Youth in low- and middle-income countries (LMICs) bear a disproportionate burden of mental health conditions, alongside low health-seeking behaviours and limited access to services. These gaps underscore the need for accessible strategies such as youth peer-based mental health programmes and supports (Y-PBMHPS). To examine whether Y-PBMHPS can help address the mental health needs of LMIC youth. We conducted a rapid review of peer-reviewed literature, searching Medline, PsycINFO, CINAHL, CAB Global Health, Science Citation Index and Social Sciences Citation Index for studies of Y-PBMHPS in LMICs published in English between 1 January 2002 and 19 September 2025. Two review authors performed title/abstract screening and full-text review. Study quality was assessed by one review author using Joanna Briggs Institute critical appraisal tools. The primary outcome was change in mental health status, expressed in standardised difference units. Of 6105 unique records identified, 329 studies were reviewed in full and 34 were included. All studies were conducted in Asia or Africa; 17 were quantitative studies (including randomised controlled trials), 9 were qualitative studies and 8 used quantitative designs with qualitative findings. Y-PBMHPS included counselling, psychotherapy, psychoeducation and self-help groups, with peers acting as leaders, facilitators, educators or service providers. Quantitative studies most frequently assessed anxiety and depression, reporting negligible to moderate effects. Qualitative findings indicated good fidelity, adherence and acceptability, alongside some feasibility challenges. Y-PBMHPS can broaden youth mental health support and services in LMICs. Clearer guidelines on peer selection, training and supervision and further research in other LMICs, including cost-effectiveness evaluations, would strengthen the evidence base.
CNS tumors present significant diagnostic challenges due to their heterogeneity. Successive editions of the World Health Organization (WHO) classification have progressively incorporated molecular markers as essential criteria. Nonetheless, in low- and middle-income countries, limited access to molecular testing hampers the full application of these classifications. To assess this situation, we decided to evaluate the impact of successive WHO classifications on glioma diagnostic accuracy in a high-volume neurosurgical center in Latin America. We conducted a retrospective analysis of patients that underwent elective tumor surgery between January 1st, 2010 and December 31st, 2024 and whose pathology report was consistent with a glioma. Demographic, anatomical, histological, and molecular data were collected. Tumors were classified according to WHO CNS Tumor Classification criteria of 2007, 2016, and 2021. Statistical analyses were performed using STATA v15.A total of 443 patients were included. Under WHO 2007 criteria, glioblastoma was the most common tumor type, with virtually all tumors classified histologically. With WHO 2016 implementation, the proportion of tumors labeled as "not otherwise specified" (NOS) and cases with incomplete tumor characterization increased. Application of WHO 2021 further highlighted diagnostic limitations, with 24% of tumors categorized as high- or low-grade glioma NOS, instead of a particular tumor type/entity. This work sheds light on the fact that the progressive complexity of glioma classification with the addition of new molecular and genetic factors may have as a counterpart an increase in the number of cases with inadequate tumor characterization due to the lack of accessibility to key molecular studies in diagnosis.
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Neurologic disorders in the neonatal period are a leading cause of death and disability in low- and middle-income countries, including Latin America. Access to specialized neonatal neurocritical care remains limited, and educational opportunities are scarce. We aimed to evaluate the feasibility, reach, knowledge acquisition, and perceived value of a virtual educational series in neonatal neurology targeting health care professionals across Latin America. This prospective educational intervention included 6 case-based webinars delivered between October 2023 and April 2024 in Spanish via Zoom. The series, organized by the Newborn Brain Society's Latin American Task Force, was open-access and promoted through regional medical societies. Participants completed demographic surveys, pre- and postsession knowledge assessments, and standardized feedback forms. The virtual webinar series covered key neonatal neurologic topics, including hypoxic-ischemic encephalopathy, seizures, hypotonia, and neuromonitoring. Presenters were local trainees with expert moderator commentaries. Outcomes included webinar attendance, knowledge acquisition (multiple-choice questions), and satisfaction (5-point Likert scale). Responses were analyzed overall and for matched pre- and postsession participants. A total of 1,424 participants from 24 countries attended the 6 webinars, with each session exceeding 100 attendees and 10 countries (meeting predefined feasibility criteria). Attendees were predominantly physicians (84%), although nurses, residents, and other professionals also participated; 23% attended multiple sessions. Knowledge scores improved significantly, with an 8%-18% increase in matched pre- vs postsession scores (p < 0.05). Participant satisfaction was high (mean feedback ∼4.8/5), and qualitative feedback highlighted the series' clinical relevance, interactivity, and value for practice. This virtual educational initiative proved feasible, engaging, and effective in improving neonatal neurology knowledge across Latin America. Such tele-education programs may help reduce regional disparities in care.
Children in low- and middle-income countries experience a greater burden of rotavirus infection relative to developed countries. Malaysia is a middle-income country; however, like other South East Asian countries, studies on rotavirus are scarce. In an effort to understand the strain diversity, we performed a study in children under five years old who attended 4 health care centers in the Papar district of Sabah state of Malaysian Borneo and collected samples from 2020 to 2021. This study provides robust molecular evidence that strains detected in Sabah, Malaysia, were generated by intergenogroup reassortment. Reassortment is one of the evolutionary mechanisms that generate diversity in rotavirus strains. We characterized a rotavirus which possessed a long RNA pattern and an unusual combination of G6P[9]. These strains have a unique constellation of G6-P[9]-I2-R3-C3-M3-A3-N2-T6-E3-H6 with an AU1-like backbone and components from DS-1, indicating an intergenogroup reassortant. Of the 11 gene segments, five were closest to feline and 2 were closest to human strains, respectively; the rest were related to human-animal strains. Novel rotaviruses generated by reassortment might influence the disease outcome and vaccination effort.
Soft tissue sarcoma (STS) is a rare and diverse type of cancer, with a disproportionate incidence and limited global epidemiological studies. This study aims to analyze the long-term trends and epidemiological features of the global burden of STS from 1990 to 2021 and to reveal the global research productivity on STS. The global burden of STS was analyzed using the methods and results of the 2021 Global Burden of Disease (GBD) Study, focusing on incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and corresponding age-standardized rates. We also analyzed STS epidemiological trends using joinpoint and age-period-cohort (APC) methods, and assessed research productivity through a composite metric incorporating funding inputs, scientific outputs, drug development pipelines, and clinical trial activity. In 2021, it was estimated that there were approximately 96,201 cases of sarcoma worldwide, resulting in 50,203 deaths. The age-standardized incidence rate was 1.16 cases per 100,000 population-years (95% uncertainty interval [UI] 1.0-1.41), while the mortality rate stood at 20.54 deaths per 100,000 population-years (95% UI: 17.46-26.09). Socioeconomic gradients were evident, with a higher incidence in high-HDI countries and mortality rates that were twice as high in low-HDI countries than in middle-HDI countries. The impacts of age, period, and cohort on mortality rates varied. The research productivity of STS have generally increased across the Socio-Demographic Index (SDI), but effective treatments remain lacking. The global burden of STS relatively stable from 1990 to 2021, with notable geographic disparities. Global investment in basic research related to sarcomas has increased, but treatment options remain limited.
Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels. Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990-2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute's APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010-2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data. In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17-78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58-23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015-2019 was approximately 60% lower than 2000-2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68-0.78) in the 1980 cohort to 0.90 (95% CI: 0.70-1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010-2019. Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.
•High overall openness: Most respondents reported moderate to high willingness to use game-based interventions to improve emotion regulation, mental health, and well-being across diverse countries.•Two distinct user profiles identified: Cluster analysis revealed a high willingness group (43%) and a moderate willingness group (57%), highlighting meaningful heterogeneity in receptivity.•Key predictors of high willingness: Younger age (18-25), male gender, frequent gaming, gaming disorder symptoms, and specific emotion regulation difficulties significantly increased likelihood of high willingness.•Factors associated with lower willingness: Higher impulsivity (low perseverance, high sensation seeking) and emotional unawareness or limited use of regulation strategies were linked to reduced openness.•One of the key findings: Participants showed lower willingness to use game-based interventions preventively than reactively. Game-based interventions show promise for mental health, yet limited research has examined individuals' willingness to engage and the factors shaping openness to these approaches. We aimed to (a) assess the extent to which individuals are willing to use game-based interventions to enhance emotional regulation, mental health, and mental well-being; (b) identify distinct participant profiles characterized by varying levels of willingness; and (c) examine socio-demographic, psychological, and game-related factors associated with this willingness. An online survey of 3745 adults aged 18–79 years from 48 countries assessed socio-demographic characteristics, gaming habits, impulsivity, emotional regulation difficulties, gaming disorder symptoms, and anxiety and depression symptoms. Participants reported relatively high willingness to use game-based interventions for improving emotion regulation, improving mental health, and improving mental-wellbeing when feeling down, and more moderate willingness to use such interventions for improving mental wellbeing when feeling good (M = 3.25; 3.35; 3.26 and 2.93 respectively; 1–4 scale, where 1 is described as “Definitely would not” and 4 is “Definitely would”). Cluster analysis revealed two distinct profiles: a “high willingness” group (43%) and a “moderate willingness” group (57%). Logistic regression results indicated that being younger, male, and having higher gaming frequency, gaming disorder symptoms, and some emotional regulation difficulties dimensions significantly predicted membership in the “high willingness” group. In contrast, higher impulsivity and greater emotional unawareness or limited strategy use predicted a lower level of willingness. Most participants were open to digital mental health tools, with willingness shaped by individual traits, highlighting the value of tailored, culturally inclusive interventions for receptive subgroups, especially young adult gamers. One of the key findings of this study is that participants showed lower willingness to use game-based interventions preventively than reactively. This suggests preventive interventions may require distinct motivational mechanisms, with implications for designing strategies that enhance engagement during periods of well-being.
Stroke is a leading cause of neurological disability and mortality worldwide, with acute ischemic strokes caused by large-vessel occlusions presenting significant health care challenges. While endovascular thrombectomy has emerged as a gold standard treatment, access to timely stroke care remains severely limited, especially in low- and middle-income countries. This review examines the multifaceted social, cultural, and systemic barriers that impede effective stroke care globally. We performed a comprehensive search of PubMed from 2004 to 2024, using keywords of acute stroke care, low-middle-income countries, social barriers, cultural barriers, and access. There are several recognized obstacles to stroke treatment, especially in the acute settings, including health fatalism, spiritual and religious beliefs that discourage medical intervention, and widespread lack of public awareness about stroke symptoms and urgency. Cultural misconceptions often lead individuals to delay or avoid seeking medical care, with some communities attributing stroke to supernatural forces or divine punishment. Language barriers, insufficient health care infrastructure, and socioeconomic challenges further compound these issues, particularly in regions such as sub-Saharan Africa and parts of Asia. Furthermore, there are critical infrastructural barriers to delivering acute stroke in a timely manner, including limited transportation to health care facilities and inadequate stroke centers in rural areas. A comprehensive strategy to address these challenges should focus on culturally sensitive education, community engagement, and infrastructure development. Recommendations include cooperating with religious and community leaders, developing targeted awareness campaigns, and creating inclusive health care approaches that respect local cultural contexts. Overall, addressing the global stroke burden not only requires technological interventions but also demands a holistic approach that bridges cultural understanding, challenges misconceptions, and empowers communities to recognize and respond to stroke as a critical medical emergency.
Epididymitis is a common urogenital infection in adult men caused by sexually transmitted pathogens, urinary tract infections, trauma, or autoimmune mechanisms, with etiologies varying by age. In addition to severe pain and reduced quality of life, it may result in complications such as abscess formation, testicular atrophy, and infertility. Despite its clinical significance, comprehensive analyses of research trends remain limited. Bibliometric and knowledge-mapping approaches can provide quantitative insights into the field's development and hotspots. Using the Web of Science Core Collection and the PubMed Database, we retrieved literature related to epididymitis published from January 1, 2014, to September 10, 2025. Bibliometric analyses of publication volume, journals, authors, institutions, countries, and keywords were conducted using the Bibliometrix R package (v5.1.1), VOSviewer (v1.6.20), and CiteSpace (v6.4. R2). Scientific knowledge maps were generated to identify research hotspots and developmental trends in epididymitis. A total of 497 publications from 2,887 authors across 955 institutions in 67 countries were analyzed. Annual output remained stable at 30-50 articles since 2014. Andrologia was the most influential journal, and Pilatz Adrian was the leading author. China produced the most publications, the United States had the highest total citations, and Germany showed the highest average citation impact and strongest international collaboration. Justus Liebig University Giessen ranked first among institutions. Research trends have shifted from clinical diagnosis toward pathogenic and immunological mechanisms. Human studies focus on clinical features and treatment outcomes, whereas animal studies emphasize immunoinflammatory mechanisms and reproductive impacts. Research on epididymitis is advancing from clinical observation toward molecular immunology and precision therapy. Future studies should further focus on sexually transmitted pathogens, the immunopathological mechanisms of epididymitis, and the relationship between chronic inflammation and male infertility.
Abusive head trauma (AHT), is considered a leading cause of fatalities resulting from physical abuse in infants under 2 years of age, with a peak incidence between 1 and 2 months after birth. The incidence of AHT ranges from 14 to approximately 40 cases per 100,000 children in industrialized countries with a mortality rate ranging from 10 to 20%. The absence of internationally recognized best practices or guidelines especially in the field of forensic medicine has resulted in methodological variability in the management of these cases across different settings. In response to this gap, a comparative working group involving experts from Italy and the Balkan countries was established, leading to the creation of a shared discussion platform. The aim of this collaborative effort was to identify strengths and critical issues in the forensic handling of abusive head trauma, ultimately with the goal of developing a shared workflow chart for the management of these complex cases within the network.
The epidemiology of vancomycin-resistant Enterococcus faecium (VREfm) varies across different countries, with a steady global increase. In Portugal, however, epidemiological data on clinical VREfm have been scarce since the early 2000s. This long-term study investigates VREfm isolates from human infections collected at a Porto hospital between 2010 and 2021. Two hundred VREfm isolates, mostly urinary (39%) were characterized by antimicrobial susceptibility testing to 8 antibiotics, chlorhexidine susceptibility, and PCR-based detection of vancomycin-resistance genes, virulence markers, plasmid replicases, and the bac43/T8 gene. Whole-genome sequencing, by Illumina, was used to assess clonal diversity (MLST, cgMLST, SNP phylogeny) and genomic content of antimicrobial resistance (AMR) genes, bacteriocins (76 genes) and putative virulence markers (35 genes). The plasmidome size and replicase initiation proteins of selected isolates was further improved by incorporating nanopore sequencing which enabled hybrid assemblies. All isolates were multidrug resistant; 98% carried vanA, while two (1%) were resistant to linezolid (G2576T mutation). Chlorhexidine susceptibility remained stably low over time (MICs: 2-4 mg/L). The population was polyclonal, with a shift from ST18-like lineages to ST80 and ST117 dominance. While ARGs and virulence markers showed no clear association with clonal waves, bacteriocin profiles did, with bac43 becoming increasingly prevalent. ST117-CT24 emerged as the most persistent clone. The plasmidome comprised stable Rep3-like mobilizable plasmids carrying bacteriocins (bac43, bacAS5), RepA_N mega-plasmids harboring virulence/AMR/bacteriocins, and highly plastic medium-to-large vanA plasmids with diverse replicase initiation proteins. Strikingly, linear vanA plasmids (repUS78_pZY2) appeared in the most recent isolates, paralleling findings in vancomycin-variable E. faecium from the same hospital and VREfm from other countries. Our findings reveal dynamic clonal shifts, novel plasmid architectures, and the key role of bacteriocins in shaping clonal success in a WHO priority pathogen. Furthermore, we highlight the need for AMR surveillance frameworks to consider factors beyond conventional prevalence metrics and core-genome comparisons. Integrating intra-species genomic heterogeneity and non-traditional evolutionary indicators will be essential to more accurately predict, track, and ultimately mitigate the dissemination of multidrug-resistant human pathogens.
Spina bifida is a common neural tube defect and remains a significant public health concern in low- and middle-income countries. Data on neonatal presentation and maternal characteristics in Eastern Morocco are limited. We conducted a retrospective descriptive study over a nine-year period in the neonatal intensive care unit of a tertiary hospital in Eastern Morocco. All neonates diagnosed with spina bifida were included. Data on clinical features, maternal characteristics, management, and outcomes were analyzed. Thirty-three neonates were included. Myelomeningocele was the most frequent type. Common complications included hydrocephalus (45%), motor deficits (30%), and orthopedic abnormalities (39%). Surgical management was performed in more than half of the cases, and some patients required ventriculoperitoneal shunting. Maternal characteristics included inadequate folic acid supplementation, consanguinity, diabetes, and reported consumption of fenugreek during pregnancy. Survival at discharge was generally high, although morbidity remained significant. Neonatal spina bifida remains a significant cause of morbidity in our setting. Maternal characteristics, particularly inadequate folic acid supplementation, underline the importance of preventive strategies. The reported consumption of fenugreek during pregnancy warrants further investigation. These findings highlight the need for improved prenatal care and preventive strategies.
Strategic hospice staffing is essential to optimize patient care and strengthen workforce performance and retention, particularly as aging populations and rising rates of life-limiting illnesses increase the demand for end-of-life care. Despite growing recognition of staffing challenges in hospice care, there is limited synthesis of evidence on effective models and practices that support high-quality, sustainable care delivery. This scoping review aimed to synthesize evidence on workforce characteristics and strategies that support sustainable, high-quality hospice care. Literature published after 2013 was searched in Ovid MEDLINE, EBSCOhost CINAHL, Ovid Embase, and Google Scholar to capture both peer-reviewed and grey literature sources relevant to hospice staffing and care quality. The review followed the PRISMA-ScR framework and was guided by the Arksey and O'Malley five-stage methodology. Search terms reflected three dimensions: 1) adult hospice care, 2) hospice staffing, and 3) the quality and effectiveness of care. Articles were included if they discussed hospice or palliative care staffing models, workforce characteristics, or operational performance metrics. Forty-seven articles were included (33 peer-reviewed publications and 14 grey literature sources), representing hospice and palliative care settings across 11 countries, with the United States most frequently studied. Core strategies to enhance workforce sustainability and patient care included staffing composition and competency, key care approaches, and volunteer integration Findings highlighted that having an appropriately structured and well-prepared workforce is critical for ensuring quality care, while strategies that promote staff well-being and streamline processes further enhance service delivery. Collectively, these themes point to guiding principles for hospice staffing: adaptable, patient-responsive models; strong interdisciplinary collaboration; ongoing training and support; and the strategic use of volunteers and technology. This review synthesizes international evidence on hospice staffing and identifies common principles that can guide practice. Taken together, these practical insights highlight an urgent need for rigorous evaluation to move beyond fragmented approaches and establish sustainable, equitable, and patient-centred staffing standards. Developing and implementing such standards is essential not only for workforce stability, but also for ensuring high-quality, compassionate care for patients and families at the end of life. Not registered. Interdisciplinary, flexible staffing models improve hospice care quality and support workforce sustainability.
Ultra-processed foods (UPFs) now dominate dietary intake in many countries and are consistently associated with higher risks of cardiovascular disease (CVD), including myocardial infarction, stroke, and heart failure. Beyond excess sodium, sugar, and unhealthy fats, UPFs may exert cardiovascular harm through food matrix disruption, processing-generated toxicants, additive exposure, and microbiome perturbation. These upstream insults converge on inflammatory, oxidative, and metabolic signaling pathways that regulate microRNAs (miRNAs), a class of small non-coding RNAs that orchestrate post-transcriptional gene expression across endothelial cells, vascular smooth muscle cells, macrophages, platelets, and metabolic tissues. In this review, we propose a unifying mechanistic framework in which UPF exposure reshapes both intracellular and extracellular vesicle (EV)-associated miRNA networks, thereby linking gut, liver, adipose tissue, and the vascular wall in a feed-forward cardiometabolic signaling loop. We synthesize evidence across epidemiology, experimental models, and human dietary intervention studies, while explicitly distinguishing established, emerging, and speculative mechanisms to avoid over-interpretation. We further discuss translational opportunities, including circulating miRNA/EV-miRNA biomarkers, nutritionally responsive miRNA signatures, and miRNA-targeted therapeutics. Together, this framework positions the UPF-miRNA/EV axis as a plausible molecular bridge between modern dietary exposure and atherosclerotic disease progression, and highlights priority areas for mechanistic validation and clinical translation.
To compare the average time between the registration of a biological drug and its recommendation for incorporation for rheumatoid arthritis (RA) and cancer (CA) at national and international levels. This retrospective, comparative study analyzed the time taken to incorporate biological drugs recommended by National Commission for the Incorporation of Technologies (CONITEC) in the Brazilian Unified Health System(SUS) for RA and CA from January 1, 2012, to March 28, 2024. The incorporation time in Brazil was compared to that of regulatory bodies in England and Australia for the same treatments. Kaplan-Meier curves and the Log rank test were used to estimate time differences between countries. In Brazil, biological drugs for RA took an average of 2,019 days from the National Health Surveillance Agency (ANVISA) approval to CONITEC's incorporation recommendation. In England, the averages were 1,242 days for RA and 1,683 for CA, while in Australia, it was 744 days for RA and 1,315 for CA. Australia incorporated drugs faster than both England and Brazil. The lengthy process in Brazil for incorporating biological technologies for RA and CA may hinder access, delaying treatment for many patients. This barrier is particularly significant for low-income individuals who rely exclusively on the SUS.
Cholera has re-emerged as a major global public health threat. Orally administered attenuated or inactivated vaccines offer protection against enteric pathogens such as Vibrio cholerae, and several World Health Organization-prequalified oral cholera vaccines are used globally as part of international cholera prevention and control measures. However, vaccine effectiveness, particularly in young children in low- and middle-income countries, is often lower than in adults, leaving this vulnerable age group at greater risk of cholera. The heat-labile toxin (LT) of enterotoxigenic Escherichia coli (ETEC) has strong mucosal adjuvant properties, and in detoxified form (double-mutant LT), it has been shown to safely improve immune responses to protein and somatic lipopolysaccharide antigens in children in Bangladesh who received the oral inactivated whole-cell enterotoxigenic ETEC vaccine ETVAX. Subsequent field trials of ETVAX in children in Zambia and The Gambia have also further demonstrated safety and immunogenicity in this difficult-to-immunize age group. Current concerns about reduced effectiveness of oral cholera vaccines in children led us to re-examine data from an earlier unpublished study conducted to discern for the first time, the adjuvant effects of LT on an orally administered vaccine in humans. The study showed that native LT improved immune responses to a cholera vaccine in adult volunteers. More recent work with double-mutant LT administered with the ETEC whole-cell vaccine ETVAX supports the findings reported here with the oral cholera vaccine Dukoral. These data suggest that modern attenuated versions of native LT, such as double-mutant LT, should be evaluated for improving immune responses to cholera vaccines.
Provision of equal access to medical services for all citizens is a challenge for the public healthcare systems of many European countries. In many of them, rural areas and other peripheral regions are gradually turning into so-called 'medical deserts', whose inhabitants' access to healthcare is obstructed, which, in turn, leads to deterioration of the quality of life and worse healthcare characteristics of the population. This problem, also experienced in Poland, is not only caused by the shortage of doctors but also by the suboptimal dislocation of the medical workforce. Currently, it is also believed that the emergence of medical deserts can be triggered by factors connected both with the demand and supply of healthcare. The aim of the study is determine the preferences of medicine students towards planned specialization and workplace (understood both as a type of institution and a geographical location) as well as to isolate the determinants of choice of the medical profession, in order to explore how these factors may indirectly contribute to the development and persistence of medical desertsMethods: A computer-assisted web interviewing questionnaire study was conducted anonymously with students in their first, third and sixth year of medicine at the Medical University of Warsaw. The research was of a pilot and exploratory nature. Students took part in the research conducted online via the Lime Survey Professional online survey service in January and February 2024. The authored research questionnaire comprised 18 questions concerning motivations for the choice of the medical profession, preferred specialization and workplace. The questionnaire was completed by 434 participants. Motivations for the selection of the medical profession of young people can be divided into those related to the profession and those connected with private life, expected salaries or time management. For some respondents, the most significant incentive was the prospect of work in the area of science (research motivations); for others it was the chance to help others (altruistic motivations). The most important factors influencing career plans were job stability (mean score: 4.5/5), the desire to have a socially meaningful profession (4.3/5), and opportunities for professional self-development (4.2/5). By identifying factors shaping future physicians' career plans, the study contributes to a better understanding of workforce-related mechanisms underlying the development of medical deserts in Poland. These findings may inform future workforce planning and educational strategies aimed at improving the distribution of medical professionals, particularly in underserved areas. However, given the pilot nature of the study and its single-university design, the results should be interpreted with caution, particularly with regard to their generalizability.
There have been concerning trends in the prevalence of anxiety among young people worldwide in recent years. Research into the influence of family support and sociodemographic factors on anxiety in young people has been conducted in various countries. To investigate the influence of family support and sociodemographic factors on anxiety levels among young people in Semarang, Indonesia. This quantitative study used a cross-sectional approach and descriptive correlational design. The sample comprised 421 young people aged 16-18 years from four schools selected through proportionate stratified random sampling. Data were collected via a sociodemographic questionnaire, the 'family' subscale of the Multidimensional Scale of Perceived Social Support (MSPSS) and the Generalized Anxiety Disorder 7-item (GAD-7) scale. Statistical data analysis was conducted using Chi-squared test and Fisher's exact test. About one third of participants (34%) experienced mild anxiety and about one half (52%) received good family support. Statistical analysis showed statistically significant associations between gender and anxiety (with girls more prone to anxiety than boys) and between family support and anxiety (family support being a protective factor for young people's mental health). These results can inform the development of targeted, gender-responsive interventions, including counselling, psychoeducation and emotional support. Integrating a gender perspective and fostering positive parent involvement may enhance the prevention, early detection and management of anxiety among young people.
Elevated blood pressure (BP) is the leading cause of death globally, with the greatest burden in low-and-middle income countries. Longitudinal BP data are limited in settings of extreme poverty. We identified longitudinal BP trajectories and associated risk factors in urban Haiti. We analyzed data from 2073 adults (≥18 years) with ≥3 facility-based BP measurements between March 2019 and April 2025 in the population-based Haiti Cardiovascular Disease Cohort. Demographic, behavioral, and clinical data were collected annually. Participants received routine clinical care based on Ministry of Health guidelines. Latent class growth mixture modeling identified systolic BP trajectory groups. Enrollment characteristics associated with BP trajectory group membership were analyzed using multivariable generalized-logit models. At study enrollment, median age was 43 years (interquartile range, 30-56); 60% were female,100% identified as Black Haitian, and 69% lived on <US$1/d. Over 13 446 facility visits (median follow-up, 3.9 years), we identified 4 systolic BP trajectories based on mean enrollment BP: normal, rising (107 mm Hg, 39.2%, mean change +0.7 mm Hg/y), moderate, rising (126 mm Hg, 34.7%, +1.3 mm Hg/y), high, reduction (151 mm Hg, 19.2%, -1.6 mm Hg/y), and very high, rebound (173 mm Hg, 6.9%, -0.8 mm Hg/y). Antihypertensive medication usage and BP control among participants with hypertension increased. Older age, lower education, and obesity were associated with high, reduction, or very high, rebound BP trajectory groups. In this cohort of young, Black adults in Haiti, we identify 4 BP trajectories, describe increases in antihypertensive medication usage and improvement in BP control, demonstrating BP care is feasible in a low-resourced setting.