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Engaging couples during pregnancy can improve HIV prevention and family health. We examined the effectiveness of two couples-focused interventions on uptake of couples HIV testing and counselling (CHTC) and maternal and child health outcomes. In this multicentre, couples-based, randomised controlled trial, HIV status-concordant and HIV status-discordant pregnant couples (aged ≥15 years) from 24 antenatal clinics across Migori and Kisumu counties in Kenya were randomly assigned (1:1:1) to one of three study groups: lay counsellors delivered five couple home visits on health and relationship skills and offered CHTC at home (home visit group); HIV self-test kits were given to women to use with their partners (HIV self-test group); standard care access with routine perinatal health services offered at their health facility, including offers of individual and couples HIV testing (standard care group). Couples were followed up to 18 months postpartum. The primary outcome was both couple members reporting CHTC uptake by 12 months postpartum. For analyses, we used generalised linear and generalised estimating equation models. This trial is registered at ClinicalTrials.gov, NCT03547739, and is complete. Between March 20, 2019, and July 26, 2022, we recruited and randomly assigned 800 couples to the home visit group (n=267), HIV self-test group (n=266), or standard care group (n=267). Two-thirds (n=533 [66·7%]) of couples included a woman living with HIV. CHTC uptake was higher in the home visit group and HIV self-test group, with 114 (56·2%; adjusted risk ratio 4·22 [95% CI 2·88-6·18]) and 106 (50·0%; 3·69 [2·50-5·45]) couples reporting CHTC by 12 months, compared with 26 (13·6%) in the standard care group. We reported 54 severe adverse events (adverse pregnancy outcomes, none related to study procedures) and 37 adverse events (two possibly related to study procedures). Both home visits and HIV self-test kits offer a gateway for positive health outcomes for perinatal women and families. Home visits, which directly engage both members of the couple, can provide additional advantages for HIV-related health. National Institute of Mental Health. For the Kiswahili translation of the abstract see Supplementary Materials section.

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Maternal, newborn, and child health (MNCH) remain a major public health challenge in Sub-Saharan Africa (SSA), where preventable mortality persists despite global commitments to reduce deaths. Weak leadership and management within primary health care (PHC) systems contribute to inefficiencies, inequities in access, and suboptimal quality and continuity of care. This systematic review examined how leadership and management practices influence MNCH outcomes in SSA. The systematic review followed PRISMA 2020 guidelines and was conceptually informed by the WHO Health System Building Blocks framework and governance-oriented leadership concepts. Searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, CINAHL, Embase, Google Scholar, and the WHO African Index Medicus (AIM) for peer-reviewed studies published between 1978 and July 2025. The protocol was registered in PROSPERO (CRD42024514304). Not applicable. Studies were eligible if they examined leadership or management practices in PHC settings and reported MNCH outcomes. Thirteen studies from seven countries and one multi-country analysis met the inclusion criteria. Leadership approaches clustered around three domains: leadership capacity building and supportive supervision, participatory and accountable governance, and community engagement mechanisms. These approaches were consistently associated with measurable improvements in service coverage and quality. Reported gains included increases in antenatal care utilization (+ 12% to + 48%), skilled birth attendance (+ 10% to + 34%), and immunization completion rate (+ 8% to + 27%). Management practices including mentorship, routine monitoring, and data-driven decision-making strengthened provider performance, coordination, and service delivery efficiency. Leadership and management are critical system-level drivers of PHC performance and MNCH outcomes in SSA. Strengthening leadership and management capacity within PHC systems represents a high-impact strategy for improving service delivery and accelerating progress toward MNCH targets in SSA.

Cell-derived extracellular vesicles (EVs) attract growing interest as biologically active, acellular platforms for therapeutic and diagnostic use in regenerative medicine, immunomodulation, and drug delivery. While EV-based products advance into clinical development worldwide, their acellular nature maps non-uniformly onto pre-existing categories. In the European Union, the 2025 European Medicines Agency/Committee for Advanced Therapies (EMA/CAT) guideline clarifies that "not substantially modified extracellular vesicles" fall outside the current advanced therapy medicinal products (ATMPs) definition, requiring case-by-case development within other medicinal-product frameworks. Conversely, the United States Food and Drug Administration (FDA) regulates exosome/EV products for disease treatment as drugs and biological products subject to premarket requirements, while other regions apply existing drug and regenerative-medicine-related instruments using jurisdiction-specific classification criteria. This heterogeneity creates challenges for regulatory positioning, quality assessment, comparability, and cross-regional clinical development. We critically examine the evolving landscape of EV-based therapeutics, focusing on regulatory, technical, safety, and ethical considerations from a global perspective. We argue EV-based products should be developed within existing medicinal product frameworks (e.g., biologics, ATMP-related instruments), provided regulatory tools are applied consistently, and operational grey zones (e.g., classification criteria, critical quality attributes (CQAs), potency strategies, and comparability) are identified for clarification. Without proposing normative frameworks, this work provides a state-of-the-art synthesis intended to support ongoing regulatory dialogue across regions. The discussion is relevant for international agencies such as the EMA, FDA, the Pharmaceuticals and Medical Devices Agency (PMDA) of Japan, the World Health Organization (WHO), and the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), as well as for scientific societies such as the International Society for Extracellular Vesicles (ISEV) promoting methodological convergence. By aligning scientific insight with regulatory awareness, this review supports advancing EV-based therapies toward safe, reproducible, and internationally credible clinical use.

Antimicrobial stewardship efforts in low- and middle-income countries (LMICs) largely focus on qualified practitioners, yet informal healthcare providers (IPs) deliver much of the primary care. Although these providers frequently dispense antibiotics, their practices remain poorly documented and are not captured in existing surveillance systems. Using the Joanna Briggs Institute methodology, this scoping review synthesised evidence on antibiotic dispensing and its determinants among IPs in LMICs. Nine databases (MEDLINE, EMBASE, SCOPUS, Global Health, CINAHL, Web of Science, LILACS, African Journals Online via Africa-Wide Information and Index Medicus for the South-East Asia Region) were searched, yielding 12 095 records, of which 37 studies met the inclusion criteria. Across 31 studies reporting dispensing practices, antibiotic use by IPs varied widely: 18%-74% in studies using standardised methods, 5%-96% in provider-reported studies and 2%-86% in consumer-reported studies. Eight qualitative studies identified key behavioural and contextual determinants shaping dispensing, including limited knowledge, experience-based learning, patient expectations, peer and pharmaceutical influence, perceived consequences of withholding antibiotics and economic incentives. Antibiotic dispensing by IPs is widespread and represents a large but unmeasured component of antibiotic use in LMICs. These findings highlight a critical gap in antimicrobial resistance surveillance and highlight the need for stewardship strategies that effectively engage this provider group.

Despite advances in interoperability, patient-supplied medical histories commonly use paper-based forms. Dissatisfaction with this inefficiency has led to the "Kill the Clipboard" initiative from the Centers for Medicare & Medicaid Services to advance digital alternatives. During the COVID-19 pandemic, patient-controlled vaccination record sharing demonstrated that Quick Response (QR) codes and digital data standards provide an effective option. Building on this, several nations are using three standards to securely view and exchange medical data: Fast Healthcare Interoperability Resources, the International Patient Summary, and SMART Health Links. This case report explores the use of QR codes and medical data standards in patient-mediated workflows to share medical histories, describing implementation experiences from four such implementations. We describe standards and developer community experience with global initiatives and implementations across the United States, Canada and the Hajj pilgrimage, which all support the use of QR codes in patient-mediated data exchange. We report on technical readiness, patient adoption and reported improvements to emergency preparedness using QR codes to share patient summaries. Advancing patient-mediated exchange with these technologies aligns with initiatives to "Kill the Clipboard." Preliminary evidence suggests this novel approach can better inform care. These four case studies demonstrate the viability of this approach and lessons learned from this digital transition.

Informed consent (IC) is central to patient autonomy, yet its role in artificial intelligence (AI) for clinical deployment, model development, and secondary data use remains unclear in medicine and dentistry. This review characterised how IC is justified and operationalised for AI; synthesised ethical, legal, governance, and practical requirements; identified gaps in consent models, stakeholders, and AI functionality; and developed author-derived communication thresholds for notification, routine clinical consent with explicit AI disclosure, or AI-specific IC. We conducted a PRISMA-ScR-guided scoping review with an OSF-registered protocol. MEDLINE, Scopus, IEEE Xplore, arXiv, Google Scholar, Web of Science, and HeinOnline were searched for English-language sources published 2015 to 25 May 2026. From 6,242 records, 116 reports were assessed; 69 were included, plus one manual source, yielding 70. Data were charted across 24 domains, synthesised, and appraised with JBI tools. Publications peaked in 2024 (22/70, 31.4%). The evidence base was non-empirical: conceptual analyses (37/70, 52.9%) and narrative reviews/book chapters (17/70, 24.3%). Medicine-only sources predominated (60/70, 85.7%); dentistry-only sources accounted for 8/70 (11.4%). Traditional IC appeared alone in 46/70 sources (65.7%) and overall in 52/70 (74.3%); dynamic consent was uncommon (6/70, 8.6%). IC was endorsed in 67/70 (95.7%) and qualified in 40/70 (57.1%). Explainability/transparency was addressed in 65/70 (92.9%), and proposed solutions in 57/70 (81.4%), but formal protocols remained uncommon (6/70, 8.6%). Thresholds consolidated rules by AI application, automation, risk, data use, and patient decision relevance. AI-related IC is widely endorsed but remains fragmented and largely conceptual. Findings support a risk-adaptive approach to AI-informed consent, calibrated to AI function, automation, risk, data use, explainability, and clinical decision impact. The author-derived thresholds offer a synthesis-informed basis for future governance guidance or framework development, pending empirical and stakeholder validation.

In remote areas where access to parenteral treatment for severe malaria or referral is limited, rectal artesunate (RAS) followed by a full course of artemisinin-based combination therapy (ACT) provided by community health workers would be a pragmatic solution. However, concerns remain that its expanded use may select for artemisinin-resistant Plasmodium falciparum strains. This baseline study assessed the presence of molecular markers of resistance to artemisinin and partner drugs and investigated factors associated with Plasmodium falciparum infection prior to RAS implementation. A community-based cross-sectional survey was conducted in remote areas of the Kapolowe health district, Democratic Republic of the Congo, in March-April 2024. Dried blood spot samples were collected from asymptomatic children aged 6-59 months. Molecular markers of antimalarial drug resistance in P. falciparum were analyzed using targeted next-generation sequencing, focusing on the Pfkelch13, Pfcoronin, Pfubp1, Pfmdr1, and Pfcrt genes. Among 1242 children screened in 906 households, 656 (53%, 95% CI: 50-55%) were P. falciparum malaria rapid diagnostic test-positive, of which 646 samples were available for analyses. Factors associated with reduced odds of asymptomatic P. falciparum infection included higher household socio-economic status and non-agricultural sources of income, whereas children from households where malaria was perceived as treatable had increased odds of infection. No validated Pfkelch13 mutations associated with artemisinin partial resistance were detected. Several non-synonymous Pfkelch13 mutations were observed more than once, including A578S (7/395, 1.8%). Two Pfubp1 mutations associated with reduced dihydroartemisinin susceptibility, D1525E (88/354, 24.9%) and E1528D (62/354, 17.5%) were observed. No resistance-associated Pfcoronin mutations were detected. The wild-type Pfcrt CVMNK haplotype predominated, while the Pfmdr1 NFSND haplotype (57/379, 15.0%) associated with reduced lumefantrine susceptibility was identified. The absence of Pfkelch13 mutations and a full reversal to wild-type Pfcrt are reassuring for directly guiding the implementation strategies of RAS and continued effectiveness of current ACTs. However, the detection of the Pfmdr1 single mutant NFSND haplotype highlights the need for continued monitoring of lumefantrine susceptibility.

In remote Australian First Nations communities, the burden of curable sexually transmitted infections (STIs) is highest for young women and men aged 16-29 years and for women is associated with two-fold higher rates of hospitalisations for pelvic inflammatory disease (PID) than for non-First Nations women. Following a randomised trial, decentralised community-led molecular point-of-care (POC) testing for STIs has operated in remote primary care across Australia for more than 7 years, improving uptake and timeliness of treatment for chlamydia, gonorrhoea and trichomonas infections. However, cost-effectiveness remains unknown. A decision analytic model was devised to compare costs and outcomes associated with a POC testing programme for chlamydia, gonorrhoea and trichomonas infections in women and men aged 16-29 years seeking care, compared with standard care (laboratory-based testing). The analysis used a government payer perspective and 10-year time horizon. The primary outcome was the cost ($A) per quality-adjusted life year (QALY) gained. Sensitivity analyses examined uncertainty around the results. Based on a combined testing positivity rate of 36% and 29% for chlamydia, gonorrhoea and trichomonas for women and men, respectively, the POC testing programme, compared with laboratory testing, produced an estimated incremental cost per QALY ratio (ICER) of $A19 714 (95% CIs $A19 608 to $A19 821) over 10 years. Among those with an STI, the POC testing programme was predicted to reduce diagnosed PID by 30% and preterm/low birth weight babies by 17%. Sensitivity analyses indicated that the ICER was most sensitive to the probability of infection and receiving treatment within 2 days, based on a willingness-to-pay threshold of $A50 000. This health economic evaluation indicates that a scaled molecular POC testing programme for the management of STIs in remote primary care settings is cost-effective compared with standard care. Sustained POC testing in this setting is likely to improve reproductive health outcomes.

Subspecialty recognition and certification in Pediatric Nephrology remain heterogeneous across Europe and globally, resulting in variations in training standards and professional mobility. To address this gap, the European Society for Paediatric Nephrology (ESPN) launched the European Board Certification in 2020 as a pan-European and curriculum-based assessment of knowledge and clinical reasoning in Pediatric Nephrology. We performed a descriptive and analytical evaluation of candidates who applied for the ESPN Board Certification in Pediatric Nephrology between 2020 and 2025. Candidate characteristics, examination performance, and factors associated with success were analyzed. The exam consisted of 100 case-based multiple-choice questions developed according to a predefined blueprint. Multivariable logistic regression was used to identify factors independently associated with passing. Additionally, a cross-sectional survey assessed candidates' perceptions of the examination and its professional impact. A total of 349 pediatric nephrologists from 52 countries and four continents completed the examination. Median age was 38.2&#xa0;years (IQR 34.7-43.5), and 59.9% were female. The overall pass rate was 54.7%, with significant variation by continent (p&#x2009;=&#x2009;0.014). Attendance at the International Pediatric Nephrology Association (IPNA)-ESPN Junior Master Class was associated with higher odds of success (OR 3.76, 95% CI 1.65-5.87, p&#x2009;<&#x2009;0.001), whereas increasing age was associated with lower odds of success (OR 0.66 per additional year, 95% CI 0.55-0.78, p&#x2009;=&#x2009;0.002). Among 74 survey respondents, perceptions regarding the examination were highly positive: 93.2% considered the content clinically relevant, 89.2% reported increased self-confidence, and 75.6% perceived a positive professional impact. Since its launch, the ESPN Board Examination has emerged as an internationally acknowledged benchmark of key knowledge and clinical reasoning in Pediatric Nephrology. Structured preparatory education enhances examination success, and certification is widely perceived as professionally meaningful. The examination plays a vital role in standardizing subspecialty criteria and reinforcing the professional identity within Pediatric Nephrology.

Interprofessional service-learning (IPSL) combines community-based experiential learning with interprofessional education (IPE), fostering collaborative competencies and civic responsibility among students. Despite growing interest, the integration of service-learning and IPE in undergraduate dental curricula remains underexplored. This scoping review was conducted using the Arksey and O'Malley framework and refined by Levac et al., adhering to the PRISMA-ScR guidelines. Several electronic databases (PubMed, Scopus, Web of Science, EBSCO, and EMBASE) were searched from 1960 to March 2025 using a combination of controlled vocabulary and free-text terms. Manual searching of reference lists and grey literature through Google Scholar and institutional repositories supplemented the database searches. Screening and data extraction were conducted by two independent reviewers based on pre-defined inclusion and exclusion criteria. Thematic synthesis was used to analyse and categorise the findings qualitatively. From 1422 records, 11 eligible studies published between 2015 and 2023 were included. Most studies were conducted in the United States, with one from Canada. IPSL interventions occurred in diverse settings, including refugee shelters, rural clinics, prisons, and global health contexts. Dental students engaged with disciplines such as medicine, nursing, pharmacy, public health, social work, law and others. Key themes included 'Implementation Contexts and Interprofessional Partnerships', 'Oral Health Promotion and Prevention', 'Oral Health Literacy Outcomes', 'Reflective Learning', and 'Student Perceptions and Attitudes'. IPSL is an impactful educational strategy for dental students, promoting both clinical and interprofessional development. Future programmes should include structured preparatory training and longitudinal assessment to sustain learning outcomes and enhance the reach of IPSL globally.

The misuse of benzodiazepines (BZDs) and Z-drugs poses significant global public health challenges. This study maps the scientific evolution and paradigm shifts in this field from 2010 to 2025.&#xa0;A bibliometric analysis of 6,311 publications from the Web of Science Core Collection was performed using VOSviewer and CiteSpace to identify collaboration networks, research hotspots, and emerging frontiers.&#xa0;The USA and Harvard Medical School dominated global contributions. Research hotspots evolved through three distinct phases:&#xa0;(1) 2010-2014&#xa0;focused on GABAA receptor subtype-specific pharmacology, specifically the role of the alpha1 subunit in midbrain disinhibition and the biological basis of addiction;&#xa0;(2) 2015-2019&#xa0;shifted toward the pharmacodynamic synergy of BZD-opioid interactions and the implementation of mass spectrometry-based toxicological surveillance; and&#xa0;(3) 2020-2025&#xa0;centered on integrated computational pharmacology (QSAR and docking) for designer BZDs, alongside digital governance using electronic health records (EHR) and machine learning for precision deprescribing. Burst detection reveals a trajectory shifting from retrospective mechanistic deconstruction to prospective, data-driven risk prediction.&#xa0;BZD research has undergone a paradigm shift from molecular pharmacology to multidimensional digital and computational surveillance. Future directions prioritize utilizing big data and in silico modeling for individualized risk forecasting and precision clinical intervention to address the complex landscape of designer analogs and improve public mental health governance.

The COVID-19 pandemic disrupted healthcare service utilisation, but evidence on its impact on perinatal outcomes is conflicting. We investigated the impact of the pandemic public health measures (eg, lockdowns, reduced healthcare access, altered health-seeking behaviour) on preterm birth (PTB), stillbirth, low birth weight (LBW), small for gestational age, caesarean delivery, breastfeeding initiation (BFI) and neonatal intensive care unit (NICU) admissions. Using linked administrative health databases, we conducted a population-based study of pregnancies before (January 2008-February 2020) or during (March 2020-March 2022) the pandemic; for the latter period, they were categorised by exposure duration. We conducted interrupted time series analyses using season-adjusted generalised linear models, and analyses were stratified by income. Among 222&#x2009;636 pregnancies (190&#x2009;694 prepandemic and 31&#x2009;942 during pandemic), PTB rates increased from 8% prepandemic to 9.1% during the pandemic, with a 19.0% relative increase overall (p<0.01). In stratified analyses, PTB rose by 27.1% in the lower-income group (8.8% to 10.1%, p=0.01) and by 19.7% in the higher income group (7.3% to 8.2%, p=0.02); however, effect modification by income was statistically non-significant. Pregnancies 100% exposed during the first and second year of the pandemic experienced higher rates of PTB by 15.0% (p=0.01) and 11.6% (p<0.01) compared with the prepandemic period, respectively. The pandemic measures were associated with no changes in stillbirth (0.7&#x2030; vs 0.61%; p=0.37) or NICU admission rates (8.3% vs 8.2%; p=0.69). LBW rates increased from 5.5% to 6.3% (13.9% relative increase, p=0.05). Pregnancies spanning the entire first year of the pandemic experienced higher rates of caesarean deliveries (24.6% relative increase, p<0.01). BFI rates decreased from 82.5% to 81.8% (3.9% relative decrease, p=0.01) compared with prepandemic, followed by a slight increase (p=0.02) during the pandemic period. The COVID-19 pandemic measures were associated with increased PTB and caesarean delivery rates, particularly among pregnancies fully exposed to pandemic measures. Over the 2-year pandemic period, stillbirth, NICU admissions and BFI rates were stable.

Adherence to radical cure for Plasmodium vivax remains a major challenge for malaria control programmes. Novel regimens, such as 7-day high-dose primaquine regimen and single-dose tafenoquine, may improve treatment adherence and antirelapse effectiveness but can increase the risk of haemolysis in individuals with glucose-6-phosphate dehydrogenase deficiency. Stakeholder (ie, policymakers, providers, patients, etc) perceptions of these risks may significantly influence the acceptability and uptake of these regimens. Understanding these perceptions is essential for policymakers to design effective communication and implementation strategies of novel radical cure strategies. Guided by qualitative methodology and a risk perception lens, this study explored P. vivax malaria stakeholders' experiences and interpretations of novel radical cure regimens. Between February and September 2023, 58 semistructured interviews and 6 focus group discussions were conducted at Arba Minch General Hospital and three health centres and health posts within the Gamo Zone of the South Ethiopia Regional State: Lante, Shecha and Shele. Participants included clinical trial staff and participants, health centre personnel, health extension workers and routine care patients. The 7-day-high-dose primaquine regimen and single-dose tafenoquine were viewed as promising solutions to the adherence challenges of the standard 14-day primaquine regimen; however, participants raised concerns about the effectiveness of the shortened treatment duration and the safety of the increased daily dose of primaquine. A risk perception lens revealed that concerns about effectiveness and safety were influenced by prior public health messaging emphasising completion of the full 14-day regimen alongside fears of overdosing and drug-induced haemolysis. Pill characteristics, including number, shape and colour as well as fears of overdosing and drug-induced haemolysis also contributed to apprehension about the safety of these regimens. Participants' perceptions of shortened radical cure regimens were shaped by concerns about effectiveness and safety, influenced by prior treatment messaging and pill characteristics such as higher dosing and pill burden. A risk perception lens can inform implementation and communication strategies for novel regimens, where addressing user perceptions alongside practical improvements, such as reducing pill burden, is essential for optimising uptake and adherence.

Carbapenemase-producing Enterobacterales (CPE) have been designated by the World Health Organization as critical global priority pathogens. Their widespread dissemination and nosocomial outbreaks pose a major public health threat. This study examined the transmission patterns and genetic characteristics of CPE isolated in New Caledonia between 2013 and 2022. A total of 214 CPE isolates were collected, comprising 199 non-duplicate clinical isolates from 164 patients and 15 environmental isolates from hospital surfaces. Isolates were characterized using phenotypic methods and whole-genome sequencing. Among clinical isolates, the most prevalent genera was Enterobacter (n&#x2009;=&#x2009;68; 34%) and Klebsiella (n&#x2009;=&#x2009;50; 25%), with 194 isolates (98%) harbouring IMP-type carbapenemases. WGS of 89 selected CPE revealed the predominance of the blaIMP-4 gene (n&#x2009;=&#x2009;82; 92%). This gene was primarily associated with IncM2-type plasmids carrying a class 1 integron, identified in 65 sequenced isolates. Long-read sequencing resolved these plasmids into seven distinct variants, differentiated by integron structures and a 9305-bp insertion. Genomic, phenotypic, and epidemiological triangulation have identified 12 hospital spread events, with 10 linked to IMP-4 IncM2 plasmids, whose transferability is confirmed by conjugation assays. These results highlighted the pivotal role of plasmid-mediated dissemination in CPE spread and emphasize the urgency of enhanced surveillance to curb silent transmission. The study provided critical insights for targeted infection control strategies in New Caledonia healthcare system, with broader implications for regional antimicrobial resistance containment. Certain bacteria that resist antibiotics, known as Carbapenemase-Producing Enterobacterales (CPE), are becoming more common worldwide and are harder to treat. This study examined how these bacteria spread in hospitals in New Caledonia from 2013 to 2022. Most carried a resistance gene called blaIMP-4, often found on a small piece of DNA that can move between bacteria. This means the resistance can spread easily between different types of bacteria. The researchers identified 12 hospital spread events, mainly caused by this gene moving between bacteria rather than a single strain spreading. These findings highlight the need for better monitoring and infection control to prevent the hidden spread of antibiotic resistance.

Metabolic dysfunction-associated steatotic liver disease affects more than 30% of adults globally, yet effective treatment options remain limited. Tirzepatide has shown promise in early clinical trials, but its real-world effectiveness with liver-related outcomes remains uncertain. Using TriNetX Global Collaborative Network, adults with steatotic liver disease (SLD) and cardiometabolic dysfunction were identified between June 1, 2022, and April 25, 2025. Individuals newly prescribed tirzepatide were propensity score-matched 1:1 to controls not receiving tirzepatide. The primary outcome was major adverse liver outcomes (MALO), defined as decompensated liver events, hepatocellular carcinoma, or liver transplantation. Among 54,882 matched individuals, tirzepatide was associated with a lower incidence of MALO compared to the control group (HR, 0.32; 95% CI, 0.28-0.37). Tirzepatide use was associated with reductions in composite decompensated liver events (HR, 0.31; 95% CI, 0.26-0.36), esophageal variceal bleeding (HR, 0.39; 95% CI, 0.26-0.58), hepatic encephalopathy (HR, 0.27; 95% CI, 0.21-0.34), ascites-related complications (HR, 0.28; 95% CI, 0.23-0.33), hepatocellular carcinoma (HR, 0.36; 95% CI, 0.25-0.53), and liver transplantation (HR, 0.16; 95% CI, 0.08-0.33). Additionally, tirzepatide was associated with lower risks of all-cause mortality (HR, 0.22; 95% CI, 0.18-0.28), major adverse cardiac events (HR, 0.46; 95% CI, 0.40-0.52), and major adverse kidney events (HR, 0.26; 95% CI, 0.22-0.32). In this retrospective study, tirzepatide use was associated with substantially lower risks of liver-related complications among patients with SLD and cardiometabolic dysfunction, supporting the need for prospective validation of its potential hepatic benefits. Metabolic dysfunction&#x2013;associated steatotic liver disease is becoming increasingly common worldwide and can lead to serious liver complications, cancer, and death. Tirzepatide is a medication used for diabetes and obesity, but its effects on liver-related outcomes in everyday clinical practice are still unclear. In this study, we analyzed real-world health records from more than 54,000 adults with steatotic liver disease and cardiometabolic dysfunction. We compared people who received tirzepatide with similar individuals who did not receive the medication. We found that people treated with tirzepatide had lower risks of serious liver complications, death, heart-related events, and kidney-related events. These findings suggest that tirzepatide may have broader health benefits beyond blood sugar and weight control.

A crisis of youth mental health exists, disproportionately affecting minoritized and low-income youth. Park- and community-based recreation programs may promote mental well-being by offering accessible and affordable recreation in non-stigmatizing settings, with the potential to reduce mental health disparities. However, these programs are not currently being used at scale. Youth Empowered Self-Care (YES) is a mental well-being intervention intended to increase timely access to park- and community-based recreation programs among minoritized low-income youth. We evaluated YES for feasibility, acceptability, and change in participants' psychological, mental, and social well-being and anxiety. This study was a single-arm prospective cohort pilot design. Youth aged 8-12 years were enrolled with two parks and recreation departments in Durham, North Carolina, and Miami, Florida, United States. Youth and caregivers were directed to the YES website, where they received information on mental health and resources, and park- and community-based programs. Data collected included website usage, program enrollment, and caregiver-reported youth psychological, mental, and social well-being and anxiety at baseline and at 3 months using the KIDSCREEN-27 and Screen for Child Anxiety Related Emotional Disorders (SCARED) measures to assess feasibility, acceptability, and change in psychological, mental, and social well-being and anxiety. Change from pre- to post-test scores and paired t-tests were used to determine change in mental well-being via the KIDSCREEN-27 and SCARED assessments. Participants (n&#x2009;=&#x2009;247) included youth aged 8-12 years (36.4% Black;34.4% White; 11.7% Hispanic; 50.2% male; 39.7% >$50,000-$75,000 annual household income). The YES website had&#x2009;>&#x2009;1,100 users, with &#x2265;&#x2009;51.0% of website users enrolling in YES. Almost all (99.1%) participants indicated that YES connected them to a program, and that they subsequently completed their program (99.5%). Eighty-five percent and 31.3% of caregivers reported an increase on the youth psychological well-being and peer and social support subscales, respectively. Nearly half (46.5%) of caregivers reported a reduction in youth anxiety. This study suggests that YES may promote youth mental well-being. Pilot data also demonstrated YES feasibility and acceptability, and linkage to mental health education and treatment. The next steps for this research entail randomized prospective trials to assess YES efficacy. NCT06255093 (www. gov); registration date: February 12, 2024.

Patient safety emerges where clinical risk governance intersects with ethical duties of non-maleficence, respect for autonomy, and institutional accountability. Safety culture surveys and patient-reported experience measures often evolve on separate analytic tracks, leaving uncertainty about how staff-facing metrics translate into patient-facing ethical practices such as disclosure after harm. We conducted an exploratory cross-sectional multi-informant survey in an acute-care hospital in Romania. Healthcare workers (defined as physicians, nurses, hospital auxiliary staff, and other clinical/non-clinical personnel involved in care delivery or immediate supervision; n&#x2009;=&#x2009;104) completed the AHRQ Hospital Survey on Patient Safety Culture version 2.0 and the Speaking Up About Patient Safety Questionnaire, capturing safety culture composites, speaking up behaviour, and psychological safety. Inpatients (n&#x2009;=&#x2009;101) completed a project-specific, not externally validated structured questionnaire covering perceived safety, communication and information, consent and involvement, confidentiality and complaint mechanisms, coordination and organisational reliability, observed safety practices, and experiences of incident communication. We conducted exploratory analyses including composite means, percent positive scores, internal consistency estimates, and examined ward-level associations. Staff composites peaked for teamwork (mean 3.84/5; 74.3% positive) and communication about error (3.74/5; 70.8% positive), while staffing and work pace (2.74/5; 29.3% positive), response to error (31.7% positive), and hospital management support (34.0% positive) showed marked compression. Patients rated coordination and organisation (mean 3.67/5) and consent and involvement (3.60/5) higher than communication and information (3.42/5). Eleven patients (10.9%) perceived a safety incident; among them, ratings for apology, explanation and follow-up clustered at the lower end of the scale (mean 1.73/5). Ward-level overall safety culture scores showed negligible associations with patient global safety, perceived safety and recommendation. Exploratory ward-group analyses suggested that patient-rated coordination aligned more closely with handoffs and information exchange than with global safety culture measures. Other cross-level associations were inconsistent and were interpreted cautiously because of broad clinical-area aggregation and limited between-group variation. Favourable speaking up climate correlated with overall safety culture (r&#x2009;=&#x2009;0.484, p&#x2009;<&#x2009;0.001) and management support (r&#x2009;=&#x2009;0.547, p&#x2009;<&#x2009;0.001). In this setting, patient-perceived safety aligned more closely with interface processes than with global culture scores, and incident communication surfaced as a salient ethical deficit. Strategies integrating psychological safety, management responsiveness, and structured disclosure practices warrant prospective evaluation as potential ways to advance moral accountability and risk governance. Given the cross-sectional, single-site design and modest sample size, these associations should be interpreted as exploratory and non-causal. Not applicable.

Global staples include cereal grains (maize, rice, wheat, barley, and sorghum), whose nutritional value is partly limited by antinutritional factors (phytic acid, oxalates, and protease inhibitors) that limit the absorption of minerals and nutrient bioavailability. Germination is an environmentally friendly and effective bioprocess that enhances the nutritional and functional characteristics of cereals by enzymatic, biochemical, and structural changes. It decreases antinutrients and increases bioactive compounds, such as &#x3b3;-aminobutyric acid (GABA), phenolics, flavonoids, vitamins, and bioactive peptides, and improves digestibility, nutrient bioaccessibility, and bioavailability. Germinated cereals have significant potential as functional foods with antidiabetic, antihypertensive, antioxidant, and anticancer potential associated with enriched phytochemicals. This review summarizes germination-induced compositional changes, functional properties, health-related effects, consumer acceptance, and safety considerations, highlighting germination as a promising strategy for producing nutrient-dense and functionally enhanced cereal foods that meet health, sustainability, and food security requirements.