Although human papillomavirus (HPV) infection constitutes a significant public health challenge, the HPV vaccination coverage remains suboptimal in China. Recent roll-out of new policies calls for an updated evaluation on the knowledge, attitude, and practice on HPV and HPV vaccination among adolescents and their parents. This nationwide cross-sectional survey targeted adolescents aged 9-17 y paired with one of their parents. Sociodemographic factors and the awareness, knowledge, attitude, practice and willingness toward HPV and HPV vaccination were collected for adolescents and their parents. Univariable and multivariable regression analyses were conducted to evaluate the factors associated with the knowledge, attitude, and practice of adolescents and their parents. A total of 1,000 pairs of adolescents and their parents were included. Awareness of HPV and HPV vaccine was 34.2% and 43.9% among adolescents, and 61.0% and 68.0% among parents. Although 77.0% of the adolescents and 78.2% of the parents believed in the benefits of HPV vaccine on adolescents, the vaccination rate remained low among adolescents (7.4%). The willingness toward HPV vaccination was significantly higher among the unvaccinated adolescents whose parents acknowledged the risk of HPV infection on themselves or communicated with their children about reproductive health. The findings underscored critical gaps in knowledge, attitude, and practice toward HPV and HPV vaccination among Chinese adolescents and their parents. To address these challenges, family-oriented, school-based and physician-led educational initiatives, enhancement of the accessibility and convenience of HPV vaccination, expansion of HPV vaccine indications, and evidence to support its inclusion in the National Immunization Program are needed. Human papillomavirus (HPV) is a very common virus that can cause several cancers and other diseases in both women and men. Vaccination during adolescence, especially before sexual activity begins, is one of the most effective ways to prevent HPV-related diseases. However, HPV vaccination coverage among adolescents in China remains low. This study surveyed 1,000 pairs of adolescents aged 9–17 y and one of their parents from across China to understand their knowledge, attitudes, and behaviors related to HPV and HPV vaccination. We found that awareness of HPV and the HPV vaccine was limited, particularly among adolescents. While most adolescents and parents believed that the HPV vaccine is beneficial, only a small proportion of adolescents had actually received the vaccine. Importantly, parents played a key role in adolescents’ willingness to be vaccinated. Adolescents were more likely to want the HPV vaccine if their parents understood the health risks of HPV, discussed reproductive health topics with them, or recognized the benefits of vaccination. Concerns about vaccine safety and limited access were common reasons for not getting vaccinated. These findings highlight the need for family-based education programs that target both adolescents and parents, improve understanding of HPV and vaccine safety, encourage open family communication and physician engagement in education initiatives, and provide evidence supporting the inclusion of HPV vaccination in the national immunization program, which may increase uptake and reduce HPV-related diseases in the future.
Are there distinct symptom clusters in women with endometriosis and adenomyosis, and how do these clusters predict quality of life? Latent class analyses of 22 438 women with endometriosis identified four symptom phenotypes, including high pain-gastrointestinal and psychological-neurological clusters; adenomyosis cases were concentrated in high‑pain classes without a minimal‑symptom group, and high‑burden phenotypes had poorer quality of life. Endometriosis and adenomyosis are heterogeneous conditions with diagnostic delays of 4-11 years. The classification based on surgical findings and imaging fails to capture the complex, systemic symptom combinations that affect patients' quality of life (QoL). Large-scale cross-sectional cohort study using data from the United States-based All of Us Research Program (Controlled Tier v8; May 2018-October 2023). The dataset included 22 438 women with electronic health records (EHR) and/or self-reported endometriosis. Four Latent Class Analyses (LCA) were performed on different patient groups: (i) the full endometriosis cohort (n = 22 438); (ii) an age-corrected subset restricted to premenopausal women (aged 18-45; n = 5542) to minimize menopausal confounding; and two subgroups derived from the age-corrected cohort to test whether concomitant adenomyosis defines distinct symptomatic phenotypes: (iii) clinically confirmed endometriosis without adenomyosis (n = 1797) and (iv) adenomyosis with endometriosis (n = 643). LCA was performed using 19 self-reported and EHR-derived symptoms and comorbidities (e.g. chronic pelvic pain, migraine, depression, gastrointestinal symptoms) to identify patient subgroups. Multinomial logistic regression assessed sociodemographic (age, BMI, deprivation index) and clinical predictors (hormonal contraceptive use, surgical history) of class membership. The association between latent classes and QoL outcomes was evaluated using data from the 'Overall Health' and 'Health Care Access and Utilization' surveys. Data are available via the All of Us Researcher Workbench (https://workbench.allofus.org). Latent class analysis of clinically confirmed endometriosis identified four distinct symptom phenotypes, most notably a severe 'High Pain & Gastrointestinal with Mood Symptoms' (High) cluster and a unique 'Predominantly Psychological/Neurological' cluster that challenges traditional gynecological-focused diagnostic frameworks. Patients with adenomyosis exhibited a distinct profile with two high-pain symptom classes and the absence of a fully asymptomatic group, indicating a higher overall disease burden. Membership in the High class was significantly associated with lower general health scores, reduced social satisfaction, and increased barriers to healthcare access. The All of Us is a United States-based research program, and the findings should be replicated in other independent cohorts to confirm generalizability across other geographical regions. The cross-sectional design limits causal inference regarding QoL outcomes. Also, the analyses rely on a mix of diagnostic approaches, including surgical and non-surgical clinical and self-reported diagnoses, which is both a strength and a limitation. The 'Minimal Symptom Burden' class may reflect under-documentation of symptoms in clinical records rather than a true lack of symptoms, and the High class may reflect to patients who have higher multimorbidity, hence have more hospital visits. These results support a shift toward personalized, interdisciplinary management of endometriosis that addresses mental health and gastrointestinal symptoms alongside pelvic pain. The identification of a 'Predominantly Psychological/Neurological' cluster suggests that young women presenting with non-classical symptoms (anxiety, migraine, depression) could be screened for endometriosis to reduce diagnostic delays and improve life-course potential. D.K. was supported by a 'Ramón y Cajal' fellowship from the Spanish Ministry of Science and Innovation (RYC2024-050099-I). O.G. was supported by a postdoctoral award from the Amy P Goldman Foundation. I.F. is the co-founder and co-owner of Sur180 Therapeutics, which is developing a novel treatment for endometriosis, and the Chief Scientific Officer of Nura Health, which is developing a non-invasive diagnostic solution for the disease. I.F. has received ARPA-H grant no. ARPA-H-ICHUB-24-101-1035 as Principal Investigator, consulting fees from Nura Health and Sur180 Therapeutics, and stock and share options in both companies. I.F. is also the inventor on patents for 'Compositions and methods for treating endometriosis' (US10695341 and US10729693) and serves as an unpaid Board Member of the World Endometriosis Society and the Fundación Puertorriqueña de Pacientes con Endometriosis (ENDOPR). H.S.T. received speaker fees from Gedeon Richter, a grant from AbbVie through Yale University, consulting fees from Regeneron, and is a co-inventor on Yale's endometriosis biomarkers and treatments (including US11993816B2, US10982282B2, and US12286629B2). He also serves on the boards of the Environmental Health Trust and Environment and Human Health. N/A.
Preconception care is an important intervention aimed at improving maternal and neonatal outcomes among women of reproductive age and HIV-positive women. Inadequate utilization of preconception care may increase the risk of vertical HIV transmission and adverse pregnancy outcomes. To assess utilization rate of preconception care and associated factors among Human Immune Deficiency Virus positive reproductive age women attending Anti-Retroviral Treatment clinics in Gamo zone, 2021. An institution-based cross-sectional study was conducted from March 1 to April 1, 2021. A total of 559 participants were selected using a simple random sampling technique. Data were collected through a structured, pretested, interviewer-administered questionnaire and analyzed using SPSS version 25. Variables with a p-value < 0.25 in the bivariable analysis were included in the multivariable logistic regression model. Statistical significance was declared at a p-value < 0.05 with a 95% confidence interval. Total of the 559 HIV-positive women selected for the study, 579 participated, resulting in a response rate of 96.5%. overall utilization of preconception care was 32%. Education, Monthly income, History of pregnancy, Number of pregnancy and Occupation were significantly associated with utilization of preconception care with (AOR: 4.42; 95% CI 1.48-13.17), (AOR: 2.85; 95% CI 1.41-5.74), (AOR: 2.99; 95% CI 1.18-7.71), (AOR: 2.97; 95% CI 1.28-6.91), and(AOR: 0.45; 95% CI 0.21-0.96) respectively. The utilization of preconception care among HIV-positive women was low. Educational status, occupation, monthly income, history of pregnancy, and gravidity were significantly associated with preconception care utilization. Healthcare providers, health facilities, and public health programs should enhance awareness creation, counseling, and accessibility of preconception care services, particularly among women with lower socioeconomic status and limited reproductive experience.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
South African women are vulnerable to HIV acquisition during the postpartum period which can result in perinatal transmission via breastfeeding; many male partners do not know their HIV status. Biomedical approaches to preventing HIV for postpartum women include pre-exposure prophylaxis (PrEP) and antiretroviral treatment for male partners with HIV. Gaps in implementation include low uptake of PrEP among postpartum women and infrequent testing of men who may be motivated to test for HIV to protect the health of their infant. We will conduct a randomised pilot trial in KwaZulu-Natal (KZN) Province, South Africa among postpartum women and their male partners. The study will pilot a combination intervention consisting of cognitive behavioural strategies (including communication skills training, motivational interviewing and problem-solving) to promote H IV self-testing (HIVST) for P artners and P rEP uptake for HIV-uninfected P ost p artum Women, the 'H4P' intervention. The study aims to determine the feasibility, acceptability and preliminary effectiveness of the H4P intervention. We will enrol 60 HIV-uninfected women, aged 18 years and older, in their third trimester of pregnancy and reporting a partner whose HIV-serostatus is unknown. Sixty male partners will also be eligible to enrol. Enrolled women will receive three oral HIVST kits to distribute to their male partners and standard of care information on HIVST and PrEP. Women randomised to the intervention arm will receive additional counselling and reproductive health-centred HIVST information for the male partner, including information about why HIV testing is important during their partners' postpartum period. To evaluate feasibility, we will calculate screening-to-enrolment ratios for women and men, the number of women who distribute HIVST kits to their male partners and the number of men who test. Acceptability will be evaluated using the Client Satisfaction Questionnaire and qualitative interviews. Effectiveness will be assessed at 3 months by measuring the proportion of women initiating PrEP via self-report and urine tenofovir measurements or receipt of injectable PrEP and the proportion of men who test positive who link to HIV care. Qualitative interviews will explore perceptions of the intervention. Ethics approval for this study was obtained from the Human Research Ethics Committee at The University of the Witwatersrand, Johannesburg, South Africa (Reference number: 250612) and the Institutional Review Boards at Massachusetts General Brigham (2025P002271, Boston, Massachusetts, USA) and the University of Alabama at Birmingham (300015167, Birmingham, Alabama, USA) in the USA. Site support and approvals were obtained from the health facility and the KwaZulu-Natal Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations. NCT07194902.
Challenges in accessing sexual and reproductive health (SRH) services among young people with migration experience in Sweden are well-documented. However, there is little exploration of strategies to address this issue and improve access. This study aims to examine existing and suggested strategies to improve access to SRH services from the perspective of professionals who provide these services. Ten professionals involved in SRH service delivery were interviewed to gain insights into both current and suggested strategies. The interviews were analyzed using qualitative thematic analysis. Four themes emerged: 1) connecting the pieces of the puzzle; 2) meeting young people where they are; 3) building trust through visibility and safety; and 4) strategies for intraorganizational and interorganizational collaboration. These strategies operate on different levels, highlighting the complexity of tackling access challenges for young people with migration experience. Examples include providing psychosocial support and accompaniment services to help young people navigate the healthcare and social welfare systems, outreach activities, building trust, and incorporating youth, antiracist, and norm-critical perspectives. Participants also underscored the importance of collaborating with various stakeholders to effectively reach this group. This explorative study has identified various strategies used and suggested by professionals to improve access to SRH services among young people with migration experience. These strategies operate at different levels as they attempt to address multiple processes of vulnerabilization of this group. Future research is needed to explore the perspectives of young people with migration experience.
Males, who disproportionately account for 83% of oropharyngeal cancer cases, are underrepresented in health promotion research, including human papillomavirus (HPV) vaccination studies. The initial exclusion of males in HPV vaccine research, policies, and interventions has negatively affected male vaccine uptake. Furthermore, stigma, a well-documented barrier to healthcare engagement, has been overlooked in HPV vaccination behaviors. This study aimed to provide a more contextualized understanding of HPV vaccine disparities among adult males by applying the Health Stigma and Discrimination Framework (HSDF) to examine how stigma is produced, enacted, and sustained across social systems, which may impact male vaccine uptake. This qualitative study analyzed previously collected data from virtual group interviews conducted in 2021 with a convenience sample of 13 vaccine-eligible males aged 18-35 residing in El Paso, Texas, United States. Participants completed a demographic survey and participated in semi-structured discussions about their knowledge, attitudes, and experiences with HPV and vaccination. Data were analyzed by employing the Critical Discourse Analysis (CDA) method and the Health Stigma and Discrimination Framework (HSDF) to guide the methodological and analytical processes, helping to map stigma processes and mechanisms across individual, interpersonal, and structural levels to identify multi-level influences on male HPV vaccine behavior. Analysis identified four overarching themes reflecting the discursive construction of stigma processes and mechanisms, spanning proximal to distal levels of influence. At the individual level, (1) male sexual health and manhood reflects how internalized sex-specific beliefs and masculine norms fostered shame and discomfort around male sexual health, often framing males as unaffected by HPV rather than vulnerable or in need of vaccination. At the interpersonal level, (2) cultural and familial forces captures how discourses of intergenerational silence, religious morality, and sexual health taboos perpetuated stigma processes and mechanisms, constraining open discussion about HPV and vaccination. At the systemic level, (3) structural barriers to vaccination reflects how policy environments, institutional practices, and health system norms perpetuate systemic-level obstacles restricting vaccine access. Finally, at the multi-level, (4) stigma resistance reflects counter-narratives that highlight affirming, peer-informed, perspectives and reframed male vaccination as legitimate and necessary. Findings provide an in-depth examination of how stigma processes and mechanisms-rooted in masculine norms, sexual health taboos, intergenerational silence, misinformation, and institutional exclusion-shape HPV vaccination access, beliefs, and behaviors among vaccine-eligible adult males. In contrast, participants expressed resistance to these stigmatizing narratives by reframing male vaccination as a necessary and achievable health behavior when supported by peer-informed, culturally resonant messaging. These findings highlight the need for multi-level interventions that replace stigmatizing discourses and practices with affirming male narratives in HPV and broader sexual and reproductive health prevention efforts.
High-risk fertility behavior is a leading contributor to adverse maternal and child health outcomes. This study assessed the prevalence and determinants of high-risk fertility behavior among reproductive-age women in sub-Saharan Africa. We conducted a secondary analysis of Demographic and Health Survey data from eight sub-Saharan African countries with extremely high or very high maternal mortality. A weighted sample of 78,353 reproductive-age women who had given birth in the five years preceding the survey was included. A multilevel mixed-effects binary logistic regression model was used to identify individual- and community-level factors associated with high-risk fertility behavior, accounting for the hierarchical nature of the data. Statistical significance was determined using AOR with a 95% CI and a P-value ≤0.05. The overall prevalence of high-risk fertility behavior was 71.46% (95% CI: 71.14%, 71.77%), with the highest prevalence observed in Chad (87.75%) and the lowest in Lesotho (40.49%). Key individual-level determinants included women's and husbands' education, religion, wealth status, child sex, marital status, mobile phone and Internet use, antenatal care attendance, history of pregnancy termination, and contraceptive use. At the community level, low poverty was associated with a reduced likelihood of high-risk fertility behavior. The prevalence of high-risk fertility behavior remains high in countries with extremely high and very high maternal mortality rates, highlighting a need to address it through urgent and concerted interventions. Policymakers and planners should prioritize interventions targeting the key determinants of high-risk fertility behavior to curb its occurrence and improve maternal and child health outcomes. High-risk fertility behavior (HRFB) is defined as having children at very young or older ages, having many births, or spacing pregnancies too closely, which can lead to serious health problems for mothers and children. This study aimed to determine the magnitude of high-risk fertility behaviors and the factors that affect the behavior among women in eight sub-Saharan African countries with very high maternal mortalities. Using data from over 78,000 women, we analyzed both individual- and community-level characteristics linked to HRFB. This study found that about 71% of women had HRFB. The highest rates were in Chad, and the lowest were in Lesotho. Factors such as low education, poverty, limited use of antenatal care, lack of contraception, and reduced access to mobile phones or the Internet increased the likelihood of HRFB. Communities with lower poverty showed lower rates. These findings underscore the need for targeted policies and programs to reduce HRFB and improve maternal and child health.
Explore Spanish-preferring participants' experiences with and perceptions of communication of genomic results through professional medical interpreters via multiple modes in the Clinical Sequencing Evidence-Generating Research consortium. In this cross-site analysis, we described self-reported data from Spanish-preferring participants (n = 334) who completed a survey after genomic results sessions conducted with a professional medical interpreter present regarding their understanding of results, perceptions of results communication quality, perceived cultural concordance, and satisfaction with and perceptions of interpretation across interpreter modes (in-person, video, phone). Overall, most respondents who had a Spanish interpreter present during their genomic results session reported: understanding the genomic results 'quite a bit' or 'extremely' well (68%), satisfaction with the language interpretation provided (94%), perceiving good quality interpretation (96%), and that the interpreter and clinical team worked well together (98%). Regarding cultural concordance, most respondents reported feeling equal respect (94%), cultural understanding (91%), ease (82%), and personal connection (67%) with both the interpreter and the clinical team. Across all interpreter modes, respondents' satisfaction and perceived quality of genomic results communication and of Spanish interpretation were high, and their perceived cultural concordance with interpreters and clinicians was similar. In open-ended responses, the factors most frequently described as influencing respondents' perceptions of interpretation centered on interpretation understandability and perceived accuracy, interpreters' kind demeanor and attentiveness to respondents' needs, and challenges with remote technology. From the perspectives of Spanish-preferring patients and parents (of minors) across diverse settings, communication of genomic results through professional medical interpreters using in-person and remote (video and phone) modalities was well-received and involved both information exchange and interpersonal facets. Remote interpretation with professional interpreters can promote quality, culturally-concordant communication in genomic settings. Attentiveness to maintaining call quality in remote sessions, along with providing interpreters of any mode with genetics-specific resources, may help facilitate patient satisfaction.
Pregnancy-related anaemia significantly affects human development across life stages. In sub-Saharan Africa (SSA), country-specific epidemiological variations primarily driven by nutritional practices, socioeconomic factors and health-system disparities contribute to heterogeneity in prevalence, severity and adverse birth outcomes (ABOs). While anaemia and micronutrient deficiencies in pregnancy are well studied globally, comprehensive trimester-specific evidence and their associations with ABOs in SSA remain scarce. This review, therefore, examines the breadth and nature of existing evidence on these associations within SSA, thereby updating current knowledge and informing regionally tailored interventions and future research. A scoping review methodology will be employed due to the limited volume of literature addressing the specific research questions and population. The review will follow the Joanna Briggs Institute (JBI) framework, applying the population-concept-context approach. Comprehensive searches will be conducted across CINAHL, MEDLINE, Cochrane Library, Scopus, Google Scholar, EBSCO Open Dissertations and relevant organisational websites. The planned search period will span from 1 January 2016 to 31 December 2025. Two reviewers will independently screen and extract data using JBI-adapted protocols within the Rayyan review platform. Any discrepancies will be resolved via discussion with the research team. Findings will be synthesised narratively through descriptive content analysis and visual mapping.This review will include peer-reviewed studies and grey literature that investigate the associations between anaemia or deficiencies in iron, folate and vitamin B12 during pregnancy trimesters and ABOs in SSA. All relevant sources of evidence will be considered, regardless of study design or methodology, provided they report on women of reproductive age who experienced anaemia in any trimester and were subsequently identified with ABOs. Birth outcomes of interest include low birth weight, macrosomia, small or large for gestational age, preterm birth, post-term birth and stillbirth. Only sources published in English from 2016 onward will be included. The studies' quality will be evaluated using Cochrane's risk of bias assessment and mixed methods appraisal tools and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. This scoping review will not require ethical approval as it will synthesise published data and reports. It has been registered with the Open Science Framework. This review does not involve human participants. The final report will be submitted for publication in a peer-reviewed journal. The findings will be used to shape subsequent research, serving as a fundamental element of the evidence and knowledge mapping framework. As this study protocol was not reviewed by an ethics committee, the appropriate contact for research integrity matters is the Faculty of Health and Environmental Sciences, Auckland University of Technology.
Long-term monitoring of threatened carnivores provides rare insight into how environmental change shapes population dynamics. We analyzed 27 years (1997-2023) of standardized visual observations from the Golestanak Core Zone, a high-altitude, strictly protected area within the Central Alborz Protected Area (CAPA) in northern Iran, which represents one of the most reproductively active habitats for the Syrian brown bear (Ursus arctos syriacus). Intensive daily ranger patrols during the snow-free season enabled reliable detection of solitary bears, females with cubs, and cubs, allowing robust quantification of population trends and reproductive output. Population indices were assessed in the Golestanak Core Zone using the Bear Litter Size Index (BLSi) and Bear Sighting Rate Index (BSRi), while habitat and environmental predictors, including land cover, NDVI, and seasonal weather variables, were derived from MODIS products and local synoptic stations and aggregated at the CAPA landscape scale. We combined linear regression with generalized linear models (GLMs) to link key environmental drivers to population indices, carefully selecting and validating models to ensure robust and ecologically meaningful inference. BSRi revealed contrasting trends: solitary bears increased markedly, females with cubs declined slightly, and cubs exhibited a weak positive trajectory, all with substantial interannual variability. BLSi rose overall from ~1.25 to 1.70 cubs per female, despite yearly fluctuations. GLM results indicated that BSRi and BLSi were strongly influenced by seasonal vegetation and human-modified landscapes. For both indices, higher NDVI in winter was consistently associated with lower values, whereas urban and built-up areas positively affected BSRi and BLSi. Other variables, including forest type and seasonal climate, had weaker and model-dependent effects. In the absence of long-term datasets and studies, this research provides one of the most extensive assessments of brown bear population fluctuations under a complex set of environmental variables in a high-elevation, human-influenced ecosystem, offering valuable insights for designing effective conservation strategies to support this threatened subspecies in today's rapidly changing world.
Background Cervical cancer is the most common cancer among women in Nepal. Traditionally, healthcare professionals collect cervical specimens for Human Papillomavirus testing. Still, many women prefer self-collection, allowing them to sample in the comfort of their homes. Self-sampling has shown promise in other countries, but its acceptability in Nepal remains unexplored. Objective To assess the acceptability of Human papillomavirus self-sampling among women in Nepal. Method This community based single arm implementation study was conducted from 5 February 2021 to 17 July 2022 using mixed methods approach. For Cervical Cancer Screening, 1625 women aged 30-60 years were recruited and vaginal samples were collected using self-sampling technique. Quantitative data were collected by assessing sociodemographic, sexual and reproductive characteristics, awareness on cervical cancer and human papillomavirus vaccination, and acceptability. Qualitative data were obtained through in-depth interviews among 31 participants. Descriptive data were reported using frequencies and percentages. In-depth interviews were transcribed and coded using inductive and deductive methods. Result Among 1625 participants, 74% agreed to self-sample for screening. Among them, 98% found it easy to understand the directions to collect vaginal swabs, 96% reported ease in using a brush for sample collection, 89.6% found it painless and comfortable, 19.2% were afraid of hurting themselves while using the brush. Only 5.3% women felt embarrassed while self-collecting the sample. Qualitative results support these findings. Conclusion Increase cervical cancer screening participation rate with positive response towards self-screening indicates that Human papillomavirus self-sampling methods have potential to increase screening uptake, and achieve the national target of 70% screening coverage.
To estimate the global, regional and national burden of maternal haemorrhage (2000-2021) and its 2050 projections in 204 countries and territories. This study systematic analysis of the burden of maternal haemorrhage sourced data from the Global Burden of Disease (GBD) 2021 study. We estimated the incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) due to maternal haemorrhage. Changes in the burden from 2000 to 2021 were computed using AAPC. To detect statistically notable changes in the trends of maternal haemorrhage metrics between 2000 and 2021, Joinpoint regression analysis using the Joinpoint Regression Programme was conducted. We also projected mortality rates, YLDs and YLLs through to 2050 using maps and trends generated by the GBD Foresight visualisation tool. Globally, the incidence of maternal haemorrhage among women aged 15-49 years declined from 881.98 per 100 000 reproductive aged women (95% uncertainty interval (UI) 687.01 to -1150.23) in 2000 to 714.00 (95% UI 556.97 o t908.54) in 2021, with an average annual percentage change (AAPC) of -0.91 (-1.37 to -0.49). Similar downward trends were observed for maternal deaths, DALYs, YLDs and YLLs attributable to maternal haemorrhage, with AAPCs of -3.78 (-4.39 to -3.18), -4.68 (-4.83 to -4.55), -1.21 (-1.54 to -0.89) and -4.80 (-5.10 to -4.52), respectively. Sub-Saharan Africa, particularly Western Sub-Saharan Africa, recorded the highest burden in 2021, which is almost 300 times higher than in Western Europe. Elevated rates of mortality, DALYs and YLDs were also evident in Sierra Leone, Chad, Niger, Mali, Nigeria, Burkina Faso, Central African Republic, Somalia and South Sudan in 2021 and projections for 2050. However, the high-income Asia Pacific region had the lowest incidence, DALYs and YLDs at 151.32 (109.63-203.68), 2.21 (1.72-2.86) and 0.87 (0.46-1.38) per 1 00 000 women, respectively. Australasia recorded the lowest maternal death count and YLLs attributed to maternal haemorrhage at 0.69 (0.50-0.90) and 0.56 (0.41-0.74) per 1 00 000 women, respectively. While the global burden of maternal haemorrhage has declined over time, significant regional and national inequities persist. Even though the 2050 projections show improvement in the burden of maternal haemorrhage, there is also regional and national variation in the rate of decrease in maternal haemorrhage burden. Targeted, context-specific interventions are urgently needed to reduce maternal haemorrhage-related mortality and morbidity.
The last survivors of the northern white rhinoceros (NWR, Ceratotherium simum cottoni), once widespread across Central and East Africa, are two non-reproductive females under continuous human protection. In order to prevent the extinction of this white rhinoceros subspecies, the BioRescue consortium founded in 2019 has developed an innovative reproductive biotechnology program. This holistic rescue strategy implements (i) advanced assisted reproductive technologies (aART) including in vitro fertilization (IVF) and embryo transfer, (ii) stem cell associated techniques (SCAT) for establishing in vitro gametogenesis (IVG), and (iii) a pangenetic rescue strategy (PRS) that uses the full spectrum of genetic diversity still available by incorporating DNA sequence information from the globally available NWR-museum specimens combined with gene editing to enrich the genetic diversity of the future living population. Key milestones of the BioRescue consortium are: 26 non-surgical oocyte collections in NWR followed by in-vitro oocyte maturation and embryo generation, first pregnancy in a southern white rhino (SWR) surrogate after heterologous embryo transfer, establishment of two SWR embryonic stem cell (ESC) lines, NWR induced pluripotent stem cell (iPSC) lines derived from somatic tissue, and robust primordial germ cell-like cell (PGCLC) induction as a first step towards IVG. Beyond biological and technical challenges, an essential part of the BioRescue project's operational framework addresses the ethical dimension of this new approach in conservation, ensuring transparency, animal welfare, and societal accountability. This multidisciplinary strategy offers a replicable model in conservation science for rescuing critically endangered or practically extinct species, linking the most advanced reproductive technologies with ethical oversight to safeguard biodiversity.
Miscarriage is defined as a spontaneous loss of pregnancy before 20 weeks of gestation. According to ASRM and ESHRE, two or more consecutive pregnancy losses are referred to as recurrent spontaneous abortion (RSA). Approximately 15% women are at risk of miscarriage worldwide and 7.4% women are at risk of RSA in India. Genetic link is the most important factor responsible for the pathogenesis of RSA. Several genes, such as HLA, FOXP3, MMP and CTLA-4, play crucial roles in this disorder. The present study was designed to evaluate the possible association of CTLA-4 with the susceptibility and/or protection to RSA. A total of 110 subjects (55 RSA cases and 55 controls) were included for this case-control study from the Indian Bengali population, aged between 19 and 35 years. Genotyping was carried out by the PCR-RFLP method. The concentration of soluble CTLA-4 (sCTLA-4) was quantified in serum using sandwich ELISA kit. Genotypic data were statistically analysed using IBM-SPSS (v27), and concentration of sCTLA-4 was determined using Sigma plot (v14). Odds ratios (ORs), 95% confidence intervals and χ 2 test were performed for genotyping data, while the t-test was used for sCTLA-4 data. Bonferroni corrected P < 0.05 was considered statistically significant. The findings revealed an association between CTLA-4 +49A>G variant and reduced risk of RSA under allelic (A versus G: P = 0.049, OR = 0.522), codominant (AA versus AG: P = 0.027, OR = 0.39), dominant (AA versus AG + GG: P = 0.022, OR = 0.379) and over dominant (AG versus AA + GG: P = 0.036, OR = 0.411) inheritance models. However, no significant association was observed between the CTLA-4-1722T>C variant and RSA. Serum sCTLA-4 concentration was significantly lowered in RSA patients as compared to controls (23.82 ± 2.71 ng/ml versus 26.66 ± 3.74 ng/ml, P = 0.0002). In conclusion, the findings of this preliminary study indicate that the CTLA-4 gene +49A>G (rs231775) variant may contribute to RSA risk in the Indian Bengali population. Further, the finding of reduced sCTLA-4 level suggests the increased risk of RSA. However, further study in a large cohort is warranted to strengthen the findings of the present study.
Small intestinal atresia (SIA) consists of a congenital obstruction of the lumen of the duodenum, jejunum, or ileum with varying severity. The aim of the investigation was to analyze the prevalence and mortality of SIA, using data from the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Data on SIA cases were collected from 25 ICBDSR members' surveillance programs in 17 countries over 1974-2015. All pregnancy outcomes were included, but terminations of pregnancy were not available for 11 programs. Statistical analysis is descriptive, and the prevalence is established by the total of SIA cases divided by the total of births. The survival time was calculated, and mortality was analyzed individually using the Kaplan-Meier method for comparison. The total prevalence of SIA was 2.1 per 10,000 births. Iran had the highest prevalence with 11.5 per 10,000 total births (95% CI: 9-14.1); on the other hand, the lowest prevalence of SIA was in Mexico-Nuevo Leon with 0.5 per 10,000 births (95% CI: 0.3-0.8), and Cali-Colombia had zero cases. In South America, a higher prevalence of SIA was estimated compared to what was reported in 2000. Most deaths occurred between Day 2 and 6, except in Bogotá-Colombia, Spain, UK-Wales, and Mexico, where the deaths occurred on Day 1. The mortality in the first year was 4.3%, but the specific causes of death were not determined in this study. The prevalence of SIA was about 2.1 per 10,000 births during a 41-year period in 25 centers, with variations in prevalence according to geographical locations. Future research is suggested to analyze changes in trends and the impact of early diagnosis and treatment in mortality.
Marker chromosomes derived from the Y chromosome are rare and can present with either disorders of sex development (DSD) or infertility. We assessed a unique case of a 38-year-old Indian male who presented with primary infertility and azoospermia. Cytogenetic analysis demonstrated a karyotype of 46,X,+mar, and further fluorescence in situ hybridisation studies confirmed the marker to be of Y chromosomal origin. Microarray revealed an interstitial deletion of 15.7 Mb spanning Yq11.1-q11.23 with preservation of the Yp arm. Multiplex polymerase chain reaction showed complete loss of the azoospermia factor (AZF) a, AZFb and AZFc regions. Based on integrated cytogenetic and molecular findings, the final karyotype was revised to 46,X,der(Y)del(Y)(q11.1q11.23). Interestingly, the marker chromosome retained the sex-determining region Y (SRY) gene, explaining the development of a male phenotype, but the absence of the AZF loci accounted for the failure of spermatogenesis. This case highlights the importance of integrated cytogenetic and molecular approaches in evaluating unexplained male infertility and represents a rare example of SRY-positive testicular DSD associated with a Y-derived marker chromosome lacking critical spermatogenic regions.
This study aimed to assess the pooled proportion of dropout from the maternal continuum of care (CoC) and its associated factors in low-income and middle-income countries (LMICs). Cross-sectional study using nationally representative demographic and health survey (DHS) data. 41 LMICs with DHS data available after the establishment of the Sustainable Development Goals from 2016 to 2024 were included. A total of 217 083 (weighted 213 474) women were included. Using Stata V.17.0, a multilevel binary logistic regression analysis was performed to examine the factors associated with dropout from the CoC. The adjusted ORs (AORs) with 95% CIs were calculated, and p<0.05 was statistically significant in the final model. Women of reproductive age (15 to 49 years) who had at least one live birth within 2 years preceding the survey. Dropout from the CoC was the primary outcome of this study, defined as initiating antenatal care but failing to receive skilled birth attendance and/or postnatal care. The pooled proportion of CoC dropout was 50% (95% CI 45 to 56%), with significant heterogeneity, which ranges from 19% in Albania to 85% in Ethiopia. Factors associated with higher odds of dropout were multiparity (AOR=1.30, 95% CI 1.26 to 1.34), grand multiparity (AOR=1.70, 95% CI 1.62 to 1.78), delayed first ANC (AOR=2.87, 95% CI 2.79 to 2.95), regions compared with the North Africa/West Asia/Europe region; SSA (AOR=2.65, 95% CI 2.34 to 3.00), Central Asia (AOR=1.78, 95% CI 1.40 to 2.26), South and Southeast Asia (AOR=2.43, 95% CI 2.14 to 2.75), Oceania (AOR=2.41, 95% CI 1.98 to 2.94), Latin America and the Caribbean (AOR=8.47, 95% CI 6.81 to 10.54), distance from health facility (AOR=1.15, 95% CI 1.12 to 1.18), getting permission (AOR=1.27, 95% CI 1.23 to 1.32), pregnancy intention (AOR=0.76, 95% CI 0.73 to 0.78) and rural residence (AOR=1.57, 95% CI 1.51 to 1.64), primary education (AOR=0.83, 95% CI 0.80 to 0.86), secondary education (AOR=0.60, 95% CI 0.58 to 0.62), higher education (AOR=0.43, 95% CI 0.41 to 0.46), middle wealth index (AOR=0.80, 95% CI 0.77 to 0.83), rich wealth index (AOR=0.65, 95% CI 0.63 to 0.68), media exposure (AOR=0.70, 95% CI 0.69 to 0.72), women aged between 20 and 34 (AOR=0.76, 95% CI 0.72 to 0.79) and age ≥35 years (AOR=0.60, 95% CI 0.56 to 0.63) were associated with lower odds of dropout. This study found a 50% dropout from CoC in LMICs with considerable heterogeneity. Factors identified as contributing to reducing dropout rates include improving women's education, increasing media exposure, enhancing women's decision-making power, ensuring better access to healthcare facilities, particularly in remote areas, and reducing adolescent pregnancies. To achieve Sustainable Development Goal 3 for maternal and child health by 2030, a coordinated, multi-level strategy is required.
Recurrent pregnancy loss (RPL) is defined as two or more failed clinical pregnancies, involuntarily ending before 24 weeks of gestation. Approximately 2%-5% of couples with recurrent miscarriages carry a balanced structural chromosomal anomaly. A non-consanguineous couple with a history of RPL was referred to the institute for genetic evaluation. The male and the female partners were of ages 31 and 30 years, respectively. The reproductive history of the female partner revealed three missed abortions during the 8th-10th week of pregnancy. The karyotype of the female partner revealed balanced chromosomal translocation between the long arm of chromosome 1 and the short arm of chromosome 10 (46, XX, t(1;10)(q32;p14)) with a clinically normal phenotype. The male partner had a normal karyotype (46, XY).
Land-use changes and habitat degradation threaten biodiversity and ecosystem functions globally. Large terrestrial mammals are particularly vulnerable due to low reproductive rates, large spatial requirements and sensitivity to human disturbances. Increasing coverage and effectiveness of protected areas (PAs) is vital to conserve mammal species and their habitats. We used camera trapping to assess the impact of human activities and landscape characteristics on diversity, occupancy and detection probabilities of 11 terrestrial mammals in northern Ukraine in 2020-2021. We evaluated the impact of human stressors and landscape modifications on species diversity, occupancy and detection probabilities across the Ukrainian Chornobyl Exclusion Zone (CEZ), regional PAs and non-PAs. We implemented hierarchical Bayesian single-species single-season occupancy models to identify the covariates that described the occupancy (Ψ) and detection (p) probabilities for each species. Species diversity, occupancy and detection probabilities were significantly higher in the Ukrainian CEZ and neighbouring Drevlianskyi Nature Reserve (highest occupancy probabilities of Przewalski's horse, Eurasian lynx, moose and red deer) than in all other areas. PA coverage positively influenced red deer, red fox and raccoon dog occupancies, while PA protection status showed mixed effects across species. Our results demonstrate that PAs are most effective when they are large, contiguous and human access restrictions are actively enforced.