Mental healthcare has emerged as a major public health issue in the aftermath of COVID-19 worldwide due to global health system challenges which hinder effective healthcare. In this, there is a knowledge gap on research exploring the perceived quality of mental healthcare amongst hospital-based health workers with a particular focus on knowledge and practice, organization and system, and job satisfaction factors for an insight towards strengthening ongoing effort for the realization of the universal health coverage goal of the comprehensive global mental health action plans. The aim of this study was to assess health workers' perceptions of quality in mental healthcare at three district hospitals in Johannesburg, South Africa. An exploratory cross-sectional research design was used on a stratified random sample of 160 health workers recruited as participants at the three selected hospitals in Johannesburg. Data were collected using a self-administered questionnaire and then subjected to descriptive statistical analysis using SPSS Version 29. It was established that healthcare workers' at the three district hospitals in Johannesburg were generally familiar with mental health guidelines and mental disorders which resulted in better patient engagement and prioritisation of mental health as being important as physical health. However the majority of these healthcare workers perceived the quality of mental healthcare at the three hospitals was low. Further assessment however revealed that these perceptions may have emanated from organizational and system incapacity, and limited satisfaction with compensation and benefits, recognition for work done and limited training. Health worker perceptions of quality in mental healthcare help provide an insight into what health systems may need to address mental health service delivery. The study of the three hospitals in Johannesburg, South Africa underscore the need to reinforce knowledge sharing through healthcare worker training, strengthen organisational and system capacity, provide adequate remuneration and benefits, and reinforce clear referral pathways and collaboration with specialists for the realisation of quality improvement and sustenance in pursuing the universal health coverage goal of the WHO Comprehensive Mental Health Action Plans and the Sustainable development Agenda on health of 2030 and beyond.
Universal Credit (UC) was a large-scale reform of the UK welfare system, replacing six existing benefits. UC aimed to simplify claims and encourage more claimants into work. Previous research has found evidence of harm to the mental health of recipients, potentially exacerbating existing health inequalities. We identify the effect of UC on self-reported measures of psychological well-being, treating the phased rollout from 2013 to 2018 as a natural experiment. We estimated differences in psychological well-being outcomes associated with the staggered introduction of the UC across local authorities, using areas where UC was not yet available as controls. We included working-age (aged 18-64 years) respondents of the Annual Population Survey in Great Britain from 2012 to 2019 (n=245 658), living in low-income households. We used the four self-reported measures of psychological well-being recorded in the survey: Life Satisfaction, Happiness, Life Worthwhile and Anxiety. We tested for differential effects by disability, age, caring responsibilities, sex, country, ethnicity, education and household structure. UC was associated with per-claimant decreases in Life Satisfaction (-0.66; 95% CI -1.01 to -‍0.30), Happiness (-‍0.41; 95% CI -‍0.77 to -0.05) and Life Worthwhile (-0.73; 95% CI -1.03 to -‍0.42), and increases in Anxiety (+0.79; 95% CI 0.30 to 1.27). These changes were 2-6 times as large as the effects on well-being of the COVID-19 pandemic. Respondents in Wales and Scotland saw comparatively greater effects compared with those in England across several outcomes. UC exposure saw greater comparative increases in anxiety among people with disabilities (+0.19; 95% CI 0.12 to 0.27), single people (+0.13; 95% CI 0.06 to 0.21) and people aged under 25 years (+0.27; 95% CI 0.15 to 0.39). The introduction of UC had adverse effects across all four measures of well-being. Vulnerable groups typically experienced greater harms, reinforcing calls for reforms to UC to reduce the health and well-being impacts of poverty and unemployment.
Postpartum depression (PPD) is a major public health concern. Despite advancements in treatment, many barriers to accessing care remain. There has been a growing interest in digital interventions for the prevention and treatment of PPD. However, for mothers with mild and moderate symptoms of depression, there is a limited offer of self-guided internet-based interventions developed with user input and with considerations on how to integrate the intervention into stepped care models for PPD. The aim of this study was (1) to describe the process of the design and development of iCARE, a self-guided digital psychological intervention for mothers with mild and moderate symptoms of PPD in Denmark, (2) present the program's theory illustrated by a logic model, and (3) explore its initial usability and prospective acceptability. Applying user-centered design methods, the intervention development followed six steps: (1) a literature review to identify evidence‑based therapeutic components of self‑guided interventions for PPD, (2) interviews with women with lived experience of PPD and group discussions with mental health experts and home‑visiting providers to identify user needs, (3) iterative design and content development with stakeholder feedback in collaboration with the Department of Digital Psychiatry, (4) prototype testing using think‑aloud usability sessions and interviews with 5 mothers, (5) a group cognitive walkthrough with mental health experts, and (6) final refinement and implementation of the iCARE program with developers and designers. Initial interviews with mothers and maternal health care providers emphasized the importance of a digital intervention offering timely psychoeducation, coping strategies, and pathways to in-person care while addressing the diversity of expressions of PPD symptoms. Stakeholders recommended a flexible program, multimodal content, and integration into maternal care systems with community health nurses supporting engagement and participation. The prototype was designed to be user-centered, engaging, and with multiple interactive features. It included components on psychoeducation, cognitive exercises grounded in cognitive behavioral therapy, acceptance and commitment principles, and mood-monitoring. The prototype was designed to be user-centered and engaging, with interactive features and components on psychoeducation, cognitive exercises grounded in cognitive behavioral and acceptance and commitment principles, and mood-monitoring. Prototype testing indicated high prospective acceptability and led to refinements across 6 themes: appropriateness of content; motivation and engagement; inclusivity and gender representation; clarity of instructions and data use; understanding of therapeutic method; and usability, layout, and navigation. iCARE is a self-guided internet-based psychological intervention for mothers with mild and moderate symptoms of PPD in Denmark. It was developed with user input by using qualitative methods, user-centered design, and psychological theory. Further research is needed to evaluate the feasibility and effectiveness of the program in a randomized controlled trial and its integration into maternal health care models such as universal PPD screening and home-visiting.
Large-area, continuous covalent organic framework (COF) films are in high demand for the fabrication of high-performance humidity sensors. However, conventional synthetic approaches of COF films are still plagued by drawbacks, such as harsh reaction conditions, film fragility, and time-consuming processes. Herein, we report a novel liquid crystal (LC)-assisted fabrication of large-area COF films, which exhibits remarkable universality for the synthesis of distinct types of COF films. Mechanistic investigations reveal that non-covalent interactions induced by LC molecules facilitate the dense packing and ordered self-assembly of organic precursors, thereby overcoming the bottleneck of large-scale film fragmentation. Featuring a response time of 4.45 s (15%-90% RH), recovery time of 1.95 s (90%-15% RH), and sensitivity of 13.90 mΩ/%RH, the COF film-based humidity sensor exhibits fast response and excellent durability. Overall, this work provides a versatile strategy to synthesize large-area COF films, enabling the construction of high-performance humidity sensors and thereby offering guidance for the development of high-performance active layers for humidity sensors.
A central feature of G protein-coupled receptor (GPCR) desensitization is the direct competition between heterotrimeric G proteins and β-arrestins (βarrs) for an overlapping binding site within the intracellular receptor cavity. Although numerous high-resolution structures of GPCR-transducer complexes exist, the exact nature of this shared site and the molecular basis of transducer competition remain unclear. To investigate this, we employed an interdisciplinary approach integrating systemic mutational mapping, bioinformatics, and structural analysis across multiple classes of GPCRs and their transducers and regulators. We identified two highly conserved leucine residues within both the βarr finger loop and the Gα C-terminal α-helix, which engage a hydrophobic patch on GPCRs formed by TM3, TM5, and TM6 in a nearly identical manner, thereby stabilizing the complexes. Notably, the GPCR kinase N-terminal α-helix also contains hydrophobic residues that associate with this same receptor patch and are vital for the GPCR-GRK engagement. Our findings reveal a conserved hydrophobic interface that mediates direct competition among GPCR transducers and regulators suggesting a universal mechanism that governs receptor access and desensitization.
The domesticated silkworm (Bombyx mori) is an established model for investigating pesticide ecotoxicology in Lepidoptera. However, a systems-level integration of its molecular response networks across diverse pesticide classes is still lacking. This review synthesizes multi-omics, physiological, and biochemical data to construct a comprehensive framework for the toxicity of B. mori. Our analysis revealed that pesticide exposure universally disrupts energy homeostasis by inhibiting mitochondrial oxidative phosphorylation (OXPHOS) and dysregulating trehalose metabolism, culminating in severe ATP depletion. The resulting overproduction of ROS sequentially triggers major defense pathways, such as the PI3K/Akt, MAPK/CREB, and CncC/Keap1 pathways. These pathways coordinate the transcriptional activation of antioxidant enzymes and detoxification proteins, including P450s, GSTs, and CarEs, via ARE- and XRE-dependent mechanisms. Concurrently, pesticides induce autophagy-apoptosis crosstalk via calcium dysregulation and caspase cascade activation. This molecular disruption is compounded by the reshaping of the gut microbiota, characterized by the enrichment of opportunistic pathogens, such as Enterobacter, and the depletion of beneficial symbionts, such as Bifidobacterium, alongside the suppression of Toll/IMD/JAK-STAT immune signaling. This dual assault on immunity and metabolism creates a synergistic 'multi-hit' effect that dramatically increases susceptibility to pathogens, such as BmNPV. This integrated framework identifies the CncC-ARE axis, mitochondrial energy sensors, and gut microbiota-host interactions as central regulatory hubs and promising targets for intervention. By translating these mechanistic insights from silkworms to broader lepidopteran pests, this study provides a theoretical foundation for ecological risk assessment and biomarker discovery. Furthermore, it establishes a roadmap for developing targeted green pest management strategies with direct implications for advancing sustainable sericulture and precision pest control. © 2026 Society of Chemical Industry.
Blood is a key component of organisms, serving numerous functions, including metabolism, innate and humoral responses, and hemostasis. Variations in hematological parameters can indicate the presence of infectious and non-infectious diseases, chronic stress, and other pathological or physiological conditions. Complete blood count testing is common in human and veterinary medicine and, when combined with clinical examination, contributes to disease diagnosis and prognosis and the monitoring of therapeutic progression. Nevertheless, hematological analysis is not routinely performed in sheep due to the lack of case-specific reference intervals, complicating the interpretation of the results. Indeed, hematological parameters may be affected by various non-pathological (environmental, genetic, physiological) and pathological factors, and they require further understanding and relevant adjustments to be universally applicable. Therefore, the objective of this paper is to summarize the existing literature and describe how various pathological and non-pathological factors affect hematological parameters in sheep, thereby supporting their incorporation into health management practices.
Background: Body mass index (BMI) is widely used as a proxy of nutritional status and related lifestyle risk patterns in public health, yet it does not capture body composition-related heterogeneity in cardiometabolic risk. Evidence on whether a more detailed body composition assessment improves population-level screening efficiency remains inconsistent, particularly in Central European populations. Methods: We conducted a cross-sectional analysis of 868 Hungarian adults participating in a nationwide mobile screening program. Locally weighted regression identified sex-specific BMI inflection points for cardiometabolic risk. Stratified receiver operating characteristic (ROC) analyses compared BMI with bioelectrical impedance-derived parameters across five outcomes. Cost- and time-effectiveness of scalable screening strategies were modeled at the population level. Results: Cardiometabolic risk increased at BMI levels below current WHO thresholds (females: 21.8-22.3 kg/m2; males: 23.8-24.3 kg/m2). Overall, body composition parameters did not outperform BMI in the full population. Subgroup-specific differences were observed, particularly among men with BMI 24-36 kg/m2 for atherosclerosis risk, suggesting limited and outcome-specific added value rather than broad superiority over BMI. Together, non-linear risk patterns, stratified performance, and population-level modeling converged on mid-range BMI intervals (females: 22-30 kg/m2; males: 24-30 kg/m2) as likely screening windows of phenotypic heterogeneity. Within these ranges, targeted InBody assessment may help refine risk assessment for selected individuals. A mixed screening strategy covering 52% of the population would cost 178.4% of BMI-only screening, while reducing throughput by 24.3%. Conclusions: Population-specific BMI thresholds may more accurately reflect early deviations in nutritional and cardiometabolic risk than current universal cutoffs. BMI remains a useful first-line marker, and body composition assessment may add complementary information in selected BMI ranges. Overall, these findings support a potentially useful, subgroup-specific screening approach, but the modeled cost and time trade-offs should be considered hypothesis-generating and require further validation.
Uncorrected refractive errors (UREs) are a primary cause of preventable visual impairment in children globally, impacting education and quality of life. In Jakarta, prevalence has surged to 40% post-pandemic, categorizing it as a serious public health problem. This study aimed to develop and validate the CIPSEL questionnaire as a rapid, culturally adapted screening tool for identifying visual impairment consistent with possible UREs among Indonesian school-aged children. A cross-sectional study was conducted in South Jakarta with 131 students aged 8-12 years. The 10-item CIPSEL questionnaire, exploring visual behaviors and symptoms, was administered via face-to-face interviews. Visual acuity was assessed using a standard Snellen chart by medical personnel blinded to the questionnaire results. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis, with optimal thresholds determined via the Youden Index and the shortest distance to (0, 1). Visual impairment was identified in 26 students (19.8%). Mean CIPSEL scores were significantly higher in students with visual impairment (4.73) compared to those with normal vision (1.95). ROC analysis showed considerable diagnostic accuracy with an AUC of 0.887 (95% CI: 0.829-0.946). A safety-first cutoff of 2.5 prioritized sensitivity (96.2%), while a balanced cutoff of 3.5 provided 80.8% sensitivity and 79.0% specificity. A tiered risk system (Low, Medium, and High) demonstrated a robust statistical association with actual clinical findings (Cramer's V = 0.534, p < 0.001). CIPSEL is a reliable and scalable screening tool for the early detection of visual impairment in Indonesian children. Its tiered risk stratification framework facilitates nuanced clinical decision-making and efficient resource allocation in school-based settings. Its accessibility for non-medical personnel and potential for digital integration support national efforts toward universal eye health.
The use of resin-based composite imitating gum tissue enhances the aesthetics of fillings located below the physiological gum line. The shear bond strength (SBS) between the gum-imitating composite and the traditional composite with different surface preparation methods was examined. The aim of the study was to evaluate which base material-G-aenial Universal Injectable (GC, Japan, flow) or G-aenial A'CHORD (GC, Japan, paste)-performs better, as well as to determine the most effective preparation method among sandpaper (control), 36% orthophosphoric acid (H3PO4), sandblasting, and 9.5% hydrofluoric acid (HF). The tested gum-imitating material was Amaris Gingiva (VOCO, Germany). The connection between the composites was evaluated using a Z005 (Zwick-Roell) universal device. Surface tests were carried out using an SJ-410 (Mitutoyo) profilometer. Evaluation of the prepared surface structures was performed using scanning electron microscopy (HITACHI S-4700). Etching with HF significantly improved the shear bond strength between composites. Sandblasting also enhanced the adhesion results, but the H3PO4 group achieved comparable results to the control group. However, since HF is not recommended for intraoral use, sandblasting (30 μm aluminum oxide particles applied with three passes at constant speed under a pressure of 2 bar from 1.5 cm) appears to be the most suitable clinical alternative.
(1) Background: Megaprosthetic reconstruction of the knee is frequently required in limb salvage surgery for oncologic indications and in complex revision arthroplasty. The Modular Universal Tumor and Revision System (MUTARS) Total Knee prosthesis is widely used in these situations. The aim of this study was to evaluate revision-free implant survival following MUTARS Total Knee implantation and to compare outcomes between primary implantation and use as a conversion procedure after failure of a previous knee prosthesis. (2) Methods: A retrospective cohort study was performed including 36 patients who underwent MUTARS Total Knee implantation at a single institution. Patients were stratified into primary implantation (n = 24) and conversion after failed prosthesis (n = 12). The primary endpoint was time to first revision. (3) Results: Overall revision-free survival was 51.6% at 2 years and 29.3% at 5 years. No significant difference in revision-free survival was observed between primary implantation and conversion procedures (log-rank p = 0.67). When mechanical failure (Henderson type III) was considered as the sole endpoint, implant survival was substantially higher, with 88.3% survival at 2 years and 57.2% at 5 years. Infection-related implant survival was 72.0% at both 2 and 5 years. Secondary amputation was required in 7 of 36 patients (19.4%), with a higher proportion observed in the primary implantation group (25.0% vs. 8.3%). Most amputations occurred within the early postoperative period. (4) Conclusions: MUTARS Total Knee implantation is associated with a substantial revision burden; however, conversion after failed prosthesis did not result in inferior revision-free survival compared with primary implantation. Endpoint-specific analyses demonstrate that biological complications, particularly infection, represent the dominant drivers of early failure.
Background: Tile C1.2 pelvic ring injuries are characterized by combined rotational and vertical instability and require reliable posterior stabilization. The aim of this exploratory biomechanical study was to compare the construct-level mechanical behavior of three posterior pelvic ring fixation strategies in a standardized Tile C1.2 injury model while maintaining identical anterior symphyseal fixation in all specimens. Methods: Nine fourth-generation composite pelvic specimens with a simulated Tile C1.2 injury pattern were allocated to three groups (n = 3 per group) according to posterior fixation method: anterior sacroiliac plating, sacroiliac screw fixation, and ilioiliac plate fixation. All specimens received the same anterior symphyseal plate. Mechanical testing was performed under monotonic axial compression using a universal testing machine and a custom acetabular support designed to ensure reproducible load transmission. A preload of 50 N was applied before data acquisition, after which displacement was zeroed. Loading was then continued up to a predefined maximum load of 1.9 kN. Axial displacement was obtained from actuator travel, and apparent axial secant stiffness was evaluated at predefined load levels. Results: Across the tested loading range, sacroiliac screw fixation demonstrated the lowest axial displacement and the highest apparent axial secant stiffness, whereas ilioiliac plate fixation showed the greatest displacement and the lowest stiffness values. Anterior sacroiliac plate fixation showed intermediate mechanical behavior. No structural failure occurred within the tested load range. Conclusions: Within the limits of this small synthetic biomechanical study, the investigated posterior fixation strategies showed different construct-level displacement and stiffness profiles under monotonic axial compression when anterior fixation was kept constant. Among the tested posterior constructs, sacroiliac screw fixation was associated with lower displacement and higher apparent stiffness within this experimental model.
In this work, we show that by coupling in situ spectroscopic ellipsometry with a molecular beam epitaxy growth chamber, the growth parameters of ternary compounds with potential for quantum and spintronic applications can be immediately ascertained during the entire growth cycle of a sample. Initially, several films of (Bi x In1-x )2Se3 with stoichiometries ranging from x = 0 to x = 1 were grown and characterized by X-ray reflectivity, X-ray photoelectron spectroscopy, and Rutherford backscattering. Using this information, ellipsometry spectra were fitted by representing the dielectric functions with Kramers-Kronig-consistent oscillators. Consequently, composition-dependent dielectric functions of (Bi x In1-x )2Se3 were parametrized to create a material file that determines the Bi content of an unknown (Bi x In1-x )2Se3 film. By using this material file, therefore, both the Bi content and thickness of a (Bi x In1-x )2Se3 film can be obtained immediately at any stage of the growth cycle. We tested the model for universality among MBE growth systems and found that the model was transferable between systems. Furthermore, the generalized model allowed us to monitor sticking and desorption coefficients for Bi2Se3 thin films in operando for the first time, with significant implications for quantum and spintronic applications by enabling more reproducible and controlled device fabrication, advancing the understanding of emergent physics, and helping address future societal bottlenecks in electronic performance and demand.
In this paper, we investigate the application of the relative entropy framework for safety assessments of steel elements with structural defects at the micro- and macro-scales. Mathematical theories developed by Bhattacharyya and by Kullback and Leibler (K-L) have been used for this purpose. This approach uses both expectations and variations, similar to the First-Order Reliability Method (FORM), but is extended to include 3rd- and 4th-order central probabilistic moments. It is necessary to use a hybrid computational technique that combines the Finite Element Method (FEM) software ABAQUS CAE 2017 with the implemented Gurson-Tvergaard-Needleman (GTN) damage model and the computer algebra system MAPLE. The iterative generalized stochastic perturbation technique has been used to determine the probabilistic moments of structural response, to utilize the Weighted Least Squares Method to approximate the structural response function, and to determine uncertainty in the stress, strain, and displacement state functions. This approach is based on relative entropy because of its universality. There is no need to assume a type of distribution of the state functions, in contrast to FORM, where a Gaussian distribution is required. This paper verifies whether relative entropy can serve as an alternative to FORM for determining reliability. The yield surface of the porous material with a random values of the void volume fraction f are also presented.
Background: Nasal valve dysfunction (NVD) is a common yet underrecognized cause of nasal airway obstruction, with a significant impact on quality of life. Despite its clinical relevance, no universally accepted diagnostic standard exists, and optimal management remains debated. Multiple diagnostic tools and surgical or minimally invasive treatments have been proposed. This systematic review and meta-analysis aimed to evaluate current evidence regarding diagnostic approaches and treatment outcomes in NVD. Methods: A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library was performed for studies published between January 1990 and January 2026, in accordance with PRISMA 2020 guidelines. Randomized controlled trials, non-randomized comparative studies, cohort studies, and case series (≥10 patients) assessing diagnostic methods or therapeutic interventions for NVD were included. Diagnostic data were synthesized narratively. The primary surgical outcome was change in the Nasal Obstruction Symptom Evaluation (NOSE) score. Risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2 tools. Results: Seventy-two primary clinical studies were included (15 diagnostic, 57 treatment-focused). Objective airflow measurements, particularly rhinomanometry and peak nasal inspiratory flow, showed greater reliability than isolated clinical maneuvers. Imaging modalities provided anatomical detail but correlated inconsistently with symptoms. Meta-analysis of 12 studies (n = 1210 patients) suggests that both traditional surgical and minimally invasive interventions can substantially improve nasal breathing, with mean NOSE score reductions of 40-55 points, though heterogeneity precludes direct comparison of their relative effectiveness. Conclusions: Diagnosis of NVD requires a multimodal approach combining clinical assessment, validated symptom scores, and selective objective testing. Surgical and minimally invasive treatments provide substantial symptom improvement when appropriately indicated. Evidence is constrained by the predominance of observational data, emphasizing the need for standardized diagnostics and robust comparative trials.
Three-dimensional (3D) printing is increasingly used for the fabrication of definitive crowns; however, whether specific post-curing hardware is mandatory for clinical success remains a practical concern. This study provided a practical comparison evaluating the effect of two post-curing units on the biaxial flexural strength (BFS), Weibull modulus (m), Martens hardness (HM), indentation modulus (EIT), water sorption (WSP), and water solubility (WSL) of 3D-printed resins for permanent crowns, compared with a conventional resin composite. A total of 200 specimens were fabricated from two 3D-printed resins (Permanent Crown™ and CrownTec™) and a conventional resin composite (Filtek Universal Restorative™) used as a control. The 3D-printed specimens were post-cured using either a Formcure or an Otoflash G171 unit. WSP and WSL were measured after 90 days of water ageing, while BFS, HM, and EIT were evaluated after 24 h of storage using standardised methods. All materials exhibited WSP and WSL values within ISO limits, with the control group showing significantly higher values and superior mechanical properties. Among the 3D-printed resins, post-curing significantly affected only HM and EIT for Permanent Crown™ resin, with no significant differences in BFS. Overall, the tested 3D-printed resins demonstrated high processing stability across different curing protocols, suggesting that clinical performance remains consistent regardless of the post-curing unit used.
Imidodiphosphorimidate (IDPi) has emerged as a powerful chiral organocatalyst featuring a specially designed cavity constructed by aryl group-substituted BINOL units. Despite extensive applications of IDPi in asymmetric reactions, the understanding of its structure-selectivity relationship (SSR) remains underdeveloped. In this study, we employed aryl fragment descriptors for the statistical modeling of IDPi-catalyzed asymmetric reactions, offering a cost-effective and efficient approach to explore the SSR of IDPi. Specifically, site parameters of remote sp2 carbon atoms were defined to capture the features of the distal ring of the aryl substituents. The established statistical models of IDPi-catalyzed cyanosilylation reactions align well with the mechanistic understandings of the crucial role of C-H···π and cation-π interactions between the distal ring of IDPi and substrate in stereo-control. More selective catalysts for the challenging cyanosilylation reaction of 3-hexanone were successfully identified by using these descriptors to define and screen the chemical space of IDPi catalysts. This work not only enriches our understanding of the SSR of IDPi catalysts but also highlights the potential application of aryl fragment and remote site parameters as universal descriptors for IDPi in statistical modeling.
Health care workers (HCWs) are at increased occupational risk of acquiring blood borne infections like Hepatitis B, Hepatitis C and HIV. To mitigate this risk, the Ministry of Health and Family Welfare recommends a three-dose prophylactic Hepatitis B Vaccination at 0,1 and 6 months for all the HCWs, who have not completed their vaccination series. However, there is insufficient baseline data on Hepatitis B virus (HBV) vaccination coverage among HCWs in tertiary setting, posing challenges to strategic planning and implementation for partially or incompletely vaccinated cohorts. This perspective highlights the critical role of healthcare managers in operationalizing HBV vaccination programs at multiple levels within the tertiary healthcare institution. It discusses the key managerial challenges encountered at the top level that includes: prolonged approval timelines, budgetary constraints, and sustaining the integration with the Universal Immunization Program demand. The challenges at middle level include maintaining updated vaccination records amidst frequent staff turnover; and at the low level: ensuring timely reminders and follow-ups for subsequent vaccine doses. Drawing on real-world experiences, this perspective underscores the importance of coordinated managerial efforts to strengthen vaccine delivery systems and achieve complete HBV vaccination coverage among HCWs.
Background: Malnutrition is a universal challenge in long-term care, significantly affecting vulnerable populations. Residents with Intellectual Developmental Disability (IDD) rely heavily on Direct Support Professionals (DSPs) for assisted feeding. Understanding DSP's mealtime experiences is essential for improving nutritional care and well-being. Objective: To examine multilevel factors associated with DSPs' mealtime experiences. Methods: This exploratory cross-sectional case study used a survey administrated to DSPs working in a long-term residential setting. Statistical analyses examined the associations between multilevel factors and DSP's positive and negative mealtime experiences. Results: The sample included 46 DSP's (98% women) from a single facility in Israel. Although DSPs reported high levels of positive feelings and satisfaction with their daily work efficacy, negative feelings were significantly associated with some organizational, environmental and resident-related factors. Negative feelings were higher among DSPs caring for residents who use wheelchairs compared to those working with residents who do not use wheelchairs (t = -2.99, p < 0.01). Negative feelings were negatively associated with institutional support (r = -0.49, p < 0.001), and perceived accessibility and adaptability of the environment (r = -0.46, p = 0.001), and showed a more modest association with communication with residents (r = -0.38, p = 0.01). DSPs' seniority, education level, and prior feeding-related training were not significantly associated with mealtime experience. Conclusions: The findings highlight that negative mealtime experiences among DSPs are associated with organizational, environmental, and resident-related factors, rather than with individual DSP's characteristics. Policy and practical adjustments to address mealtime experiences for residents with IDD are suggested.
Autism spectrum disorder (ASD) is highly heterogeneous in symptom onset and severity, comorbidities, and treatment responsiveness, challenging the notion of a single pathogenic mechanism. Increasing evidence indicates that some individuals with ASD exhibit prominent peripheral physiological alterations, including gastrointestinal (GI) dysfunction, gut microbial dysbiosis, immune imbalance, oxidative stress, and mitochondrial/energy metabolic vulnerability. In this context, gut-derived metabolites-particularly short-chain fatty acids (SCFAs)-have emerged as plausible modulators of the neurodevelopmental milieu through the expanded gut-immune-metabolic-brain axis. This review synthesizes: (i) SCFAs' biogenesis and physiological roles, (ii) context- and developmental stage-dependent effects, (iii) the clinical heterogeneity of reported microbiome and SCFA alterations in ASD, and (iv) propionate as a frequently discussed candidate signal and the interpretive boundaries of preclinical evidence. Human studies show substantial inter-study variability in SCFA alterations (increases, decreases, or no differences), influenced by factors such as sample type (stool vs. blood), GI symptoms, diet, medication exposure, and analytical variability. Accordingly, SCFAs should not be treated as universal ASD biomarkers but rather as context-dependent metabolic signals relevant under specific clinical and biological conditions. Building on this premise, we propose the conceptual framework of "metabolic ASD" representing a metabolically informed dimension of biological variability in which peripheral metabolic-immune perturbations may contribute to neurodevelopmental vulnerability. To avoid premature causal claims, we outline design requirements for future research, including stratified study designs, longitudinal cohorts, and integrative multi-layer analyses. Ultimately, metabolic ASD should be positioned as a testable precision medicine research framework rather than a universal etiological model.