-lead electrocardiography, non-invasive mean arterial blood pressure (MAP), and the in Spectra TM StO2 Spot Check device with near-infrared spectroscopy (NIRS) technology. The group GA also received end-tidal CO2 monitoring and tissue hemoglobin index (THI), and StO2 monitoring. RESULTS: The data of 90 patients showed that age, weight, height, American Society of Anesthesiologists score, amount of bleeding, duration of surgery, and anesthesia were not statistically significant. Tissue oxygen saturations were detected between groups at the 15th, 30th, 45th, and 60th minutes. The values of group EA at the 15th, 30th, and 45th minutes were higher than group SA (p=0.001; p<0.05). CONCLUSION: This study shows that general anesthesia, as opposed to spinal and epidural anesthesia, offers superior thenar tissue oxygenation in a prone position during posterior lumbar discectomy surgery, despite the ongoing debate over the pros and cons of this position.
Bowel injuries represent a growing burden in blunt and penetrating abdominal and it is associated with poor outcome especially in developing countries. However, the anatomical patterns and factors associated are not well understood in the mentioned settings. This study aimed to determine the anatomical patterns and factors associated with traumatic bowel injury among patients undergoing surgery for abdominal trauma at Kampala international University teaching hospital (KIU-TH) and Fort Portal Regional Referral Hospital (FRRH). This was a prospective observational study where consecutive sampling was used to select 99 patients of all ages admitted in surgical wards at KIUTH and FRRH with abdominal trauma and undergoing laparotomy during the study period that consented from 30th September to 30th December 2024. During laparotomy, it was confirmed whether there was bowel injury or not and then injury identified was repaired. Analysis was done using STATA version 16. Variables with a p value < 0.05 were considered significant. This study enrolled 99 study participants with abdominal trauma, and 34 of them had bowel injury. The most common part of the bowel injured was the small bowel (76.5%), specifically the jejunum (43.3%). The most frequently performed surgery was primary repair (58.7%). In the multivariate analysis, penetrative trauma (aOR: 3.62, p = 0.048) significantly increased the odds of bowel injury. Complications were significantly higher in the bowel injury group (30.6%) compared to those without (12.0%). Two deaths occurred during the study: one patient with bowel injury succumbed to complications of peritonitis and septic shock, while another death occurred in the non-bowel injury group due to liver laceration. Bowel injury is prevalent in penetrating abdominal trauma and is frequently associated with severe complications such as septic and hypovolemic shock. Strengthening paramedical services and ATLS training is essential to improve hemodynamic stability on arrival and reduce mortality.
The potential impact of increasing exposure to blue light (BL; 450-470 nm) from digital devices during early life on skeletal development remains largely unexplored. This study aimed to investigate the effects of BL exposure and its duration during the prepubertal period on the epiphyseal plate. Thirty-six Sprague Dawley rats (18 male, 18 female), aged 21 days, were randomly divided into six groups: Control (CG), Blue Light-6 h (BL-6), and Blue Light-12 h (BL-12). CG rats were maintained under a standard 12-h light/dark cycle, while BL groups were exposed to blue light for 6 or 12 h daily until the first pubertal sign (vaginal opening or preputial separation). After euthanasia, femur and tibia lengths were measured. Epiphyseal plate and proliferation zone thickness were histologically assessed. IGF-1 and IGFBP-3 expression levels in the epiphyseal plate were evaluated using immunohistochemistry; serum levels were analyzed by ELISA. Females: The median days for the onset of puberty were 38th, 32nd,and 30th for CG,BL-6,and BL-12 respectively(p = 0.001). The occipital tail length difference(%) was greater in BL-6 and BL-12 compared to CG(p = 0.029, p = 0.006). Femur length in BL-6 was greater than in CG(p = 0.04). No differences were found in serum IGF1 and IGFBP3 levels among the groups(p = 0.83, p = 0.61). The epiphyseal plate length, proliferation zone length, and IGF1,IGFBP3 expression in BL-12 were higher than in CG(p = 0.0004, p = 0.0004). Males: The median days for the onset of puberty were 38th, 30th,and 28th for CG,BL-6,and BL-12 respectively(p = 0.0001). The tail length difference (%) in BL-12 was greater than in CG(p = 0.02) while serum IGFBP3 levels in BL-6 were higher than in CG(p = 0.03). The epiphyseal plate length, proliferation zone length, and IGF1, IGFBP3 expression in BL-12 were higher than in CG(p = 0.0002, p = 0.0002). Degeneration and calcification consistent with changes in the proliferation zone were observed in both sexes. Prepubertal blue light exposure induces structural and molecular changes in the growth plate, accelerating both proliferation and maturation. These changes mirror early gonadal maturation observed in previous studies and suggest systemic neuroendocrine involvement. While linear growth may initially increase, accelerated epiphyseal maturation could ultimately restrict final height.
In the first days after childbirth, women often sleep less and have poorer sleep because of physiological and psychological changes and their new responsibilities. Given the side effects of chemical medications, herbal remedies are increasingly considered. This study aimed to determine the effect of fenugreek oral capsules on the sleep quality of primiparous women during the postpartum period. This two-group, triple-blind, randomized controlled trial was conducted in 2023 on 60 primiparous women attending health centers in Sabzevar. Eligible women took either a 700 mg fenugreek seed extract capsule or a 700 mg placebo capsule containing Avicel powder once daily, starting on postpartum day 3,4, or 5 and continuing until day 60. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) before the intervention and on the 15th, 30th, and 60th days postpartum. Data were analyzed using SPSS (version 22) with descriptive and inferential statistical tests. A p-value of less than 0.05 was considered significant. Before the intervention, the mean sleep quality score was 12.7 ± 1.7 in the fenugreek group and 11.3 ± 2.1 in the placebo group. This difference was statistically significant (p = 0.009), indicating that the two groups were not fully comparable at baseline. On the 15th day postpartum, sleep quality scores were 11.3 ± 1.9 in the fenugreek group and 12.1 ± 1.4 in the placebo group, demonstrating no significant difference between the two groups. However, after adjusting for baseline differences using analysis of covariance, the difference in mean sleep quality score between the two groups became statistically significant (F = 17.1, df = 2, p < 0.001). The average sleep quality scores in the intervention and placebo groups were 8.1 ± 1.5 and 10.0 ± 1.5, respectively, on the 30th day postpartum and 5.1 ± 1.4 and 8.9 ± 1.5, on the 60th day postpartum. The scores were significantly lower in the intervention group compared to the placebo group (p < 0.001). Because the two groups differed in sleep quality scores before the intervention, analysis of covariance was performed. This analysis confirmed significant differences between the groups on postpartum days 30 and 60 (day 30: F = 21.4, df = 2, p < 0.001; day 60: F = 54.6, df = 2, p < 0.001). Fenugreek oral capsule improved self-reported sleep quality of primiparous women during the postpartum period. Therefore, fenugreek may be an effective herbal option for improving sleep quality in primiparous postpartum women. However, future studies should use objective methods to assess sleep. The current study has been registered in the Iran registry of clinical trials ( http://www.irct.ir/ ) on the date 14-03-2023 with registration no. IRCT20230306057640N1.
Lambda-cyhalothrin (LCT) is a broad-spectrum pyrethroid insecticide widely used in agricultural fields. The present study evaluated the haematological, biochemical, residue accumulation and histopathological effects of sublethal LCT exposure in Labeo rohita. The 96-h LC50 was determined as 0.116 mg/L. Fish were exposed to sublethal concentrations of 0.0038, 0.0058 and 0.0116 mg/L, corresponding to 1/30th, 1/20th and 1/10th of the LC50 concentration, for 21 days. Sublethal exposure to LCT caused significant haematological alterations. Red blood cell count, haemoglobin, haematocrit and mean corpuscular volume decreased, whereas white blood cell counts increased significantly in a dose-dependent manner. Mean corpuscular haemoglobin showed non-significant changes. Glycogen content declined markedly in muscle and gut. However, similar reductions were observed in the liver and kidney, indicating energy depletion. Protein levels exhibited tissue-specific responses: reductions in the kidney and brain, with other tissues showing non-significant changes, indicating compensatory, organ-specific metabolic adaptation. Serum biochemical parameters remained largely unchanged, except for a reduction in cholesterol to 0.0058 mg/L, possibly reflecting the lower sensitivity of enzymatic endpoints compared with tissue-level alterations. GC-MS analysis confirmed dose-dependent accumulation of LCT in muscle tissue. Histopathological alterations were observed in the gill, liver, kidney and brain tissues. Overall, the study presents integrated evidence of physiological, biochemical and histopathological detrimental effects on the organism.
Myocardial infarction (MI) remains a major cause of morbidity and mortality worldwide. Although considerable advances have been made in its diagnosis and management, the development of safe and effective cardioprotective agents remains an active area of investigation. Natural products continue to attract interest as potential therapeutic candidates because of their diverse pharmacological activities. Aegeline, an alkaloidal amide isolated from Aegle marmelos, has demonstrated antioxidant and anti-inflammatory properties; however, its cardioprotective effects in experimental myocardial injury have not been fully characterized. The aim of this work was to assess the cardioprotective effects of aegeline in an experimental MI model. Isoproterenol (ISO) (85 mg/kg, subcutaneouslySC) was employed to trigger acute MI in experimental rats. Aegeline was administered to the rats at doses of 5 and 10 mg (p.o.) on the 29th and 30th day, respectively, followed by ISO (85 mg/kg) (s.c.) on the same days. Aegeline exhibited cardioprotective properties against ISO-induced damage, as evidenced by the amelioration of altered histopathological features, reduction in myocardial damage, and improvements in antioxidant and oxidative stress markers, inflammatory indicators, and signaling pathways, along with inhibition of apoptotic expression. In addition, aegeline did not affect liver or kidney function. Molecular docking using AutoDock Vina v1.2.6 revealed the strong binding affinity of aegeline for CK-MB (PDB ID: 3B6R), with key hydrophobic, hydrogen-bonding, and salt bridge interactions. Additional targets included LDH (7DBJ), cTnT (1J1D), and cTnI (7SC2), though CK-MB exhibited the most favorable interaction profile. Molecular dynamics simulations supported these findings through principal component analysis, dynamic cross-correlation, free energy landscape mapping, and generalized born surface area (MM-GBSA) binding free energy analysis. This study demonstrates that aegeline attenuates experimental myocardial injury by reducing oxidative stress, inflammation, and apoptosis. Computational analyses support potential molecular interactions with proteins associated with myocardial injury, while the biochemical and histopathological findings provide primary evidence for its cardioprotective activity.
Earlier diagnosis of blood-borne viruses (BBVs)-HIV, hepatitis B (HBV) and hepatitis C (HCV)-remains a significant public-health focus. Opt-out testing in secondary healthcare settings can improve early diagnosis and linkage to care as part of BBV transmission elimination targets. This scoping review used APEASE criteria (acceptability, practicability, effectiveness, affordability, side-effects and equity) to evaluate opt-out BBV testing interventions in emergency departments (EDs) and medical assessment units (MAUs). A systematic search of three databases was conducted for peer-reviewed literature up to 30th June 2025. Inclusion criteria were: (a) opt-out BBV testing intervention; (b) taking place within a secondary care setting; and (c) in the UK, Ireland, Australia and Canada. Data were extracted and analysed using APEASE criteria. Twenty-eight studies met inclusion criteria. Opt-out testing was acceptable to patients and healthcare professionals, particularly when supported by clear communication, staff training and leadership engagement. Practicability varied by setting; barriers included time constraints, unclear responsibilities and logistical challenges. Automation using electronic systems facilitated implementation. Effectiveness was demonstrated through increased testing uptake and case identification, especially in EDs. Minimal evidence exists on affordability and is likely to vary by population prevalence. No significant side effects (unintended outcomes) were reported, and universal testing was associated with reduced stigma. Opt-out testing can improve access to testing for underserved populations, supporting its role in promoting health equity. Opt-out BBV testing in secondary care settings (EDs and MAUs) is a feasible, effective and equitable intervention when supported by appropriate infrastructure and resources. Efforts should focus on optimizing implementation strategies and extending opt-out testing, including to lower-prevalence settings.
To evaluate real-life use, perceived clinical value, and barriers to the implementation of fractional exhaled nitric oxide (FeNO) among allergy-immunology specialists in Türkiye. This nationwide online survey, developed by the Asthma Working Group of the Turkish National Society of Allergy and Clinical Immunology, included 35 multiple-choice questions administered to pediatric and adult allergy-immunology specialists and fellows after the 30th National Congress. Of the 200 respondents, 75% (n = 150) were female, 54% (n = 108) were early-career physicians, and the majority (n = 125, 62.5%) worked in a university or training and research hospital. Asthma was identified as the primary indication for FeNO measurement by 95% (n = 190), of participants. FeNO was most frequently perceived as useful for phenotyping patients before biologic therapy initiation (n = 150,75.0%), monitoring treatment response (n = 141,70.5%), assessing asthma severity (n = 105, 52.5%), and supporting diagnosis (n = 85, 42.5%). In asthma management, FeNO was considered valuable for guiding decisions before biologic therapy (n = 173, 86.5%), assessing treatment adherence (n = 147, 73.5%), estimating exacerbation risk (n = 134, 67.0%), and adjusting inhaled corticosteroid doses (n = 119, 59.5%). Nearly all participants (n = 195, 97.5%) agreed that FeNO should be used as a complementary tool. However, only 7.0% (n = 14) reported routine FeNO use in daily practice. Limited device access, high cost, lack of reimbursement, and insufficient training were identified as major barriers. Knowledge gaps were prominent, with 61% reporting little or no practical knowledge of FeNO. This first national survey demonstrates a marked gap between clinicians' recognition of FeNO's clinical value and its limited real-world use in Türkiye, largely due to cost, access, and educational barriers.
Skeletal muscle cramping among patients with end stage kidney disease receiving dialysis is not uncommon and has been identified by patients as a high priority, bothersome, unaddressed physical symptom. The primary objective of this systematic review was to quantify the global prevalence of skeletal muscle cramps among dialysis patients. Four databases were searched through September 30th 2025. All available peer-reviewed observational and non-randomized experimental studies of non-hospitalized patients receiving dialysis reported in English were included in the analyses, whereas case reports/series, randomized control trials, systematic reviews, and meta-analyses were excluded. Timing of muscle cramps was dichotomized as overall or intradialytic. Random-effects meta-analysis was conducted to quantify the pooled prevalence of skeletal muscle cramps. Risk of bias was assessed using the Newcastle-Ottawa scale. Ninety-four studies reported the prevalence of muscle cramps in 32,223 patients receiving dialysis across 36 countries on 5 continents. Most studies were performed in hemodialysis patients (n = 54, 57%), and 16 studies reported the prevalence of intra-dialytic cramps specifically. The overall pooled prevalence of skeletal muscle cramps was 55% (95% confidence interval (CI) 50%-59%, 95% prediction interval (PI) 20%-86%), whereas the pooled intradialytic prevalence of skeletal muscle cramps was 33% (95% CI 22%-47%, 95% PI 4%-87%). The prevalence of muscle cramps was higher among patients receiving hemodialysis vs peritoneal dialysis, new/incident vs prevalent patients, and a four-week vs one-week survey recall period, with significant between-study heterogeneity. Most studies (n= 50, 53%) were identified as having a moderate risk of bias. The global overall pooled prevalence of muscle cramps among patients receiving dialysis was high (55%), though there were considerable between-study heterogeneity and risk of bias. Our findings highlight the complexity of quantifying skeletal muscle cramps among dialysis patients and offer insights into specific subpopulations and methods of symptom ascertainment for future epidemiologic, pathophysiologic, and therapeutic studies.
In resource-limited primary healthcare (PHC) settings, nurses often have limited opportunities for refresher training and capacity-building. This study evaluates a structured nursing refresher training program implemented in slum-based PHC clinics, focusing on changes in clinical competence, patient safety practices, and adherence to healthcare protocols. A single-group pre-post quasi-experimental study was conducted among 250 nurses from 40 primary health clinics. Knowledge and practice skills were assessed before and after the training. Data were analyzed using STATA version 15.0. Descriptive statistics and paired t-tests were applied, and mean differences with 95% confidence intervals (CIs) were reported. Generalized Estimating Equations (GEE) with an exchangeable correlation structure were also used to examine associations between independent variables and changes in knowledge and practice scores. Of the 250 participants, 231 completed the study. The mean age was 31.6 years (± 6.67), with an average of 5.63 years (± 4.21) of job experience. The mean knowledge score increased from 11.91 to 15.62, with a mean difference of 3.71 (95% CI: 3.15-4.27). Similarly, mean practice scores increased from 19.53 (95% CI: 19.29-19.77) to 26.11 (95% CI: 25.87-26.35), with a mean difference of 6.58 (95% CI: 6.26-6.90). The findings indicate improvements in knowledge and practice scores following the training intervention. However, due to the absence of a control group, causal interpretations should be made with caution. The results highlight the potential value of continuous education and capacity-building initiatives for healthcare providers in similar settings. ClinicalTrials.gov number NCT06523907, Date of Trial registration: registered in 23rd July 2024, Recruitment done on 29th of July 2024, study started from 30th of July 2024 and study completed 28th of September 2024. https://clinicaltrials.gov/expert-search?term=NCT06523907.
Healthcare-associated infections (HAIs) are a major patient safety concern, particularly in low-resource settings. The multi-modal strategy (MMS) is a core component of infection prevention and control (IPC) aimed at hand hygiene (HH) practice. The Hand Hygiene Self-Assessment Framework (HHSAF) is a standardized tool to evaluate institutional HH implementation via MMS. This study assessed institutional HH implementation of MMS components using the HHSAF across Ethiopian hospitals. A cross-sectional study was conducted from 1st January to 30th August 2025 in 20 public hospitals. Data were collected using the World Health Organization (WHO) HHSAF and validated through on-site assessments by senior IPC officers. Hospitals were classified as inadequate (0-125), basic (126-250), intermediate (251-375), or advanced (376-500) according to WHO criteria. Domain-specific and overall HHSAF scores were summarized using medians and interquartile ranges (IQRs) in SPSS v.25. The median HHSAF score across hospitals was 203.75 (IQR: 153.75-233.75), indicating that 14 hospitals were classified at the basic level of implementation. Tertiary hospitals scored higher (210; IQR: 152-225) than secondary hospitals (178; IQR: 155-197.5) (Mann-Whitney U = 47.5, P = 0.85). The median HH compliance rate was 42.5% (IQR: 30-49.5), with 15 of 20 (75%) of hospitals having a compliance rate below 50%. Institutional safety climate was positively correlated with the combined four-domain HHSAF score (r = 0.77, P < 0.001). HH implementation using MMS in Ethiopian hospitals showed significant variability and an unsatisfactory level. Strengthening leadership engagement is associated with higher HHSAF scores. Addressing critical system-change gaps, particularly in infrastructure and resource availability, is essential for sustained improvement.
This article, for Health's 30th anniversary special issue, engages with feminist theoretical frameworks which have been used to interrogate the ways reproductive health knowledges are made, shared, and contested. The paper begins by critically revisiting the history of the Women's Health Movement, illustrating how representationalist epistemologies can fall short in disrupting the material-discursive apparatuses that uphold dominant biomedical logics. Following this, the article explores what a diffractive, new materialist methodology can offer to this field. Haraway's 'virtual speculum' and Barad's 'agential realism' are explored as provocations for reimagining how we can engage diffractively with the mediation of reproductive bodies and technologies. This paper therefore argues that a diffractive, agential realist approach not only decentres human agency, but foregrounds the entangled processes through which knowledge and health are enacted.
Adoption of recommended self-management behaviors has been associated with a lower risk of disease progression, cardiovascular morbidity, and mortality in patients with chronic kidney disease (CKD). This systematic review aims to identify factors associated with the adherence of non-dialysis-dependent CKD (NDD-CKD) patients to recommended self-management practices. Following PRISMA guidelines, we searched PubMed, Embase, Scopus, Medline, and CINAHL Plus databases from 1st January 2010 to 30th June 2024. The extracted data included associations of variables with self-management scores. The findings were descriptively presented in a grouped tabular form. The study was registered with the PROSPERO, CRD42024547304. From 1,914 studies identified, 16 cross-sectional studies with 3,658 participants were selected for inclusion. Objective CKD knowledge, health literacy, self-efficacy and social support consistently showed positive associations with self-management across multiple studies. This systematic review revealed multiple factors associated with self-management in NDD-CKD patients, with disease-related knowledge, health literacy, and self-efficacy showing the most consistent positive associations across studies. Healthcare providers and policymakers should develop and implement health literacy and awareness programs as a strategy for improving patient outcomes. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=547304, identifier CRD42024547304.
Real-world evidence on major depressive disorder (MDD) management in children and adolescents is limited in Japan. This study aimed to evaluate the antidepressant treatment persistence rate in this population. This study evaluated the antidepressant treatment persistence in children and adolescents (aged 6-18 years) with MDD who had claims data from 6 months before to 1 year after the index date between 2012 and 2017 using a large-scale Japanese claims database. Treatment persistence was defined as the absence of a prescription gap beyond 30 days. Factors associated with it were examined using a Cox proportional hazards model (JMP ver.18). In total, 1,582 patients on the index date were included. The treatment persistence rate for any antidepressant was 62.6% on the 30th postindex day, 46.1% on the 60th postindex day, 22.3% on the 180th postindex day, and 10.2% on the 365th postindex day. The most frequently prescribed initial antidepressant was sulpiride (30.0%). By drug class, selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed (39.9%), followed by tricyclic or tetracyclic antidepressants (TCAs) (18.3%) and serotonin and norepinephrine reuptake inhibitors (SNRIs) (6.3%). The significant factors associated with treatment discontinuation with any antidepressant were treatment initiation with sulpiride, noradrenergic and specific serotonergic antidepressants, serotonin antagonist and reuptake inhibitors, or TCAs, as well as consultations with nonmental health specialists. Antidepressant treatment persistence rates in children and adolescents with MDD were low. However, the rate varied depending on the first prescribed antidepressant and mental health specialist involvement. Relatively high persistence was observed among those prescribed SSRIs or SNRIs as their initial antidepressant treatment and those who received clinical interventions provided by mental health specialists. Given the claims data and no clinical severity measures, these findings should be interpreted with caution.
Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) may disrupt maternal fatty acid (FA) metabolism; however, compartment-specific responses, nonmonotonic dose-response relationships (NMDRs), and mixture effects remain insufficiently characterized. We quantified 14 plasma PFAS and comprehensively profiled FAs, FA-class distributions, health-related indices, and product-to-precursor ratios in plasma (n = 192) and red blood cells (RBCs; n = 119) from pregnant women in China. Associations were assessed using multiple linear regression (MLR), restricted cubic splines (RCS), and Bayesian kernel machine regression (BKMR). Perfluorooctane sulfonate (PFOS) was the predominant PFAS, with a median concentration of 3.90 ng/mL, accounting for 45.9% of the total PFAS burden. MLR revealed distinct compartment-specific patterns. In plasma, PFOS and PFOS-related metrics were inversely associated with long-chain n-3 polyunsaturated FAs (PUFAs), including EPA, DHA, Σn-3, and EPA + DHA (β = -0.83 to -0.44), and positively associated with saturation- and n-6-dominant ratios, including Σn-6/Σn-3, ARA/DHA, and ΣSFA/ΣPUFA (β = 0.35-0.78). In RBCs, associations were fewer and were mainly characterized by inverse relationships of total PFAS and long-chain PFAS with arachidonic acid and n-3 PUFA biomarkers (β = -0.75 to -0.65). RCS identified significant NMDRs only in plasma, primarily exhibiting inverted U-shaped or threshold-type patterns, with PFOS breakpoints of approximately 3.00-7.39 ng/mL, corresponding to the 30th-80th percentiles, within environmentally relevant exposure ranges; stronger disruptions were observed above these thresholds. BKMR supported compartment-specific mixture effects, showing nonlinear, PFOS-dominated associations in plasma, with posterior inclusion probabilities of 0.93-1.00, but largely linear and more distributed contributions in RBCs, where saturation ratios increased and n-6 PUFAs decreased with increasing co-exposure. Overall, real-world prenatal PFAS exposure was associated with PUFA depletion and a shift toward more saturated and potentiall pro-inflammatory FA profiles through compartment-specific and nonlinear pathways.
Stereotactic body radiation therapy (SBRT) is a non-invasive alternative to surgery for the management of early-stage non-small cell lung cancer (ES-NSCLC). Despite excellent control rates, outcomes of SBRT are still heterogenous, and there is a clear need for biomarkers to guide treatment selection, estimate recurrence risk, or identify patients who may benefit from treatment intensification. Given the increasing role of immunotherapy in this setting, we conducted a systematic review to summarise the available evidence on prognostic and predictive immunological biomarkers in stage I-II NSCLC treated with curative SBRT. PubMed/MEDLINE, Scopus, Embase, and ClinicalTrials.gov were screened on 30th November 2025. Full-texts from database inception written in English were considered eligible if presenting the association between immunological biomarkers and oncological outcomes in patients treated with SBRT. Due to the heterogeneity of the included studies in terms of biomarkers, outcome definitions, and analytical approaches, neither a formal meta-analysis nor a GRADE assessment was performed. Consequently, statistical heterogeneity and publication bias were not formally assessed. Risk of bias was assessed with the Newcastle-Ottawa Scale (NOS). Ten studies, for a total of 1019 patients, met the inclusion criteria. Eight were retrospective cohorts, one was a prospective observational study, and one was a phase I trial. Overall, the included studies showed moderate-to-high methodological quality, with most achieving adequate follow-up and higher NOS scores, demonstrating adequate selection criteria, outcome ascertainment, and control of confounders. Median sample size was 82 (interquartile range 61-117). The most frequently investigated biomarkers were neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), with elevated baseline levels consistently associated with poorer survival. CD44 emerged as a potential predictive biomarker, with higher expression correlating with increased risk of recurrence after SBRT and validated in an external surgical cohort. Immune-profiling studies identified prognostic signatures-such as PD-1+, CD4 T cells and Th17 subsets-but none demonstrated predictive value for SBRT response. Current evidence highlights the predominance of prognostic, rather than predictive, biomarkers in ES-NSCLC treated with SBRT. While CD44 and other tumour microenvironment-related markers are promising, available data remain exploratory. Larger biomarker-driven studies are needed to enable personalised treatment allocation between surgery and SBRT and to guide rational use of systemic therapies in early-stage disease. The present work was conducted within the framework of the MONDRIAN trial.
the partograph is a graphical record of the progression of labour and the main maternal and fetal parameters over time. Partograph allows early detection of abnormalities in the progression of labour, such as obstructed labour, which was responsible for 8.3% of maternal deaths and 39.7% of stillbirths in sub-Saharan African countries. The objective of this study was to assess knowledge and identify factors associated with a good level of knowledge among obstetric care providers regarding the partograph. this was a cross-sectional study conducted between February 1st and June 30th, 2024. The study was conducted in 14 Health Districts, including urban-rural and rural Health Districts selected among the 20 Health Districts in the West Region of Cameroon, using a stratified random sampling technique. Data were collected using a semi-structured self-administered and pre-tested questionnaire administered to obstetric care providers encountered during a monthly coordination meeting of healthcare facilities in the study´s Health Districts. Descriptive statistics, univariable and multivariable logistic regression analysis were performed. We determined the adjusted odds ratios with a 95% confidence interval, and a P-value less than 0.05 was considered statistically significant. a total of 373 obstetric care providers participated in the study, with an average age of 39.6 ± 10.6 years; 64.6% (241) were women, 64.3% (240) were nurses, and 79.1% (295) worked in Health Centers. The proportion of obstetric care providers with good knowledge of the partograph was 59.8%. Working in a District Hospital/Medical Center aOR: 2.76, 95% CI 1.24-6.87; p = 0.019, being a midwife/general practitioner aOR: 5.41, 95% CI 1.51- 26.8; p = 0.018, working in a health facility located in a rural Health District aOR: 1.71, 95% CI 1.05-2.81; p = 0.032, and having 6-10 years of service aOR: 6.03, 95% CI 1.22-35.4; p = 0.031 were factors associated with good level of knowledge about the partograph. In addition, 94.1% (351) obstetric care providers expressed the need for additional training on the partograph. less than two-thirds of participants had a good knowledge of the partograph. We recommend conducting interventions aimed at capacity building and the systematic use of partograph by obstetric care providers in general, and those working in Health Centers in particular; ensure that work teams are formed by pairing less experienced obstetric care providers with those who have more years of service and increase the recruitment of midwives in different health facilities.
Adolescent girls and young women (AGYW) are among the high-risk groups for new HIV infection, particularly in Sub-Saharan Africa (SSA). HIV testing is an entry path to HIV care and treatment and is crucial in ending the HIV epidemic by 2023. Despite the availability of HIV Testing Services (HTS) in most SSA countries, including Tanzania, most AGYW are undiagnosed HIV or have ongoing HIV exposure. This study explored the enablers for and barriers to the uptake of HTS among AGYW aged 15-24 in northern Tanzania. This qualitative study was conducted between 4th October and 30th November 2024 in the Kilimanjaro Region, northern Tanzania. We included AGYW attending four purposively selected Care and Treatment (CTC) sites. Four Focused Group Discussions (FGDs) (two for 15-19 years and 20-24 years, respectively) were conducted using a semi-structured interview guide to explore perceived enablers for and barriers to the uptake of HTS among AGYW. Data were analyzed using thematic content analysis, and findings were presented narratively, using verbatim quotes. A total of 32 AGYW participated in the FGDs, more than half (53%) were aged 20- 24 years old and had primary education, and 63% (n = 20/32) were still in school. Perceived enablers that may facilitate the uptake of HTS include small blood samples collected, trust of a sexual partner, confidentiality of HIV test results, and existing social support. Other perceived enablers were the provider-centred HIV approach, comprehensive HIV education, health benefits of ARV use, and antenatal care as an entry point to HTS. Perceived barriers to HTS uptake include lack of HTS knowledge, being asymptomatic, fear of HIV test results, spiritual healing beliefs, being visible at the health facility, and anticipated stigma. Other perceived barriers were the provider's negative attitudes, long waiting times, lack of confidentiality of HIV test results, and transport costs. This calls for a multifaceted, client-centred intervention that strengthens the perceived enablers and simultaneously addresses the perceived barriers to create an enabling environment for uptake of HTS among AGYW.