Work-related musculoskeletal disorders (MSD) affect over 1.7 billion people globally with a huge economic burden. Despite decades with legislations, policies and risk-reduction interventions, we see no decreases in MSD prevalence. Current prevention models focus on eliminating workplace hazards, overlooking that physical and psychosocial work factors can also promote musculoskeletal health (MSH). We were commissioned through the Danish Working Environment Agreement to develop new approaches addressing this conceptual gap. Through iterative stakeholder dialogue with Danish policymakers, social partners, and workplace practitioners, we developed and visualized the CoWork (Copenhagen work-related) MSH model to shift the focus from preventing MSD through risk reduction toward actively promoting work-related MSH. The model aims to bridge theory with workplace structure and implementation by addressing stakeholder requests for clear terminology, conceptual understanding in a workplace context, and actionable guidance. The CoWork MSH model provides a new definition of work-related MSH as "a state of physical, mental, and social well-being of the locomotor system in relation to work" as well as five integrated elements; (i) a health-oriented approach, (ii) a just-right work factor conceptualization, (iii) the Organizational, Management, Group, !ndividual (OMG!) workplace framework, (iv) an intervention guidance, and (v) health economics perspective. This approach recognizes that work factors can benefit rather than harm health when properly designed and implemented. The CoWork MSH model represents a paradigm shift, extending from risk reduction to MSH promotion, providing researchers, policymakers, and practitioners with a framework for understanding, researching, and practice to promote workplace MSH.
暂无摘要（点击查看详情）
Most employees will experience serious illness, caregiving, dying and loss (End-of-Life (EoL) experiences) at multiple points throughout their working lives. These experiences impact affected employees but also their colleagues in terms of health and wellbeing, and the workplace as a whole in terms of workplace safety, productivity and labour relations. The impact of EoL experiences on employees means that workplaces are called to play a more active role in providing support for EoL experiences. To describe how the EU-CoWork (2024-2028) project addresses its main aims to (1) create Compassionate Workplace cultures, practices and policies and improve health and wellbeing for employees dealing with EoL experiences in different national work contexts in Europe; (2) describe and evaluate the process of co-creation and implementation of Compassionate Workplace Programs (CWPs) and how these influence the programs' outcomes. EU-CoWork employs a facilitated and co-creative Developmental Evaluation approach to the development of 12 tailored CWPs across four European countries (Belgium, Austria, Sweden and Greece). To evaluate the outcomes and processes leading to these outcomes, a mixed-methods Realist Evaluation methodology is applied, formulating and testing Context-Mechanism-Outcomes configurations and combining longitudinal quantitative and qualitative data collections. EU-CoWork will generate evidence to support an expanded model of occupational health and safety risk factors sensitive to the specific challenges related to employees' EoL experiences. In doing so, several challenges will have to be navigated: involving employees with EoL experiences while avoiding overburdening them, avoiding tokenistic engagement, managing power differentials, balancing the need for scientific rigour with the flexibility required in co-creation, reconciling different epistemologies and disciplinary traditions and organisational resistance to change. There are potential long-lasting broader societal impacts through the stimulation of open discourse on EoL topics, the reconciliation of work and care, and changes in gendered work and care patterns.
Malaria remains a major public health challenge in sub-Saharan Africa. Increasing mosquito resistance to insecticides can significantly limit current vector control strategies. Spatial repellents represent a promising complementary tool by disrupting mosquito human-seeking behaviour. This trial aimed to evaluate the efficacy of IR3535 as a spatial repellent in Tambai, a high-transmission rural area in central Mozambique. This was a randomised, Before-After-Control-Intervention trial. Four Tambai blocks were randomly selected, with 40 households randomly assigned to receive IR3535 spraying and 40 assigned to as a no-repellent control group. Plasmodium falciparum malaria prevalence was estimated in children under 5 years of age using polymerase chain reaction, before, at year one and at year two. Data were first analysed using frequentist methods and subsequently using spatiotemporal Bayesian models, incorporating INLA-based models to assess the impact of repellent intervention on mosquito density and diversity, sporozoite rates, and malaria prevalence in the repellent and control groups. A total of 5716 mosquitoes were collected, 57.2% were Anopheles and 42.7% were Culex sp.. An. funestus s.l. females, were the most prevalent mosquito both indoor (92.7%) and outdoor (82.5%), followed by An. gambiae and An. tenebrosus. The total number of An. funestus s.l. females was lower in the repellent group compared with the control group [indoors: 765 vs 1,432; outdoors: 175 vs 293], as was the average number of mosquitoes collected per household [indoors: 18.6 vs 35.0; outdoors: 4.3 vs 7.1]. Spatiotemporal analysis revealed evidence of repellent-associated reduction in mosquito densities, with species-specific and indoor-outdoor differences, highlighting An. funestus s.l. dominance and spatial-temporal clustering patterns. P. falciparum prevalence among children under five declined from 72.6% (95% CI = 64.1-80.2) at baseline to 51.3% (95% CI = 43.5-59.1) at year one and 43.3% (95% CI = 35.7-51.1) at the end of the study, with similar reductions in both repellent and control groups. Sporozoite rates were slightly lower in the repellent group, particularly outdoors, however, these differences could not be directedly attributed to the repellent. Our findings indicate that the use of IR3535 as a spatial repellent reduces indoor and outdoor malaria vector densities, which may contribute to reduced malaria transmission. ClinicalTrials.gov NCT04419766.
Ferroptosis, a novel form of programmed cell death, is highly dependent on intracellular hydrogen peroxide (H2O2) and Fe2+ levels. Numerous nanomaterials have been developed to co-deliver H2O2 and Fe2+ or their prodrugs into tumor cells, aiming to enhance hydroxyl radical (•OH) level via Fenton reaction. However, the •OH generation efficacy is frequently undermined by catalase (CAT) and ferritin in cytoplasm, which can respectively catalyze H2O2 to H2O and oxidize Fe2+ to Fe3+. Herein, we designed and constructed a hollow nanofactory with dotted interior surface (HNDIS), which is composed of hollow mesoporous iron oxide nanoparticle (HMION, "house" of the nanofactory) with mesoporous channels ("window" of the nanofactory), and ultrasmall gold nanoparticles (AuNP) on the interior surface ("machine" of the nanofactory). The unique "window" allows pass for glucose to co-work with AuNP and HMION to drive H2O2 production and Fe2+ release, and then generate a huge amount of •OH. Macromolecules cannot pass through the "window", which prevents the undesirable catalysis of ferritin and CAT. In vitro and in vivo experiments have demonstrated potent •OH production ability and powerful tumor suppression efficacy based on ferroptosis for HNDIS, offering a promising pathway to combat drug-resistant large tumors.
Malaria remains a public health threat globally, mainly in African countries. Despite the progress made over the years, its control and elimination by 2030 appear to be a challenge. The community perspective on factors contributing to malaria burden is essential to develop preventive measures adapted to local contexts. Understanding the transmission rates, symptoms, prevention and treatment of malaria are essential for a population to effectively control the disease. This study assessed the knowledge, attitude, and practice (KAP) of Tambai residents to identify the possible gaps related to high malaria burden in a study implementation area. This was a cross-sectional study design with a qualitative approach held in Sofala province, Nhamatanda district, Tambai community. This KAP study was carried out before the intervention in May 2021 and after in June 2022. All heads of households from the study implementation area were surveyed using a semi-structured questionnaire. Data were processed in Microsoft excel, exported and analysed in Statistical Packages for the Social Sciences (SPSS) version 29.0. The knowledge of the heads of households on symptoms, mode of transmission, prevention and treatment of malaria was high before and after the intervention (149; 96.8%) and (143; 91.1%), respectively. Heads of households show no differences on KAP regarding symptoms, mode of transmission, prevention and treatment of malaria when intervention and control or before and after intervention were compared. Both intervention and control groups showed high KAP before and after intervention, suggesting that the implementation of the REPELMALARIA project did not have an either positive nor negative impact on KAP scores. These findings suggests that the higher malaria cases in the study area are not related to the malaria knowledge, attitude and practice of householders. This results are from the main clinical trial registed in ClinicalTrials.gov ID: NCT04419766.
Wireless Sensor Networks (WSNs) face significant challenges, such as security threats, and susceptibility to various internal and external attacks, impacting data integrity and network reliability. Trust-aware machine learning (ML) based security frameworks are vital solutions to overcome these challenges by improving security, decision-making, accuracy, and attack detection. These models utilizes ML to actively monitor trust levels, enhancing accuracy of malicious behavior detection and strengthening network security and integrity. In this context, we propose a Secure Machine-learning-based Adaptive Reliable Trust (SMART) model, suitable for unattended autonomous WSN environment. The proposed SMART model provides enhanced security and accuracy through fast and trustworthy dynamic generation of trust values. The proposed SMART model uses a novel ML algorithm that derives multiple trust features such as Co-Location Relationship (CLR), Co-Work Relationship (CWR), and Cooperativeness-Frequency-Duration (CFD). These features together give rise to an proactive trust score for sensor nodes, enabling predictions of likely misbehavior and allows for informed decisions regarding the reliability of individual sensor devices. Furthermore, SMART framework approach utilizes both immediate (direct) trust and derived (indirect) trust, making use of logical time windows to systematically watch for honest and suspicious interactions. SMART utilizes an efficient K-means clustering algorithm to assign data points to the nearest K-centers, optimizing cluster identification. Furthermore, It utilizes Principal Component Analysis (PCA) for significant variance identification and makes use of an SVM-based method for dimension reduction and accurate decision-making with lower time and space complexity. Performance measures such as accuracy, F1-score, recall, FNR, malicious SD detection, and trust value change measure its performance. Simulation results confirm that the SMART model can identify malicious nodes with a detection rate of 96%, FNR of 0.7%, F1-Score of 0.75, and accuracy of 96% even when there are 50 malicious nodes. This confirms the ability of the SMART model to enhance the trustworthiness and security of WSNs considerably.
Obstruction differential diagnosis involves tumors, "acute abdomen", and chronic pseudo-obstruction (CIPO). Pediatric CIPO cases have different backgrounds than adults' and impairs development. The cases are rare; diagnosis and treatment are still not well established. Diagnosis is complex; clinical, radiological, molecular, and manometric pathologic data are essential. The performance of broad radiological investigations and manometry is cumbersome in a small intestine. Herein, we present cases of a 14-year-old girl and 11-year-old boy with visceral myopathies (VMs). Presented cases show unique hardship in the analysis of standing and contrast bedside X-ray images-the colon distension alone speaks to Hirschsprung, and the clinicians could not confirm suspected short-segment disease for a long time. VMs are usually diagnosed up to 12 months of life and accompanied by other organ dysfunctions, which are herein absent. The key features here were also the involvement of the small intestine, lack of distant colon contraction, and for the long-lasting case in the boy, loss of haustration. The initial diagnosis relied on clinical data (vomiting, malabsorption, >6-month obstruction, and uncharacteristic biochemical tests), radiology (lack of tumor, enlargement of diameter, and fluid in small and large intestines), and manometry (presence of propagation wave and of anal inhibitory reflex in recto-anal manometry). Examination of intestinal muscle biopsies involved hematoxylin-eosin, trichrome-Masson staining, and immunohistochemistry. The characteristics were fibrosis, small vacuoles, muscle layer thinning, and decreased expression of smooth muscle actin and desmin. The localization of biopsies was chosen after X-ray examination, due to interruption and with various degree changes. The final diagnosis was put forward after the analysis of all accessible data. The diagnosis of VM underlines the importance of interdisciplinary co-work. An earlier intestine muscle biopsy and well-designed molecular panel might fasten the process of diagnosis. Deeper exploration of phenotype-genotype correlation of various VM presentations in the future is crucial for personalized treatment.
Clinical practice generates a wealth of data daily, collected for the purpose of providing healthcare. However, this data holds the potential to contribute to the generation of knowledge. The aim of this study was to describe the process of submitting requests for access to clinical records for research and the heterogeneity in the evaluation of a national research project by the boards of directors and ethics committees of hospitals, hospital centers, and local health units within the Portuguese national health service. The procedures and waiting times are described. The results of this study highlight considerable variability in the process of submitting requests for access to clinical data and the evaluation of research protocols. They also reveal lengthy waiting times for obtaining authorizations. This study underscores the urgent need to continue the discussion on the ethical and legal issues involved in studies requiring access to clinical records or other health data. A prática clínica gera diariamente um manancial de dados, recolhidos com o fim de prestar cuidados de saúde. No entanto, estes dados encerram em si um potencial de contributo na geração de conhecimento. Este estudo visou descrever o processo de submissão de pedidos de acesso a registos clínicos para investigação e a heterogeneidade na avaliação de um projeto de investigação de âmbito nacional, pelos conselhos de administração e as comissões de ética dos hospitais, centros hospitalares e unidades locais de saúde do Serviço Nacional de Saúde. São descritos os procedimentos e os tempos de espera. Os resultados deste estudo evidenciam uma considerável variabilidade no processo de submissão de pedidos de acesso a dados clínicos e avaliação de protocolos de investigação. Evidenciam igualmente longos tempos de espera até à obtenção de autorizações. Este estudo revela a necessidade urgente de continuar a discussão sobre as questões éticas e legais que os estudos que necessitam de acesso a registos clínicos, ou outros dados de saúde, envolvem.
Information and communication technologies are crucial for social and professional integration, but access to technology can be difficult for people with physical impairments. Text entry can be slow and tiring. We developed a free and open-source module called Predict4All for use with AAC (augmentative/alternative communication) software in French language. It offers spelling error-tolerant word prediction. We aimed to evaluate the feasibility of using the system in people with learning or physical impairments and to perform a preliminary evaluation of its efficacy on spelling correctness and text input speed. We conducted a prospective interventional, two-center feasibility study between February 2020 and March 2022. We included people with learning difficulties or neurological diseases impacting verbal or written communication. We evaluated fatigue, cognitive load and satisfaction, spelling correctness and text input speed and technical issues. We used 3 experimental setups: WITHOUT (neither prediction nor correction), PRED (prediction without correction), PREDCORR (prediction with correction). Twelve participants completed the study. Fatigue (all conditions), cognitive load, satisfaction (PRED and PREDCORR) did not differ between Day 0, Day 30 and Day 120, for either center. No technical issues were reported. The percentage of errors decreased significantly between Day 30 and Day 120 with word prediction software (p = 0.026), with no difference between PRED and PREDCORR (p < 0.447). Our study has shed light on the potential of the Predict4All engine with successful results, as the system performed effectively without technical or methodological obstacles. Furthermore, the engine has been adopted in clinical practice at both centers by both healthcare professionals and users. Predict4All is a free and open-source module developped for use with AAC (augmentative/alternative communication) software.Predict4All provides real writing assistance for people with learning or physical impairments on spelling correctness and text input speed.Predict4All has been adopted in clinical practice at both centers by both healthcare professionals and users.
Nature-based solutions (NBSs) offer environmentally rational, socially acceptable, and economically viable alternatives for solving diverse water issues. Therefore, the involvement of local communities is crucial, as their participation in developing shared knowledgewithin their territories is essential for building and sustaining resilient ecosystems. This study highlights a co-created, nature-based initiative that led to the construction of a vegetated vermifilter for greywater reuse and monitoring in a small community at the Nonguén School Community, located in the Biobío region, central Chile. The project was initiated in 2019, but not completed until 2022 due to the COVID-19 pandemic. The vermifilter was based on green filters and was used to recover white greywater (dishwater and handwash water) for irrigation use. The circular biofilter, built by the community and directly connected to the kitchen, consisted of four distinct layers: rock, sand, topsoil, and sawdust. It also included populations of earthworms and wetland plants, all primarily collected by the community. Water analysis (i.e., pH, temperature, BOD5, TSS, nitrate, phosphate, turbidity, dissolved oxygen, and total and fecal coliforms) demonstrated a moderate effectiveness during a measured period in 2022. We highlight and discuss the fundamental role of the participation of the local community in the whole co-work process and key lessons and barriers to further optimize a vermifilter design.
In this paper, we present an approach to cluster interaction forms in industrial human-robot co-work using spatiotemporal graph convolutional networks (STGCNs). Humans will increasingly work with robots in the future, whereas previously, humans worked side by side, hand in hand, or alone. The growing frequency of robotic and human-robot co-working applications and the requirement to increase flexibility affect the variety and variability of interactions between humans and robots, which can be observed at production workplaces. In this paper, we investigate the variety and variability of human-robot interactions in industrial co-work scenarios where full automation is impractical. To address the challenges of interaction modeling and clustering, we present an approach that utilizes STGCNs for interaction clustering. Data were collected from 12 realistic human-robot co-work scenarios using a high-accuracy tracking system. The approach identified 10 distinct interaction forms, revealing more granular interaction patterns than established taxonomies. These results support continuous, data-driven analysis of human-robot behavior and contribute to the development of more flexible, human-centered systems that are aligned with Industry 5.0.
Exoskeletons are wearable structures that support and assist movement, or augment the capabilities of the human body. These functionalities could theoretically assist bystanders or rescuers performing manual chest compressions during out-of-hospital cardiac arrest, as this emergency procedure is prone to physical exhaustion. Compressions are an intense muscular effort involving a dynamic muscular pattern with conflicting postural constraints. Rescuer fatigue sets in rapidly, leading to postural instability and a lack of mechanical power delivered by the arms to the patient's torso, which affects hemodynamic efficiency. Physical augmentation and postural stabilization are two functions that could be provided by an exoskeleton during cardiopulmonary resuscitation. This device would combine the advantages of manual and mechanical chest compressions, bypassing anthropometric parameters such as the rescuer's aerobic capacity and muscle mass to maintain efficient chest compressions, and avoiding the negative issues associated with over-assistance through a servomotor function. This concept paper examines the specifications of an ideal theoretical device in this context, noting the potential technical difficulties and barriers to implementation.
G-quadruplex (G4)/hemin DNAzymes with conversion of substrates into colorimetric readouts are well recognized as convenient biocatalysis tools in sensor development. However, the previously developed colorimetric G4/hemin DNAzymes are diffusive substrate-based DNAzymes (DSBDs). The current colorimetric DSBDs have several drawbacks including high dosage (∼mM) of diffusive substrates (DSs), colorimetric product toxicity, and single colorimetric readout without tolerance to fluctuation of experimental factors and background. In addition, the usage of high-dosage DSs can smear the G4 foldings and their discard is more harmful to environment. Therefore, exploring alternative DNAzymes with potential to overcome these drawbacks of DSBDs is urgently needed. We herein developed associative substrate-based DNAzymes (ASBDs). Cyanine dyes were selected as associative substrates (ASs) due to their binding competency with G4/hemin DNAzymes. With respect to DSBDs, ASBDs needed only low dosage (∼10 μM) of ASs to be able to cause a rapid and visible substrate conversion. In addition, since cyanine dyes are NIR dyes with high extinction coefficients and their conversion products have absorption bands at shorter wavelength. Therefore, a colorimetric ratio response can be developed to follow activities of G4/hemin DNAzymes with competency to tolerate fluctuation of experimental factors and background. In particular, herein developed ASBDs can endure somewhat concentration fluctuation of H2O2. ASBDs are able to cowork with other enzymes (for example, glucose oxidase) to realize cascade sensing. The developed ASBDs can operate at low dosage of substrates with a colorimetric ratio response and can overcome the drawbacks met in DSBDs. We expect that, by designing ASs with fruitful color panel in the future, our work will inspire more interesting in developing environment-benign and low-carbon G4/hemin DNAzymes and desired colorful high-performance sensors.
Herein, the texture properties, polyphenol contents, and in vitro protein digestion characteristics of soymilk single- or co-fermented by non-typical milk fermenter Bacillus natto (B. natto), Propionibacterium freudenreichii subsp. shermanii (P. shermanii), and traditional milk fermenter were evaluated. Co-fermenting procedure containing B. natto or P. shermanii could raise the amounts of gallic acid, caffeic acid, and GABA when compared to the unfermented soymilk. Co-fermented soymilk has higher in vitro protein digestibility and nutritional protein quality. Through peptidomic analysis, the co-work of P. shermanii and Lactobacillus plantarum (L. plantarum) may release the highest relative percentage of bioactive peptides, while the intervention of B. natto and Streptococcus thermophilus (S. thermophilus) resulted in more differentiated peptides. The multi-functional bioactive peptides were mainly released from glycine-rich protein, β-conglycinin alpha subunit 1, and ACB domain-containing protein. These findings indicated the potential usage of B. natto/S. thermophilus or P. shermanii/L. plantarum in bio-enhanced soymilk fermentation.
The epidemiology and characteristics of SARS-CoV-2 in the hospitalized Mozambican pediatric population are scarce. We aimed to assess the burden of COVID-19 in the pediatric population at Hospital Central de Maputo and identify comorbidities and factors associated with death among hospitalized COVID-19 cases. A cross-sectional study was conducted from October 2020 to October 2022. Available records were retrieved from admission books. Univariate and bivariate analyses were reported to describe the sample characteristics. The frequency of pediatric cases admitted with COVID-19 was 0.6% (95% confidence interval (CI): 0.5-0.6; 364/63,753), and the frequency of pediatric cases hospitalized with COVID-19 was 2.5% (95% CI: 2.2-2.9; 173/6807). The monthly frequency of pediatric cases admitted and hospitalized with COVID-19 ranged from 0.1% to 5.4% and from 0.2% to 42.1%, respectively. In children hospitalized with COVID-19, underweight was the most observed comorbidity (17.4%; 19/109); death was observed in 30% (95% CI: 22.2-39.1; 33/110), and it was significantly higher in underweight children than in non-underweight children (61.5% [8/13] vs. 21.3% [16/75]; p-value = 0.005). Given the heightened risk of mortality among undernourished children compared to non-undernourished children, vaccination for COVID-19 should be prioritized for undernourished children.
This article summarizes the clinical experience in treatment of refractory tinnitus with He's santong therapy of acupuncture (three techniques of acupuncture to remove the blockage and promote circulation). Refractory tinnitus is characterized by a mixture of deficiency and excess, which is implicated in the dysfunction of zangfu organs, resulting in physical and mental injuries. In association with the complicated conditions of the diseases and etiology, He's santong therapy of acupuncture is adopted. The needling with filiform needles acts directly on the affected site to regulate the mind and improve the hearing, the fire needling works on removing the refractory illness and blockage through heating up, and bloodletting on activating blood circulation and promoting qi flowing to eliminate the pathogens. The three techniques of acupuncture co-work on harmonizing the mind, promoting the circulations in the ear to stop tinnitus. 总结贺氏三通法治疗难治性耳鸣的临证经验。临床上难治性耳鸣多为虚实夹杂之象，总属脏腑功能相失，以致形神俱伤所致。结合其病情反复、病因复杂的临床特点，采用贺氏三通法治疗，借毫针之精妙直达病所，调神宁耳；凭火针温通之力消除痼垒，以愈沉疴；加以放血疗法活血行气，引邪外出，“去宛陈莝”。三法结合，共奏调神定志、通耳止鸣之效。.
Selecting individuals who are the right "fit" for correctional work is not an easy task for prison administrators because of the dangerous nature of correctional work and the centrality of prison employees in the prisoner's rehabilitation process. We analyze fitness for correctional work from the employee's perspective, complementing the scholarship focused on the employer's view. We measure occupational fitness in terms of co-worker expectations, analyzing 104 semi-structured interviews conducted with Federal Canadian Correctional Officer recruits in 2018/2019. Recruits in our sample expected a correctional officer to be accountable, reliable, and confident. Understanding the mind-set of new hires provides insights into the correctional officer role and allows employers to align employer-employee expectations, as well as review training and recruitment, which can improve the employee well-being and reduce turnover rates.
To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS). Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only 2 randomized prospective studies with some limitations to date. A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing syndrome but with serum cortisol >50 nmol/L after a 1 mg overnight dexamethasone suppression test into an adrenalectomy group (n = 66) or control group (n = 66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP). Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3-66), the adrenalectomy group (n = 46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared with the control group (n = 46; 6.5%, P = 0.002; 15.2%, P = 0.002; and 23.9%, P = 0.029, respectively) after matching for age and sex. Adrenalectomy [odds ratio (OR) = 10.38, 95% CI = 2.09-51.52, P = 0.004], body mass index (OR = 1.39, 95% CI = 1.08-1.79, P = 0.010), and cortisol after a 1 mg overnight dexamethasone suppression test levels (OR = 92.21, 95% CI = 5.30-1604.07, P = 0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR = 5.30, 95% CI = 1.63-17.25, P = 0.006) and diabetes (OR = 8.05, 95% CI = 2.34-27.65, P = 0.001) were independently associated with improved glucose control. Adrenalectomy (OR = 2.27, 95% CI = 0.87-5.94, P = 0.095) and hypertension (OR = 10.77, 95% CI = 3.65-31.81, P < 0.001) demonstrated associations with improved BP control. adrenalectomy improved weight, glucose, and BP control in patients with MACS.
Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.