Chattogram, a major economic hub with an expanding population, requires additional healthcare facilities. This study identifies current pharmaceutical waste management practices throughout the district and assesses their impact on public health in both urban and rural settings. A descriptive cross-sectional study was conducted in Chattogram, Bangladesh (January 2023-December 2024) to assesse pharmaceutical waste management in urban, peri-urban, and rural areas. Four semi-structured questionnaires targeted 506 university students, 116 pharmacists, 10 healthcare professionals, and three pharmaceutical companies, selected via stratified and simple random sampling. Face-to-face interviews and field observations evaluated disposal practices and infrastructure. Data were analyzed using descriptive statistics and thematic analysis in Excel and R. All participating pharmaceutical companies generated waste (50% hazardous, e.g., expired drugs; 50% non-hazardous, e.g., packaging), using incineration and minimization, but only 33.33% had trained personnel. All healthcare professionals (100%) knew waste hazards, yet only 50% were trained; 80% used segregated disposal, with 70% incineration and 40% landfilling. Of 116 pharmacists, 90% returned expired drugs, but 91% lacked training; 95% deemed expired medicines most harmful. Among 506 students, 51.38% were unaware of medication waste, 51.19% of take-back systems, 44.07% stored unused prescriptions, and 56.52% noted no university waste facilities. In addition, 42.89% agreed that improper disposal poses environmental risks, and 52.96% health risks, suggesting critical needs for training and infrastructure. In Chattogram, pharmaceutical waste management was found to be a major issue due to a lack of awareness, training, and infrastructure. Despite some basic practices, major gaps persist, particularly in rural areas, emphasizing the need for education, regulation, and improved disposal systems.
Pharmaceutical wastage presents a significant challenge to health systems in developing countries, including Ethiopia; however, evidence regarding its magnitude and drivers remains limited. This study aimed to examine the extent of pharmaceutical wastage in public health facilities in Northwest Ethiopia, identify its key determinants and consequences, and explore feasible solutions to minimize losses and improve pharmaceutical efficiency. Unlike previous single-method studies, this research integrates financial quantification with a qualitative exploration of systemic issues, thereby providing a comprehensive evidence base to inform policy and supply chain reforms. An explanatory-sequential mixed-methods design was employed in 17 public health facilities. A cross-sectional survey of 121 health professionals, selected through stratified random sampling, quantified wastage and perceptions using self-administered questionnaires. Descriptive statistics (MS Excel 2016, Statistical Package for the Social Sciences [SPSS] v26) were applied. In-depth interviews with purposively selected key informants provided qualitative insights, thematically analyzed using QDA Miner Lite v2.0.9. The total value of wasted pharmaceuticals was ETB 12,201,119.21 (approximately $235,089.00), calculated using the average 2022 exchange rate of $1 = 51.9 ETB, resulting in an overall wastage rate of 4.0%. A decline was observed from 4.72% in 2012 to 2.96% in the 2014 Ethiopian fiscal year. Expired products accounted for nearly 98% of the wastage value. Health professionals identified lack of accountability, receipt of near-expiry products, and absence of inter-facility transfer mechanisms as major causes. Key informants further highlighted facility, supplier, and system-level weaknesses as contributing factors. Although wastage rates showed a declining trend, levels remain above the national standard, with expiration the leading cause. Strengthening accountability, introducing electronic inventory systems, and enabling redistribution of near-expired products between facilities are essential to minimize losses and improve efficiency in resource-limited health systems.
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Radiopharmacy is a specialized area of hospital pharmacy dedicated to the preparation and appropriate use of radiopharmaceuticals for diagnostic imaging and targeted therapies. While clinical pharmacy activities are well established in many hospital settings, their integration into radiopharmacy remains poorly documented and lacks standardization, particularly in the context of the rapid development of theranostic applications. This descriptive, cross-sectional study aimed to assess current clinical pharmacy practices in radiopharmacy across the HUGOPharm network. Between July and September 2025, an anonymous online questionnaire was distributed to radiopharmacy teams, collecting information on prescription analysis, biological monitoring, interdisciplinary collaboration, and other clinical pharmacy activities. Descriptive statistics were used to analyze responses. All participating centers reported verifying patient identity and key prescription parameters; however, substantial variability in practices was observed. Pharmacotherapeutic analysis was more frequently performed for therapeutic procedures (71%) than for diagnostic procedures (57%). Pre-procedure biological testing was common in therapeutic contexts (86%) but infrequent for diagnostic applications (29%). No center reported conducting structured medication reviews or pharmaceutical consultations. The implementation of radioligand therapies, such as [177Lu]-PSMA, was associated with enhanced safety checks and increased interdisciplinary collaboration. Overall, clinical pharmacy in radiopharmacy is developing but remains inconsistently implemented. Structured clinical pharmacy activities appear particularly relevant for theranostic procedures and may represent priorities for future practice development to support patient safety and integrated care.
The objective of our study was to evaluate medication-related safety, tolerability and preliminary effectiveness of short-term benzodiazepine tapers to manage atypical withdrawal syndromes among individuals with opioid use disorder (OUD) exposed to the toxic unregulated drug supply containing high levels of non-pharmaceutical fentanyl and benzodiazepines. We present a case series of individuals with OUD accessing hospital-based withdrawal-management services (N = 18) who were prescribed a benzodiazepine taper alongside medications for OUD (MOUD) in Vancouver, Canada between October 2023 and July 2024 (NCT06639373).Data were collected through baseline questionnaires (i.e., sociodemographic characteristics) and chart reviews; descriptive statistics are reported. Among the 18 participants receiving benzodiazepine tapers, the median age of participants was 30.5 years (IQR 23.8, 44.3), 11 were male, and 8 were unstably housed. All participants received diazepam. The mean total diazepam dose per patient was 93.2 mg (SD 55.7 mg) and the mean duration of the tapers was 5.61 days (SD 3.11). The mean maximum and minimum daily diazepam doses administered were 30.3 mg (SD 13.7 mg) and 7.9 mg (SD 2.5 mg). No medication-related adverse events or tolerability issues were reported. Among participants who completed withdrawal-management (n = 11), the majority (n = 8) remained on therapeutic doses of MOUD continuously for 30-days following discharge. One-third of patients (n = 6) had a patient-initiated discharge event. Short-term benzodiazepine tapers may be a useful adjunct to MOUD in managing complex withdrawal syndromes due to an increasingly adulterated drug supply. Further research on screening, diagnosis, and withdrawal management for this challenging clinical scenario is needed.
Effective infectious disease control requires understanding transmission dynamics and behavioral factors that influence non-pharmaceutical interventions (NPIs) such as social distancing and quarantining. To investigate these dynamics in a real-life setting, we conducted a two-week gamified epidemic experiment at Wenzhou-Kean University, China, involving nearly 1,000 students. A Bluetooth-enabled app was used to simulate the spread of a virtual pathogen and collect real-time behavioral and epidemiological data. We developed a Susceptible-Exposed-Asymptomatic-Infected-Removed model with time-varying transmission rates to incorporate behavioral feedback and assess the effectiveness of interventions. Our results show that NPIs alone may not be sufficient unless coupled with high compliance driven by elevated risk perception. Participants who adhered strongly to NPIs significantly reduced transmission. Additionally, superspreader statistics and a heavy-tailed transmission tree structure mirroring patterns seen in biological outbreaks provides support for the external validity of the data. This studyreveals the importance of integrating adaptive human behavior and heterogeneity into epidemiological models and highlights the potential of our app-based epidemic experiments as tools for studying outbreak dynamics in real-life settings.
Drug-drug interactions (DDIs) remain a significant but often overlooked threat to patient safety. While Pharmacists are expected to play a critical role in identifying and preventing DDIs, real-world practice may not reflect this responsibility. This study aimed to assess the gap between community Pharmacists' DDI knowledge and their actual dispensing practices in Western Saudi Arabia. A sequential explanatory mixed-methods study was conducted between September and November 2025 among 356 licensed community Pharmacists in Makkah, Jeddah, Madinah, and Taif. The quantitative phase involved a validated, structured questionnaire evaluating Pharmacists' knowledge and self-reported practices regarding DDIs. This was followed by a qualitative observational phase involving 134 unannounced simulated patient (SP) visits, each presenting one of four predefined high-risk DDI scenarios (ibuprofen-furosemide, omeprazole-clopidogrel, fluconazole-phenytoin, and phenytoin-warfarin). Statistical analyses included descriptive statistics, non-parametric group comparisons (Wilcoxon and Kruskal-Wallis tests), multivariable linear regression, and Fisher's exact test, conducted using RStudio (p < 0.05). Survey findings demonstrated moderate to high theoretical DDI awareness, with 62-79% of Pharmacists correctly identifying major interaction pairs. Pharm. D. graduates achieved higher knowledge scores than B. Pharm graduates (median 5.0 vs. 4.0; p < 0.001). However, simulated visits revealed a substantial practice gap: only 15% of Pharmacists identified the DDI in real-time, and approximately 75% took no corrective action. Most encounters lasted less than one minute, and over 80% of interacting medications were dispensed without inquiry or reference checking. Despite adequate theoretical knowledge, community Pharmacists demonstrated limited real-world application of DDI management. This knowledge-practice gap poses a patient safety concern and underscores the need for system-level interventions, including decision-support tools, workflow optimization, and strengthened prescriber-Pharmacist communication.
Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and relative FFR increase after PCI are determined by the interaction of baseline disease pattern, adequacy of PCI, and residual disease burden in a target vessel. However, the prognostic impact of relative FFR increase after PCI remains uncertain. The aim of this study was to evaluate the prognostic relevance of relative FFR increase in addition to post-PCI FFR in patients undergoing PCI. From the International Post PCI FFR Extended Registry, 1,497 patients with pre-PCI FFR ≤0.80 were analyzed. The relative FFR increase was expressed as a percentage and calculated as percentage FFR increase (ΔFFR%) with PCI ([post-PCI FFR - pre-PCI FFR]/pre-PCI FFR × 100). The primary endpoint was 5-year target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization (TVR). TVR was further specified as target lesion revascularization (TLR) or non-TLR TVR. Maximally selected log-rank statistics identified 15.0% and 0.80 as the cutoffs to discriminate the occurrence of TVF for ΔFFR% and post-PCI FFR, respectively. Failure to meet either cutoff was associated with increased risk for TVF (ΔFFR%: 10.9% [122 of 1,148] vs 17.6% [59 of 349] [adjusted HR: 1.72; 95% CI: 1.23-2.42; P = 0.002]; post-PCI FFR: 10.9% [136 of 1,279] vs 21.3% [45 of 218] [adjusted HR: 2.08; 95% CI: 1.47-2.94; P < 0.001]). Patients with post-PCI FFR ≤0.80 had increased TVF compared with those with post-PCI FFR >0.80, regardless of sufficient (≥15.0%) or insufficient (<15.0%) relative FFR increase. The higher risk for TVF in patients with post-PCI FFR ≤ 0.80 compared with those with post-PCI FFR >0.80 was driven primarily by non-TLR TVR (2.2% vs 6.0%; P = 0.015) in the sufficient ΔFFR% group (≥15.0%), whereas it was attributable mainly to TLR (6.6% vs 17.0%; P = 0.008) in the insufficient ΔFFR% group (<15.0%). Relative FFR increase after PCI provides prognostic implications comparable with post-PCI FFR. Among patients with insufficient relative FFR increase, post-PCI FFR ≤0.80 was associated with an increased risk for restenosis within stented segments, whereas among those with sufficient relative FFR increase, post-PCI FFR ≤0.80 was associated with risk driven by disease progression in nonstented segments.
Diverse ginseng species exhibit highly similar morphological features, leading to potential concerns of adulteration. Difference in chemical composition, combined with sensory qualities, could be key to distinguishing between ginseng species and enabling their quality control. However, comprehensive metabolomic comparisons linking chemical profiles to sensory traits remain limited. This study aimed to differentiate Korean ginseng (Panax ginseng) and American ginseng (Panax quinquefolius) using multi-platform metabolomics approach combined with multivariate statistics by analyzing different tissue parts (whole, body, and root). Korean ginseng was overall enriched in sucrose, citric acid, acetic acid, β-panasinsene, and ginsenoside Ra2, whereas American ginseng contained higher succinic acid, β-farnesene, quinquenoside R1. Electronic tongue profiling further distinguished taste attributes, with Korean ginseng showing stronger sweetness and bitterness and American ginseng exhibiting higher sourness. These integrated findings identified discriminant markers and demonstrated the potential of integrated metabolomics and sensory analysis for ginseng authentication and quality assessment. The online version contains supplementary material available at 10.1007/s10068-026-02137-5.
Background: Mechanical subgingival instrumentation remains the gold standard in periodontitis treatment; however, it may leave residual debris and induce surface alterations. Adjunctive strategies such as air polishing and ethylenediaminetetraacetic acid (EDTA) might optimize root surface conditions. Objective: To evaluate, by scanning electron microscopy (SEM), the effects of scaling and root planing (SRP) combined with EDTA, with or without adjunctive erythritol- or glycine-based air polishing, on root surface alterations and smear layer formation. Materials and Methods: Ten extracted human teeth affected by periodontitis (yielding twenty samples) were included. Two teeth served as descriptive controls. The remaining teeth were allocated to four treatment groups. The first three groups included samples obtained from the middle portion of the roots: S (SRP + EDTA), Se (SRP + erythritol air polishing + EDTA), and Sg (SRP + glycine air polishing + EDTA). The fourth group, Js, consisted of samples from the cementoenamel junction (CEJ) treated with SRP + EDTA. SEM images were appreciated qualitatively and assessed using ordinal scores (0-3) for marks, cracks (×100), and smear layer (×1000). Non-parametric statistics were applied. Results: A significant difference in mark scores was found among S, Se, and Sg samples (H = 13.411, p = 0.001), with Se samples showing lower mark scores than S (p = 0.001). Crack scores also differed among groups (H = 12.038, p = 0.002), with higher values observed in Se compared to S (p = 0.001). Smear layer scores did not differ among groups (H = 0.102, p = 0.950). Compared with S samples, Js differed only in marks (p = 0.009), with no significant differences in cracks or smear layer. Conclusions: Within the limitations of this in vitro study, root surface alterations and smear layer formation showed variable responses across treatment protocols, with comparable smear layer scores. Similar effects were observed for CEJ and mid-root samples; however, these findings should be interpreted with caution. Further studies are needed to clarify the potential clinical relevance of these observations.
Targeted delivery of drugs and hyperthermia in cardiovascular disease demand the accurate delivery of nanoparticles in complex arterial geometries. This paper introduces combined hybrid computational model that concomitantly examines the combined impact of nanoparticle radius and interparticle spacing on the thermal and mass transport characteristics of ternary bio-nanofluid flow under magnetohydrodynamic (MHD) effect. The ternary fluid is composed of blood fluid with suspended nanoparticles such as gold (Au), silver (Ag) silica (SiO2). The mathematical model accounts for geometric properties of nanoparticles such as nanoparticles radius and interparticle spacing for their practical utility for several medical interventions. The numerical analysis is based on hybrid computational strategy, where the solutions are determined through the bvp4c numerical solver and then a novel supervised multi hidden layers Artificial neural network (ANN) is integrated. The proposed model has a high predictive capability with an exceptionally high accuracy with the lowest Mean squared error and ideal regression coefficient MSE=9.6327×10-11, Gradient=9.5681e-08, Mu=1e-09, and R2=1.0. Some of the main findings indicate that less spacing between particles (h=0.1) leads to continuous networks of thermal percolation, which enhance the thermal conductivity by up to 35% to improve the efficiency of hyperthermia, whereas the larger nanoparticles (radius ≥1.5) offer a higher drug-loading capacity, yet the rate of heat transfer decreases by 15-20%. Optimization of the magnetic parameter (M=0.1-0.7) also decreases flow velocity by 28% and extends the nanoparticle residence time at the stenosis by 35% which allows sustained drug delivery, results directly applicable to clinical-strength (1.5-3T) MRI-guided interventions. Radiation parameter (Rd=0.5-2.5) increases temperature of the arteries by 15-20% giving controllable thermal modulation to applications of hyperthermia. The proposed model predicts that optimal nanoparticle preparations (50 nm radius, 20 nm spacing) have to potential to lower the rate of restenosis by 30-40% in relation to traditional drug-eluting stents. The purpose of such an integrated computational-machine learning systems is to give quantitative advice to stent coating design, nanoparticle formulation, and optimization of treatment protocols, and has been directly used in biomedical interventions. The results can be used to offer practical advice to stent manufactures, interventional radiologist and pharmaceutical developers to create evidence-based cardiovascular therapy of the next generation.
The collection of updated post-COVID-19 data on social contacts is critical for future epidemiological assessment and evaluation of non-pharmaceutical interventions. We conducted two waves of an online survey in Italy (March 2022 and March 2023), collecting representative data on direct (verbal/physical) and indirect (indoor co-location) contacts. Using a generalised linear mixed model, we analysed social contact determinants and the impact of work-from-home and distance learning on reducing a pathogen's reproduction number (R). Additionally, we calibrated an age-structured model to the 2023-2024 influenza A epidemic in Italy to explore the impact of alternative in-person attendance scenarios on infection attack rates. We find that in-person attendance significantly increases contacts: adults attending in person have 1.69 times (95%CI: 1.55-1.83) more contacts than those staying home, while children/adolescents 2.36 (95%CI: 1.96-2.84). Limiting in-person work alone marginally affects R, whereas combining work-from-home with distance learning (from primary school onwards) reduces R by up to 23.2% (95%CI: 13.7-30.1%), with minimal additional benefit from suspending early childcare. In the influenza A case study, seasonal infection attack rates range from 14.7% (95%PI: 12.8-16.5%) under full in-person attendance to <0.2% under the most restrictive scenario. Moderate interventions (suspension of tertiary education and work-from-home) reduce attack rates by up to one fourth among adults (15-64 years) and one sixth among older individuals. This study provides post-pandemic contact matrices for Italy, essential for modelling transmission of respiratory pathogens, and quantitative evidence on the epidemiological impact of targeted physical distancing measures, thereby supporting future policy design. Respiratory viruses spread through everyday contacts between people. Understanding how human interactions changed after the COVID-19 pandemic is important for preparing for future outbreaks. We conduct two online surveys in Italy in 2022 and 2023 to measure the number of social contacts across different age groups. We explore factors associated with higher numbers of contacts and find that people attending work or school in person report substantially more contacts than others. We estimate how combining work-from-home and distance learning could reduce the transmission potential of respiratory viruses, using seasonal influenza to illustrate the impact on a real-world epidemic. These findings provide updated estimates of social contacts and can support policymakers in planning targeted measures to limit transmission during future epidemics.
Background: Hormone receptor-positive (HR+), Human Epidermal growth factor Receptor 2 (HER2-negative) metastatic breast cancer (MBC) represents a substantial proportion of breast cancer cases in Saudi Arabia. Despite the established efficacy of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, particularly Palbociclib, in randomized control trials, real-world data from local institutions in Saudi Arabia remain limited. Objectives: This study aimed to evaluate progression-free survival (PFS), overall survival (OS), and toxicity profile among HR+, HER2-negative MBC female patients treated with Palbociclib at King Fahad Medical City (KFMC). Methods: A retrospective study was conducted on female patients with HR+/HER2-negative MBC treated with oral palbociclib combined with endocrine therapy (ET) at KFMC between January 2021 and September 2024. Data were collected from electronic health records. Descriptive statistics were conducted using mean for continuous variables and frequency for categorical variables. Survival analyses were conducted using Cox regression, log-rank tests and Kaplan-Meier analysis. Results: A total of 169 female patients with HR+/HER2- MBC were included. In the first-line setting, the median PFS was 20.14 months (95% CI: 14.65-30.49), compared with 11.3 months (95% CI: 7.98-not estimable) in the second-line setting. For OS, the median OS values were 53.1 months (95% CI: 41.2-not estimable) in the first-line group and 23.7 months (95% CI: 18.5-not estimable) in the second-line group. Significant predictors of shorter PFS included age, Body Mass Index (BMI), type of ET, cancer type, line of therapy, family history of cancer, and history of VTE. Visceral metastasis (HR = 3.087; p = 0.0229) and ECOG performance status of 4 (HR = 13.86; p = 0.0156) were associated with significantly shorter OS. The most common hematological adverse events (AEs) were neutropenia (45.6%), followed by anemia (5.9%), leukopenia (5.3%), and back pain (5.3%). Most toxicities were managed with dose reduction, holding treatment, or supportive care. Conclusions: Palbociclib demonstrated favorable survival outcomes and a manageable safety profile, with neutropenia being the most common AE. This study provides region-specific real-world evidence supporting the use of Palbociclib in HR+/HER2- MBC. These findings align with global trial data and highlight the importance of individualized treatment in clinical practice.
Triple-negative breast cancer (TNBC) is an aggressive subtype with limited therapeutic options due to lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. While neoadjuvant immunotherapy shows promise, the impact of spatial organization of tertiary lymphoid structures (TLS) and tumor-infiltrating lymphocytes (TILs) on treatment efficacy remains incompletely characterized. This exploratory study aims to establish an AI-based quantitative framework for analyzing tumor-immune spatial interactions and develop a predictive model for chemo-immunotherapy response. We developed an integrated AI pipeline for automated analysis of hematoxylin-eosin (HE)-stained breast cancer samples. The framework incorporates: 1) TLS detection and classification, 2) TIL quantification, and 3) spatial relationship mapping between lymphocytes and tumor cells. Biomarkers associated with Miller-Payne (MP) response grades were identified using multivariate statistics, enabling construction of a random forest prognostic model. The TLS recognition model demonstrated substantial agreement with pathologists (κ=0.73), while the TIL classifier achieved 0.92 accuracy. Analysis of 32 HE images from triple-negative breast cancer (TNBC) cases treated with neoadjuvant chemo-immunotherapy revealed significant associations: stromal lymphocyte density and percentage positively correlated with MP grades (p<0.05); average cell counts in 2-cell and 3-cell lymphocyte aggregates showed no significant correlations; shorter mean minimum distances between lymphocytes and tumor cells within 10-30 μm radius range were inversely associated with MP grades (p<0.05). The spatial-feature-based prediction model achieved an AUC of 0.81 (95% CI: 0.76-0.86). This study established an AI-driven HE analysis pipeline that precisely quantified spatial determinants of tumor-immune interactions. Lymphocyte spatial organization, particularly proximity to tumor cells and lymphocyte aggregation patterns, serves as a critical predictor of chemo-immunotherapy response beyond density metrics. The validated MP-grade prediction model demonstrates translational potential for clinical decision-making in TNBC management, although external validation in larger cohorts is warranted.
The advantage of Raman spectroscopy (RS) in renal analysis lies in its capacity to non-invasively acquire label-free molecular vibrational fingerprint information from biological samples. It characterizes alterations in diverse biomolecules, including proteins, lipids, nucleic acids, urates, oxalates, and cytochromes, facilitating the detection of molecular and metabolic abnormalities prior to the manifestation of morphological changes. The review explains how RS deciphers the molecular characteristics of various kidney diseases without using dyes. Comparisons are drawn among surface-enhanced Raman spectroscopy (SERS), tip-enhanced Raman spectroscopy (TERS), confocal Raman microscopy (CRM), and coherent Raman techniques to elucidate their applications in molecular mapping of urine, blood, kidney tissue, and individual cells. We also summarize the Raman spectral features of diverse biological samples for the molecular diagnosis of kidney diseases, with attention to the role of advanced analytical methods, including multivariate statistics, machine learning, and deep learning, in spectral interpretation and disease classification. Coupled with high-throughput instrumentation, miniaturized platforms, and artificial intelligence, RS holds potential for precision diagnostics and clinical translation in nephrology.
Community pharmacists play a crucial role in advising patients on self-medication for minor ailments such as the common cold and influenza. Howeve, behavioral factors influencing their consultation practices remain underexplored in Indonesia. To evaluate community pharmacists' knowledge, attitudes, and practices (KAP) regarding self-medication consultations for common cold and influenza, and to interpret these behaviors using the COM-B (Capability, Opportunity, Motivation-Behavior) framework. A cross-sectional survey was conducted among 221 community pharmacists in the Malang Region, East Java, Indonesia. A validated 67-item questionnaire assessed pharmacists' KAP. Data were analyzed using descriptive statistics, the item difficulty index (Pd), and the Relative Importance Index (RII), and multiple linear regression to identify behavioral predictors. More than half of pharmacists demonstrated moderate knowledge levels (50.7%). Most knowledge items were moderately complex (Pd = 0.30-0.79). Pharmacists showed highly positive attitudes (RII > 0.90, range: 0.84-0.95) and generally good, though inconsistent, practice behaviors (median RII = 0.93, range: 0.50-0.95). Attitude was the strongest predictor of practice (β = 2.314, p < 0.001), whereas knowledge was not. Interpreted through the COM-B framework, Indonesian community pharmacists demonstrated moderate knowledge, positive attitudes, and generally good but inconsistent practices in self-medication consultations for the common cold and influenza. Attitude emerged as the primary behavioral determinant influencing practice. Interventions that enhance motivation, establish structured consultation guidelines, and integrate digital decision-support tools may strengthen responsible self-medication services in Indonesia.
Numerous bacteria coexist in the human body and constitute the 'normal microbiota'. Data on the normal vaginal microbiota are limited in Africa, particularly in Cameroon. This study aimed to determine the distribution of lactic acid bacteria (LAB) isolated from vaginal samples of Cameroonian women. This cross-sectional analytical study was conducted in Douala, Cameroon, from March 2024 to March 2025. It included non-menopausal women aged 18 to 50 years without gynaecological infections. Vaginal swabs were cultured on MRS and M17 media and identified by MALDI-TOF mass spectrometry at the Pasteur Centre for lactic acid bacteria, and by API mini-galleries for pathogenic organisms. Microbiota typing was performed using the Nugent scoring system. Descriptive and inferential statistics were conducted using SPSS v25.0, XLSTAT, and the VITEK MS Knowledge Base. Logistic regression and Poisson regression were applied where appropriate; significance was set at p < 0.05. A total of 783 participants were enrolled; the majority were aged 29-39 years (44.2%). Microbiota type IV (depleted) was the most prevalent (48.1%). Overall, 67.6% of samples harboured pathogenic bacteria, while 32.4% yielded LAB. Among 260 LAB isolates, Enterococcus spp. dominated (59.2%), mainly E. faecalis (33.5%) and E. faecium (22.3%). Bacteria belonging to the former Lactobacillus group accounted for only 18.8% of all LAB. Age (p = 0.019), region of origin (p = 0.012), and marital status (p = 0.011) were significantly associated with LAB prevalence. The distribution of vaginal lactic acid bacteria in Cameroonian women depends on age, marital status, and region of origin. The predominance of Enterococcus spp. over canonical lactobacilli represents a distinctive microbiological signature, potentially reflecting biogeographical and socio-cultural adaptations, which calls for region-specific approaches to vaginal health management.
As Phase III trial costs and durations rise, pharmaceutical companies increasingly use quantitative methods to decide if a drug should progress beyond Phase II. A key method is the probability of success (PoS) for Phase III, calculated using the power function averaged across a treatment effect distribution estimated from Phase II. This paper explores PoS's role, particularly in moving from Phase II trials with putative surrogate endpoints to Phase III trials with clinical endpoints. Since the relationship between these endpoints is often unknown, expert input is necessary (prior elicitation). We propose the bivariate meta-analysis and a copula-based extension to characterize their relationship, using visual tools to simplify parameter elicitation. Specifically, we begin by eliciting the marginal distributions of the two quantities of interest. Then, to assist in eliciting the concordance parameter, we use the distribution of the treatment effect on the clinical endpoint conditional on the treatment effect on the putative surrogate. Our approach is illustrated in prophylactic vaccine development, linking immunological and clinical endpoints.
Bronchial asthma (BA) is a major public health problem worldwide and represents a significant health burden in Saudi Arabia. The prevalence and risk factors of asthma vary across regions and are influenced by genetic, environmental, occupational, and lifestyle-related factors. A cross-sectional epidemiological study was conducted among 738 adults residing in the Makkah region of Saudi Arabia. Data were collected using a self-administered questionnaire that included sociodemographic characteristics and potential risk factors for asthma. Crude and adjusted odds ratios were calculated to assess associations between participant characteristics and self-reported BA. Of the 738 participants, 192 (26.0%) reported having BA. Asthma prevalence differed significantly across cities within the Makkah region (Taif, Makkah, and Jeddah) and among individuals who lived or worked near factories (P < .01). Among asthma patients, 76.6% reported using asthma medications. The most frequently reported environmental and lifestyle exposures included the use of chemicals in cleaning, farming, or hair styling (76.6%), use of air conditioners (73.4%), and use of firewood for heating or cooking (70.3%). Passive smoking was reported by 57.3% of patients, while 46.0% were active smokers. The prevalence of BA among adults in the Makkah region was considerable and varied by geographic location and environmental exposure. Living or working near factories and exposure to indoor and occupational risk factors were associated with asthma. These findings underscore the importance of addressing regional environmental and occupational factors in asthma prevention and management strategies in Saudi Arabia.
IntroductionFinancial toxicity (FT) is more prevalent among rural-dwelling cancer survivors who also face greater cancer care-related travel burdens. We sought to examine how FT and travel burdens may pose dual burdens for cancer survivors, and assess their effects on care experiences and subsequent cost-coping strategies.MethodsRapid qualitative analysis of semi-structured interviews with rural-dwelling cancer survivors who screened positive for FT per the COmprehensive Score for financial Toxicity (COST) measure. Our analysis was structured around three inductive themes: rural-dwelling patients' experiences of cancer treatment while navigating FT, patient perceptions of travel burdens undertaken in the course of accessing cancer care, and perceived implications of both FT and travel burdens for care on HRQoL.ResultsThe (n = 12) participants in our study were mostly women, with a median age of 60.1. The median COST score was 9.5, indicating a high degree of FT, and the median round-trip travel distance was 25.6 miles. Participants reported cost-coping strategies to reduce travel-associated costs, such as "stacking" appointments to reduce travel costs and taking advantage of non-medical assistance offered by health systems' financial assistance programs (e.g., gas cards). Participants also reported shared burdens with caregivers who also shouldered costs.ConclusionsEstimates of travel distances to cancer care likely understate travel burdens, because they do not capture the frequency of appointments and their associated indirect and opportunity costs for cancer survivors experiencing FT. Financial assistance for cancer survivors should be responsive to the dual and cumulative financial and travel burdens of cancer care. Rural-dwelling cancer survivors are more likely to experience Financial Toxicity (FT) in tandem with greater cancer care-related travel burdens. This qualitative study sought to examine how FT and travel burdens may pose dual burdens for cancer survivors, and assess their effects on care experiences and subsequent cost-coping strategies. We conducted semi-structured interviews with (n = 12) participants sampled from the Lessening the Impact of Financial Toxicity (LIFT) study, an intervention that screened for FT and provided site-based financial navigation services and supports. Interview participants were mostly women, with a median age of 60.1. The median COmprehensive Score for financial Toxicity (COST) score was 9.5, indicating a high degree of FT, and the median round-trip travel distance was 25.6 miles. Participants reported cost-coping strategies to reduce travel-associated costs, such as “stacking” appointments to reduce travel costs and taking advantage of non-medical assistance offered health systems’ financial assistance programs (e.g., gas cards). Participants also reported shared burdens with caregivers who also shouldered costs. Concomitant caregivers- or cancer survivors who were also caregivers- were especially in need to supports to mitigate the dual burdens of cancer care-related FT and travel burdens.