To characterize methodological aspects and the quality reporting of economic evaluation in HTA reports of drugs submitted to the Brazilian public health system. An electronic search for HTA reports focusing on drug incorporation into the public health system published between 2020 and June 2024 was conducted in the Conitec database. The study selection and data extraction were performed to obtain bibliographic data, base case characteristics, and methodological features. Furthermore, the quality reporting of economic evaluation was verified by the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). Descriptive statistics summarize the data extracted from the documents. We included 188 economic evaluations of HTA reports about drug reimbursement; the great majority submitted to private companies or public institutions. Most economic evaluations adopted cost-utility or cost-effectiveness analysis using a comparator in the public system. Economic evaluation studies presented frequent inconsistent reports of cost and health outcomes and in the deterministic and probabilistic sensitivity analyses. Markov, decision tree, and partitioned survival model were the main mathematical models applied. Cost-effectiveness analysis mainly adopted QALY or QALY plus life-years gained as health outcomes, but there was a lack of clarity in the methods to incorporate health utilities in the cost-utility analysis. Finally, we identified that the quality reporting of economic evaluation needs to be improved. The methods and reporting quality of economic evaluations submitted to Conitec exhibit heterogeneity characteristics. Strengthening and standardizing guidance for preparing health economic evaluations is needed to ensure greater consistency, transparency, and decision-making reliability.
In forensic genetics, the allele and haplotype frequencies of relevant populations are required to determine the weight of evidence for DNA matches. In recent years, ethical concerns have been raised about population studies published in forensic journals and compiled in Forensic Genetics Frequency Databases (FGFDs), particularly regarding consent procedures for sample collection, the overrepresentation of vulnerable groups, and the risk of donor re-identification. A comprehensive review of ethical practices in forensic population genetics research on identity DNA polymorphisms and ancestry informative markers was conducted, focusing on papers published in Forensic Science International: Genetics and indexed in MEDLINE (2007-2025) and Forensic Science International: Reports (2019-2025). A decline in the number of published forensic population genetics papers was observed following the adoption of dedicated ethical guidelines in 2020. However, increased attention to ethical issues, such as the need for informed consent (IC) of sample donors and approval by pertinent ethical review boards (ERB), predates 2020, with a linear increase over time in the proportion of papers reporting IC and ERB approval. Among the included papers, 48.7% were conducted by or in collaboration with law enforcement laboratories, 39.1% involved minority populations, and 14.3% used forensic casework samples, all of which represent potential sources of ethical concern. In most studies conducted by multinational teams, researchers from the countries of the sampled populations were involved, with the notable exception of Africa, with 31.0% of studies having no African-affiliated authors. Furthermore, even after 2020, a substantial proportion of studies (11.8%) reported complete genotypes of DNA markers associated with a high risk of re-identification. The most common form of non-compliance with the 2020 ethical guidelines was the failure to report written informed consent (40.0%). Overall, the proportion of studies classified as ethically "low risk" according to the Forensic Database Advisory Board increased significantly after 2020, reaching 78.5% of the papers published in that period. Notably, during the preceding period (2010-2020), the proportion of low risk studies was significantly higher for DNA markers for which editorial guidelines required quality control by an FGFD (42.1%) than for other markers (30.3%). To support editors and peer reviewers, suggestions are proposed to improve ethical guidelines for the publication of forensic population genetics data, with particular attention to ERB approval documentation, secondary use of biological samples, and recognition of the role of researchers from the country of population samples collection in multinational studies.
Health researchers often struggle with challenges such as translating complex texts, interpreting nuanced information, conducting detailed statistical analyses, and more. Artificial Intelligence (AI) models, by providing easy access to information, offer a promising solution to these challenges. This study aims to examine university students' perspectives on the impact of AI models in overcoming these challenges. This survey study was conducted in 2023 by using a researcher-developed questionnaire. A total of 445 students from the Kerman University of Medical Sciences participated and completed the questionnaire. Descriptive statistics and linear regression were used to analyze the relationship between independent variables and the impact of AI models on health research. Open-ended responses were coded and stored in MAXQDA. Sixty percent of students reported moderate or greater familiarity with AI models, while only 52% had moderate or greater usage of these tools. Over 70% considered the associated risks high. Participants rated AI models most favorably for "Translation of an article" (Mean = 3.33, SD = 1.07), "Article rephrasing" (Mean = 3.33, SD = 1.07), and "Reference search" (Mean = 3.27, SD = 1.14), with the lowest ratings for "Article submissions" (Mean = 3.10, SD = 1.01), "Data analysis" (Mean = 3.23, SD = 1.01), and "Proposal submissions" (Mean = 3.23, SD = 0.91), respectively. The most important applications of AI models were noted in "Translation of research" (Mean = 3.44), "Grammer checking" (Mean = 3.46, SD = 1.12), and "Text editing" (Mean = 3.35, SD = 1.14), while the least were in "Correspondence with journal editors" (Mean = 2.99, SD = 1.20), "Adherence to journal guidelines" (Mean = 3.07, SD = 1.17), and "Response to the reviewers' comments" (Mean = 3.12, SD = 1.13). "Providing false information" (n = 34), "Failure to apply legal and ethical standards in research" (n = 10), and a "Loss of ability and creativity among researchers" (n = 9) were the most significant risks of using AI models in health research. AI models show promise for improving research efficiency and quality, but further efforts are necessary to mitigate perceived risks and encourage broader adoption.
Extreme heat is the most significant climate threat to public health, disproportionately impacting marginalized groups, including outdoor workers, older adults, and low-income rural populations. While the physiological consequences of heat-related illness-ranging from cardiovascular strain to acute kidney injury-are well-documented, a critical gap remains in the equitable implementation of mitigation strategies. This paper examines North Carolina as a case study due to its proactive leadership in heat-health mitigation, examining the evolution of the state's Heat Health Alert System and the NC DETECT surveillance platform. North Carolina is well-positioned to pioneer a multi-modal "push" communication strategy, leveraging the ubiquity of smartphone technology and Wireless Emergency Alerts to provide "just-in-time" guidance to high-risk outdoor workers and rural residents. Simultaneously, the state can strengthen its robust surveillance infrastructure by integrating data from non-traditional care sites, such as farmworker clinics, and standardizing occupational data collection. These advancements would transform existing systems into a comprehensive, community-informed model of resilience. By expanding communication modalities and data inclusivity, North Carolina offers a scalable framework for translating meteorological risk into actionable, equitable policy-ensuring that advancements in climate preparedness protect and empower the most vulnerable populations.
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Diabetic retinopathy is one of the most common microvascular complications of diabetes, with over 100 million people affected worldwide. The development of mobile health applications can play an effective role in managing and monitoring diabetic retinopathy. Still, the development of these applications first requires the identification of the minimum dataset. Therefore, the purpose of this study is to identify and determine the minimum dataset as the first step in designing a self-care mobile application for patients with diabetic retinopathy. This Descriptive-Validation Study was conducted in 2025 in two phases: design and validation of the MDS. In the first phase, a comprehensive review of the research literature was conducted and electronic databases such as PubMed, Web of Science, Scopus, and Google Scholar were searched until October 2024. Then, data elements were extracted and identified. In the second phase, these elements were validated by 20 experts from the fields of endocrinology, ophthalmology, and health information management using the Delphi technique. Then, in order to include patients' opinions, a researcher-made questionnaire was administered to 20 patients with diabetic retinopathy. Fifty-five MDS elements were validated in three domains: administrative, clinical, and functional data, using two rounds of the Delphi technique. Data elements with over 75% expert approval were included in the final dataset: 13 administrative, 19 clinical, and 19 functional elements. The Ministry of Health and Medical Education, app designers, and developers can utilize the findings of this study to develop a high-quality application that addresses the educational and informational needs of patients with diabetic retinopathy.
Adherence to medication is key for effective treatment, especially for chronic illnesses. Poor adherence leads to more hospital visits, worse health outcomes, and higher healthcare costs. Many tools exist to measure adherence, but they often lack cultural sensitivity or only fit specific diseases. This study aimed to create and validate a culturally relevant tool for assessing medication adherence in Bengali-speaking patients with chronic illnesses. This was a cross‑sectional scale‑validation study. We used a multi‑step approach comprising item generation, expert review, translation, pre‑testing, and psychometric validation. An initial pool of 27 items was refined to a final 9‑item Bangladesh Medication Adherence Scale (BMAS). Data from 300 patients at Bangladesh Medical University (BMU) were analyzed using IBM SPSS Statistics, version 29.0 for exploratory factor analysis and descriptive statistics, and SmartPLS 4 for confirmatory factor analysis and structural equation modeling. The 9‑item scale was then cross‑validated in an independent sample of 155 patients with hypertension from a district hospital. Exploratory factor analysis revealed a three-factor structure that explained 63.8% of the variance. Confirmatory factor analysis showed a strong model fit, with most factor loadings above 0.70. The scale had high internal consistency (Cronbach's α = 0.889) and strong composite reliability (ρC = 0.898). Convergent and discriminant validity were confirmed by the Fornell-Larcker criterion and Heterotrait-Monotrait (HTMT) analysis. Nomological validity was supported by links to health locus of control and quality of life measures. These findings indicate that the BMAS is a reliable and valid instrument for assessing medication adherence among chronically ill patients in Bangladesh. Its use in clinical practice and public health research could support better adherence monitoring and inform interventions to improve treatment outcomes.
Physical activity reduces the risk of mortality and age-related chronic diseases, yet its association with biological age measured by DNA methylation (DNAm) clocks remains unclear. This systematic review and meta-analysis aims to evaluate the association between physical activity and biological age measured by DNAm clocks. In this systematic review and meta-analysis, we conducted a systematic search of Embase, Cochrane Central Register of Controlled Trials, PubMed, Ovid, Scopus, and Web of Science from Jan 1, 2011, to June 6, 2025, to identify articles on the associations of physical activity and DNAm age, epigenetic age acceleration (EAA), or epigenetic age deviation in humans. Studies were included if they were peer-reviewed, published in English, included a study population with a mean or median age of 18 years or older, and investigated the association between DNAm clocks and physical activity in humans. Studies were excluded if the study population was a disease-specific population without controls. We evaluated risk of bias using an adapted Newcastle-Ottawa Scale and Cochrane Risk of Bias scale. We then performed a random-effects meta-analysis using reported or estimated standardised β coefficients and SEs. We also conducted a publication bias analysis and influence analysis. The study was registered with PROSPERO, CRD42024499021. We identified 34 437 articles and, after removal of duplicates and screening, 44 studies were included in the systematic review comprising 145 465 participants: 62 887 (43·2%) females and 82 578 (56·8%) males, with mean ages ranging from 24·1 years to 78·5 years. Across studies, higher levels of physical activity were generally associated with lower DNAm age, although many individual associations did not reach statistical significance. Seven cross-sectional studies contributed to the meta-analysis. Each one SD higher in metabolic equivalent of tasks-min per week was associated with 0·03 SD lower Horvath EAA (β=-0·03 [95% CI -0·05 to -0·01]) and 0·09 SD lower GrimAge EAA (-0·09 [-0·12 to -0·05]). No statistically significant association was observed for Hannum EAA or PhenoAge EAA. Higher physical activity is significantly associated with lower biological age as measured by Horvath EAA and GrimAge EAA. However, evidence is predominantly from cross-sectional studies, limiting causal inference. Future longitudinal studies and clinical trials using standardised, objectively measured physical activity are warranted to clarify dose-response relationships, and to determine whether physical activity can causally modify ageing trajectories, thereby informing precision strategies for healthy longevity. The National University of Singapore and the National Medical Research Council of Singapore.
AMR is a global health threat, and prisons and refugee camps are high-risk environments for the acquisition and spread of multidrug-resistant organisms (MDROs). This scoping review aims to map the existing evidence on antimicrobial resistance (AMR) in prisons and refugee camps, focusing on burden, risk factors, surveillance, resistance patterns, and mitigation strategies. The scoping review followed the Arksey and O'Malley methodology and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) checklist. Using predefined search terms related to AMR, literature was identified through searches of SCOPUS, PubMed/MEDLINE, Google Scholar, the Directory of Open Access Journals (DOAJ), and grey literature sources, including reports from the World Health Organization (WHO) and the United Nations High Commissioner for Refugees (UNHCR). The literature was screened based on inclusion and exclusion criteria to select relevant studies. Studies were screened based on predefined inclusion and exclusion criteria, and data were extracted into Microsoft Excel for descriptive and thematic analysis. From 3659 records identified at the initial search, 26 primary studies from 18 countries met the inclusion criteria. Most studies addressed AMR burden (65.4%), followed by risk factors (26.9%), while surveillance and mitigation strategies were each addressed in 3.8% of studies. Key themes were categorized as primary focus, while additional themes were recorded as secondary focus areas. Overall, the studies reported a high prevalence of multidrug-resistant organisms. MRSA colonization reached 15.7% in Swiss refugee canters and 21.3% in Finnish cohorts, while ESBL carriage was as high as 32.9%. Additionally, multidrug-resistant tuberculosis (MDR-TB) prevalence reached 9.5% in Ethiopian prisons. Risk factors included prior hospitalization, self-medication, prolonged antibiotic exposure, treatment interruptions, overcrowding, and poor hygiene Surveillance efforts were limited, and evidence on mitigation strategies was scarce, with only two studies describing antimicrobial stewardship program (ASP) implementation in prison settings in Italy and the United States. The review shows that overcrowding, inadequate sanitation, interrupted healthcare, and poor stewardship are the main causes of the high incidence of AMR in prison and refugee camps. To protect these susceptible groups and stop the spread of AMR worldwide, it is critically necessary to improve surveillance, infection control, and context-specific mitigation techniques.
The mountain pygmy-possum (Burramys parvus Broom, 1896) is a critically endangered marsupial, native to alpine-subalpine regions of Australia. Little research has been conducted on their health, including no formal parasite surveys. Parasite dynamics can reflect host and ecosystem health, acting as sensitive indicators of changing environmental, social, intra- and inter-species interactions and can contribute directly to host species knowledge. Reports of parasites affecting B. parvus are limited, with most from incidental observations. This study sampled ticks and fleas from B. parvus at eight sites in Kosciuszko National Park, New South Wales, Australia. A combination of morphological and molecular techniques was used to identify specimens, and screen for Rickettsia and Bartonella. The ticks were identified as Ixodes tasmani Neumann, 1899 and Ixodes sp. cf. tasmani Neumann, 1899. Ixodes heathi Kwak, 2018 was not found. The ticks that underwent molecular identification based on partial cox1 belonged to I. tasmani group within two distinct phylogenetic clusters. New mitogenomic reference sequences for two tick taxa and four flea species were obtained. Fleas were identified morphologically as Acanthopsylla rothschildi (Rainbow, 1905), Acanthopsylla scintilla (Rothschild, 1936), Pygiopsylla hoplia Jordan and Rothschild, 1922 and Stephanocircus simsoni Rothschild, 1905. Molecular screening found no evidence of Bartonella, one positive flea for Rickettsia, and a single suspect (late amplification) for Rickettsia. Statistically, greater B. parvus body weight was associated with decreased odds of tick presence and load, and male B. parvus had higher odds of flea presence. This study provides a systematic, standardised and formal survey of ticks and fleas of B. parvus in New South Wales, Australia, and establishes a baseline for future investigations into the impact of ectoparasites on the welfare of this critically endangered marsupial, supporting improved conservation measures across its restricted distribution.
The aim of this study is to develop and validate a maternal Prenatal Risk Index (m-PRI) comprised of preexisting maternal conditions and patient characteristics associated with increasing severity levels of severe maternal morbidity (SMM). Using administrative data from the Premier Healthcare Database, this cohort study analyzed inpatient deliveries between 2016 and 2023 across 864 hospitals and 49 U.S. states to develop the m-PRI. Multivariable ordinal logistic regression was used to quantify the association between 46 candidate conditions and an ordered set of SMM severity levels derived from an inpatient mortality-weighted SMM composite index. The final m-PRI is a composite risk score, calculated by summing the weights of existing patient conditions. The predictive performance of the m-PRI was evaluated against the Obstetric Comorbidity Scoring System (OCSS) using precision-recall area under the curve (PR-AUC) metrics overall and across subgroups. Across 7,174,412 maternal delivery hospital encounters, 56,612 patients experienced at least one SMM indicator. The final m-PRI incorporated 28 conditions. On the validation dataset, the m-PRI achieved a PR-AUC of 0.223 (95% CI: 0.194-0.254), modestly higher than the OCSS (0.173; 95% CI: 0.147-0.201), with a significant mean difference of 0.050 (95% CI: 0.036-0.064, p < 0.001). Subpopulation analysis demonstrated that PR-AUC values were consistently higher for the m-PRI than OCSS across all evaluated subgroups. The m-PRI improves upon existing methods by weighting maternal risk factors based on their association with mortality-informed SMM severity levels on an ordinal scale, rather than a dichotomous composite indicator. By incorporating a more expansive set of relevant maternal risk conditions, the m-PRI detects previously unmeasured risk, both overall and across clinical subgroups. The U.S. Department of Health and Human Services Office on Women's Health supported this project under contract 75P00120C00066.
Post-obstructive pulmonary edema (POPE) is a rare, life-threatening complication of strangulation. Management is based on low-grade evidence, and outcomes are poorly characterized. To report a systematic review of POPE following near-hanging, illustrated by a case report that represents the first documented African case. We combined a novel case report with a systematic review of published case reports and case series, conducted per a pre-registered protocol on the Open Science Framework (OSF). A clinical trial number was not applicable. A comprehensive search of major databases identified all relevant published cases. Data on demographics, management, and outcomes were extracted and synthesized descriptively. Fifteen cases from 11 publications were included. Patients were predominantly young (median age 24). Symptoms overwhelmingly presented pre-hospital (93%). Glasgow Coma Scale (GCS) on admission was low (median 6), and the overall mortality rate was 40% (6/15). Adjunctive therapies were reported to be administered more frequently in survivors than in non-survivors, including diuretics (55.6% vs. 16.7%) and corticosteroids (44.4% vs. 16.7%), representing a potential clinical signal. POPE following strangulation is associated with high mortality in young, otherwise healthy populations. This review identified a tentative association between adjunctive diuretic or corticosteroid therapy and improved survival. While these hypothesis-generating findings require cautious interpretation due to the low-level evidence, they represent a potential clinical signal necessitating further prospective evaluation and standardized reporting.
Adolescence is a critical developmental period during which parenting practices interact with temperament and sociocultural context to shape mental health and adaptation. Most parenting models are derived from Western settings, with limited evidence from India. This simultaneous mixed methods study drew on cross sectional data from the Indian Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA) cohort, including adolescents aged 12-17 years (parent report n = 931; child report n = 836). Exploratory factor analysis was conducted on parent and child versions of the Alabama Parenting Questionnaire. Qualitative data were obtained through in-depth interviews with 31 adolescents and their parents and analysed using thematic analysis. Findings were integrated at the interpretation stage. The original APQ structure did not replicate. Parent reports yielded three dimensions-Involvement/Positive Parenting, Poor Monitoring, and Corporal Punishment-while child reports yielded five, distinguishing father's and mother's involvement. Inconsistent disciplining did not emerge as a distinct construct. Qualitative findings indicated high involvement and behavioural and psychological control, largely driven by academic goals. Adolescents experienced these practices as both supportive and restrictive, with parental openness shaping communication. Contextual pressures, including resource constraints and urban stressors, contributed to a competency-control paradox. Parenting of adolescents in India must be understood within its relational and sociocultural ecology. While involvement and control function as primary supports, excessive control may constrain broader competency development. Integrating parent and adolescent perspectives is essential for culturally grounded research and intervention.
Nanomaterials are widely produced and used due to their unique physicochemical properties. Adding nano calcium carbonate to Unplasticized PolyVinyl Chloride (UPVC) improves durability and sustainability. Studies have shown that occupational exposure to UPVC powder can affect the health of employees. There are also such studies about occupational exposure to nanomaterials. Therefore, this study seeks to investigate occupational exposure to a combination of these substances. This is a cross-sectional Descriptive-analytical study conducted in 2022 at a company utilizing UPVC powder containing calcium carbonate nanoparticles in Tehran province. In this study, biomarkers of oxidative stress (Malondialdehyde (MDA), Superoxide Dismutase (SOD), and Total Antioxidant Capacity (TAC)) were measured in the blood of 100 employees. Also, the activities involved with nanomaterials were assessed for risk using the Nanotool method. Seventeen participants were female, and 83 were male. The mean ± standard deviation for age and work experience was 35 ± 9 and 6 ± 5 years, respectively. MDA, SOD, and TAC levels were elevated in the exposed group compared to controls. These differences were significant only in the case of TAC. Among the 12 activities investigated, 6 activities (50%) showed the maximum risk level. The high levels of biomarkers observed in the exposure group compared to the control groups (TAC p-value < 0.001, MDA p-value = 0.80, SOD p-value = 0.4), coupled with the elevated risk levels associated with activities involving nanomaterials. Findings suggest that exposure to powders containing nanomaterials may endanger the health of employees and shows the importance of adhering to safety principles when working with powders containing nanomaterials in the investigated company and across the broader nanomaterials industry.
The integration of machine learning (ML) approaches with immune biomarker research may facilitate the identification of candidate markers for achieving personalized medicine approaches in severe mental illnesses (SMI). This systematic review synthesizes the available evidence on ML algorithms applied to immune biomarkers in major depressive (MDD), bipolar (BD) and schizophrenic spectrum disorders (SZ), examining their performance across different clinical uses including diagnostic, prediction, monitoring, prognostic categories, in accordance with the Food and Drug Administration - Biomarker, EndpointS, and other Tools (FDA BEST) framework. We performed a PRISMA-compliant systematic search of PubMed, Web of Science, Scopus and PsycINFO databases until 14 July 2025, including 43 eligible studies with a total sample of 11,556 participants, 8339 with SMI (3228 MDD, 2614 BD and 2497 SZs) and 3217 healthy controls. We systematically described population, ML input data (including blood collection conditions, pre-processing steps, sample type, laboratory assay, missing data, and multimodality), and algorithms (supervised versus unsupervised models, feature selection, validation strategy, outcomes, and performance metrics). Overall, ML models showed moderate to high but heterogeneous performance. Diagnostic applications were the most common (AUC = 0.650-0.990), though predictive, monitoring, and prognostic uses were underrepresented and more variable. Across disorders, pro-inflammatory markers (IL-6, IL-8, TNF-α, IFN-γ, CRP) and IL-10 emerged most consistently, and data-driven approaches suggested shared immune subtypes beyond categorical diagnoses. However, substantial methodological and biological heterogeneity was observed, including inconsistent handling of missing data, limited external validation, and variable feature selection. Immunology-specific sources of variability (such as fasting status, circadian rhythms, and measurement batch effects) were rarely addressed, and the long-term stability of immune-based ML signatures remains largely unexplored. These gaps currently limit clinical translation and underscore the need for standardized protocols and more rigorous ML pipelines.
Air pollution is currently one of the major environmental problems related to human health, affecting many diseases. In this regard, while studies have established an association between air quality and Type 2 Diabetes Mellitus (T2DM), there is still a need to refine exposure-response functions. Therefore, this study aims to establish the exposure-response function that relates the concentration of two air pollutants (NO2 and PM2.5) to the hazard ratio associated with acquiring T2DM, based on various cohort studies conducted worldwide. To achieve this, a methodology using nonlinear function adjustments will be employed. This function is then applied to determine the number of T2DM cases attributable to air pollution across Europe for different age groups, using atmospheric concentrations from 1991 to 2020. Results indicate a significant nonlinear relationship between pollutant exposure and T2DM cases, with higher risks observed in areas with elevated levels of NO2 and PM2.5 (specifically, in large European cities and in central Europe, mainly related to traffic and industrial activities). NO2 relates to 3754000 [3428000 - 3957000; 95% CI] annual T2DM cases, which represent 0.51% [0.46%-0.54%; 95% CI]; while PM2.5, annual cases increase to 5109000 [4036000 - 6581000; 95% CI], corresponding to a 0.69% [0.55%-0.89%; 95% CI] of cases of T2DM attributable to this pollutant. The analysis revealed that, despite lower concentrations, PM2.5 shows a higher impact on T2DM incidence compared to NO2, especially at lower exposure levels. Findings underscore the need for stringent air quality regulations, particularly in urban and industrial regions, to mitigate air pollution's health impacts.
Problem-solving skills involve organizing and using information. This requires certain tendencies and prerequisites. This research aimed to study how learning motivation affects problem-solving. It also looked at critical thinking as a mediator. The focus was on students at Jiroft University of Medical Sciences, Iran, in 2024. The study was cross-sectional and involved 290 students from various fields at Jiroft University of Medical Sciences. It took place from January to May 2024. Data were gathered using standard questionnaires on learning motivation, problem-solving, and critical thinking. We analyzed the data with descriptive tests and structural equation modeling using Smart PLS3 and SPSS-23. The findings showed that learning motivation positively impacts problem-solving (p = 0.001, β = 0.52). It also boosts critical thinking (p < 0.001, β = 0.59). Moreover, critical thinking enhances problem-solving (p < 0.001, β = 0.63). Learning motivation improves problem-solving through critical thinking (p < 0.001). The results suggest that good learning motivation and critical thinking improve problem-solving. Therefore, we recommend that university leaders enhance learning motivation and offer training to boost critical thinking, leading to better problem-solving.
Digital dietary assessment tools are highly beneficial for nutrition research and personalized interventions. This paper describes the development and evaluation of eNutriFFQv2.0, an updated online food frequency questionnaire designed to reflect current diets in the United Kingdom (UK). Updates included modernized food lists based on recent UK population surveys, food composition tables, and food portion photos to improve accuracy and user experience. To assess reproducibility, UK adults completed the FFQ twice, 14 days apart; validity was evaluated against a 3-d weighed food record in a sub-sample. Multiple statistical methods were used. After excluding participants with unfeasible energy intakes, 87 participants completed the reproducibility and 53 the evaluation. The final eNutriFFQv2.0 captured 164 items and estimated intake for 56 nutrients and 6 food groups. Agreement with the WFR was acceptable to good for 25 out of the 29 nutrients analyzed (weighted kappa 0.21-0.77), with ≤10% misclassification into opposite quartiles for most nutrients. Bland-Altman plots showed good agreement for energy (176 kcal/d higher in FFQ1) and macronutrient estimates. Reproducibility was good for 24 out of the 29 nutrients analyzed (weighted kappa 0.58-0.85) with <5% misclassification. Mean bias for estimates of carbohydrate, fat, and protein was small (0.0-0.7). Energy estimates were 209 kcal/d (10.7%) higher in the first compared with the second completion of the FFQ. These findings demonstrate that eNutriFFQv2.0 is a valid and reliable tool for assessing nutrient intake in UK adults, offering a practical, scalable solution for research and public health in the context of digital health and personalized dietary interventions.
The first weeks of postnatal age is the most hazard time when three-quarters of neonatal death encountered. Africa is the region where most neonatal mortality is recorded and the problem is unresolved yet. Because evidence matter to have significant health improvement, this analysis aimed to generate continental based data on early neonatal death and its predictors. PICO research question approach was used to search citations from PubMed, Research 4 life, Cochran Library, Google scholar, Epistimonikos, Scopus and Google up to February 2025. Joanna Briggs Institute (JBI) prevalence/cohort/case control studies critical appraisal tools were used to assess the quality of the included articles. All studies conducted in Africa that reported the magnitude of early neonatal mortality, its associated factors and studies that reports both were included. Data was extracted using Microsoft Excel spreadsheet and imported into STATA version 17 for analysis. Publication bias was evaluated through funnel plots and further examined using Egger's and Begg's tests. A random effects meta-analysis model with 95% CI was computed to estimate the pooled effect size. After a comprehensive search and screening process, 18 articles encompassing 15 892 samples were identified from 2853 citations. The pooled magnitude of early neonatal mortality among neonates admitted to neonatal intensive care units found to be 14% (CI: 0.11-0.17), the highest estimate observed in Morocco 17% (CI: 14-21), followed by in Ethiopia 15% (CI: 10-19) with substantial heterogeneity (I 2) level of 96.68% and P value of .00. Because of significant publication bias, the pooled magnitude was imputed, shifting the early neonatal mortality from 14% to 10% (CI: 0.102-0.111). Prematurity, asphyxia and hypothermia were the three most commonly reported factors in the included articles. Consequently, the meta-analysis result showed that prematurity, asphyxiated and hypothermia increases the risk of early neonatal mortality with pooled adjusted odds ratio of 5.4 (CI: 2.83-8.10), 3.35 (CI: 2.07-4.62) and 4.38 (CI: 3.52-5.24), respectively. This review reviled that early neonatal mortality in Africa is still a serious issue requiring further intervention, highlighting challenges within the region health care system. Africa needs to intensify efforts to prevent preterm birth and improve preterm care; to prevent the incidence of asphyxia and establish hypothermia free delivery and newborn care services.
Midline diastema is an unpleasant condition that affects a patient's smile and causes significant aesthetic concerns. Treating diastema and achieving the desired aesthetics, function, and harmony can be challenging without invasive treatment. This case report demonstrates a minimally invasive approach to closing a lower midline diastema. A 38-year-old female patient presented to the dental clinic at King Khalid University with the primary complaint of a "large space in the lower front tooth region." Her medical history indicated no significant health concerns. The patient was diagnosed with localized periodontitis, stage III, grade B. She presented with a Miller class III gingival recession at the lower central incisors, an aberrant frenum, a decreased width of keratinized gingiva, and a midline diastema of 6 mm. A free gingival graft is used to increase the width of the keratinized gingiva, followed by the placement of a zirconia resin-bonded bridge to close the space. The treatment yielded a satisfactory outcome, as evidenced by an increase in the width of keratinized gingiva from 1 mm at baseline to 5 mm at 4 months and a gain of 1 to 2 mm in clinical attachment level. Two months following surgery, complete closure of a 6-mm lower midline diastema was successfully achieved using a zirconia resin-bonded bridge. The use of a free gingival graft effectively increases the width of the keratinized gingiva. A resin-bonded bridge offers satisfactory aesthetics and functionality, providing a conservative treatment that makes it a favorable option for closing lower midline diastema compared with more invasive and time-consuming procedures, such as bone grafting or orthodontic treatment.