This study evaluated the effectiveness of a brief, Theory of Planned Behavior-based educational program on weight management and related health outcomes among university employees. In this quasi-experimental study conducted at two major universities in Erbil, Iraq, 200 employees with a body mass index (BMI) ≥ 25 kg/m² self-selected into an intervention (n = 100) or control (n = 100) group. The intervention consisted of five individual 35-40-minute sessions delivered over 12 weeks and covered obesity awareness, culturally adapted nutrition education, physical activity, and behavior-change strategies. The control group received only standard written materials. Primary outcomes were changes in body weight, BMI, and waist circumference. Secondary outcomes included lipid profile, fasting glucose, quality of life (Impact of Weight on Quality of Life-Lite [IWQOL-Lite]), dietary quality, and physical activity. All assessments were performed at baseline and 12 weeks. The intervention was associated with a mean weight loss of 7.46 kg (95% CI 6.44-8.48) compared with a gain of 0.58 kg in the control group (adjusted difference - 8.04 kg; p < 0.001; Cohen's d = 2.40). 79% of intervention participants lost ≥ 5% of their initial body weight (versus 0% in controls), and 41% lost ≥ 10%. Significant improvements were also observed in BMI, waist circumference, lipid profile, quality of life, and dietary quality (all p < 0.001; d > 1.8). Mediation analysis indicated that improvement in dietary quality accounted for 82% of the observed association between group assignment and change in BMI. A brief, low-cost, culturally adapted educational intervention delivered in the workplace was associated with exceptionally large weight loss, cardiometabolic benefits, and psychosocial gains, with perfect retention. These findings suggest that this model may offer a promising approach for obesity management in Middle Eastern settings. However, confirmation in randomized controlled trials with longer follow-up is required before firm conclusions regarding scalability and effectiveness can be drawn. The study was not prospectively registered in a clinical trial registry because it employed a quasi-experimental design with participant self-selection rather than random allocation. However, the full study protocol including all primary and secondary outcomes, eligibility criteria, intervention details, and the statistical analysis plan was finalized, approved by the Hawler Medical University Ethics Committee (reference HMU-REC-2024-18, 15 September 2024), and locked prior to the start of participant recruitment and data collection. No outcomes were added, removed, or modified after data inspection, and no post-hoc analyses were conducted beyond those pre-specified in the protocol. The manuscript adheres fully to the TREND reporting standards for non-randomized evaluations.
The commitment of health personnel in initiatives for improving their working conditions is recognised as a key condition for the success and the sustainability of such initiatives. Healthcare organisations are faced with the challenge of deploying strategies needed to mobilise this commitment. The objective of this article is to present the results of a qualitative evaluation of a bottom-up co-construction project aimed at engaging oncology staff in four Québec healthcare organisations in a process of transformation and improvement of their working environment. As part of our constructivist approach, we utilised a qualitative method, which involved conducting one-on-one interviews and gathering documentary data, including survey results, to assess the development and implementation of an intervention across four oncology units. We conducted one-on-one interviews from January 26, 2023 to March 5, 2023 with 17 workers from different categories. We collected documentary data that cover the pre-implementation activities, the co-construction workshops, and the intervention implementation. All collected data were coded and analysed using QDA Miner 6.0, and our findings were validated iteratively throughout the project, involving regular interaction with participants. Fourteen areas of vulnerability emerged across the four dimensions studied, and six were targeted by workers as priorities: emotional exhaustion; role conflict; ability to learn; leadership; team cohesion; and communication. Interventions developed to address the prioritised areas included: co-development workshops; training sessions aimed at enhancing workers' control over their working environment; team connectivity through professional and social activities; staffing and workload reviews; support from a psychosocial professional; and coaching. According to workers, most improvements occurred in two targeted areas, team cohesion and communication, even in the units where these issues were not prioritised at first. Participants pinpointed some factors that facilitated the implementation of the intervention and its impact (engagement, organisational support, the bottom-up approach) and others that created constraints (staff shortages, conflicting priorities, level of commitment). This exploratory work offers insightful perspectives on how a bottom-up co-construction approach can serve as a lever to engage workers to improve their work experience. It may inspire other healthcare organisations, both in oncology and in other fields of activity.
Los Angeles County-wide criminal justice reform and policy decision-making focused on reentry and diversion from incarceration usually include only the voices of law enforcement and other public-sector employees, with little input from impacted community members. The Reentry Health Advisory Collaborative (RHAC), founded in 2020 with grant funding, was established to engage formerly incarcerated individuals and their communities in county safety-net health systems. We aimed to assess the impact of RHAC and the importance of formerly incarcerated community input in safety-net programs and policymaking. In 2022, following 3 years of RHAC implementation, online qualitative surveys were conducted with RHAC members and reentry service collaborators, including agency staff, nonprofits, and policymakers, to understand RHAC's influence and how lived experiences inform justice and health systems. Thirty replies from collaborators (59%) and eight from members (100%) resulted in thematic findings that highlighted benefits of involving formerly incarcerated persons in program and policy decisions-such as their firsthand experiences, focus on root causes, and community and socioeconomic tailoring approaches-and challenges like limited political power, varying receptiveness to ideas and inclusion, and a lack of sustainable funding. Members shared outcomes like motivation, peer support, leadership skills, and advocacy training needs. Recommendations for future inclusion emphasized promoting awareness and strategies for relationships with public-serving institutions, early inclusion for impacting pivotal decision-making, and continued engagement with the community through on-the-ground grassroots efforts. Barriers to reentry included basic needs, access issues, lack of support, and discrimination. Compensating lived experience in health and justice services promotes inclusive, equitable policies that reflect community needs.
Objectives. Proper use of personal protective equipment (PPE) is essential for worker safety, but many employees fail to use it correctly due to limited knowledge, negative attitudes and low perceived control. This study assessed the effectiveness of a health belief model (HBM)-based educational intervention on PPE use among factory workers in Yasuj. Methods. This quasi-experimental study (2022-2023) randomly assigned 109 workers were to experimental (n = 56) and control (n = 53) groups. The intervention included six 60-min in-person sessions delivered by a researcher and an occupational health expert. Data were collected via an HBM-based questionnaire before and 2 months after the intervention. Statistical analyses included paired t tests, independent t tests and χ2 tests using SPSS version 27. Results. Pre-intervention assessments showed no significant differences between groups (p > 0.05). Post intervention, the experimental group demonstrated significant improvements in all HBM constructs - knowledge, attitudes, perceived susceptibility and severity, perceived benefits and barriers, self-efficacy, guidance for action - as well as PPE-related behavior (p = 0.001). Conclusion. HBM-based educational interventions effectively enhance PPE usage by improving knowledge, shaping positive attitudes and addressing perceived barriers and benefits. These findings support structured educational programs as a key strategy for promoting workplace health and safety.
The role of age diversity has increased attention in organizations with the focus of collaboration between younger and older employees. The present study aims to investigate the perceptions of younger generation towards others with respect to organizational commitment, trust and job satisfaction in the healthcare field, particularly in nursing. A quantitative survey was conducted to collect data from 696 working young professionals in nursing within the healthcare sector in Pakistan. Structural equation modeling was employed to examine the relationships among the variables using Smart-PLS Software version 4.1.0.9. The obtained results show that the perceptions of working professionals from Generation Z with respect to generational stereotyping, positive effect and inclusiveness about other generations are positively correlated with trust and job satisfaction by mediating role of organizational commitment in the nursing sector. Research highlights perception of Generation Z at workplace impacted on trust, satisfaction, and commitment and closely connected to improved quality of work life. The study contributes to the existing literature on nursing management of intergenerational interactions. It advocates for redesigning systems to focus on development and well-being within the nursing sector.
The antiviral protein MORC3 is frequently inhibited by viruses. To counteract viral antagonism, MORC3 represses a noncanonical pathway of type-I-interferon (IFN) such that viral inhibition of MORC3 triggers ( > 10,000-fold) IFN induction. How MORC3 represses this pathway, and why IFN induction upon MORC3 loss is so potent without canonical IRF3/7 transcription factors, is unknown. Here, we show that MORC3 restricts chromatin accessibility at tandem repeat elements harboring up to 61 homotypic transcription factor motifs. One such element becomes a potent enhancer of IFNB1 upon MORC3 loss. Its motif cluster contains 45 PU.1 binding sites and is necessary and sufficient for MORC3-mediated repression and enhancer activity upon MORC3 loss. PU.1 recruits MORC3 to repress this enhancer by recruiting DAXX and enabling H3.3 incorporation. Upon MORC3 loss, PU.1 drives IRF3/7-independent IFN induction. Other restricted tandem repeats contain homotypic motif clusters of SPI, AP-1, and SP/KLF transcription factors. Our findings uncover a TF motif cluster-driven repression mechanism by MORC3 at tandem repeats, enabling specific repression of an IFNB1 enhancer such that viral antagonism of MORC3 induces interferon.
Leucine-rich-repeat-containing protein 15 (LRRC15) is selectively expressed on cancer-associated fibroblasts (CAFs) and constitutes a promising biomarker for imaging the tumor microenvironment. Using a combinatorial library approach, assisted by machine learning, we developed disulfide-constrained peptides (DCPs), notably ML-YSD-07 and ML-PD-03, that demonstrate subnanomolar affinities for murine LRRC15 (muLRRC15) and specifically localize onto muLRRC15-expressing fibroblasts. PET imaging with 18F-radiolabeled ML-YSD-07 exhibits specific tumor accumulation in a murine pancreatic cancer model highly enriched with LRRC15-expressing CAFs. Crystal structures of apo-muLRRC15 and of ML-YSD-07-bound muLRRC15 show that the DCPs evolved to adopt a distinct binding conformation that efficiently interacts with a flat epitope on muLRRC15. Collectively, this work identifies potent, molecularly engineered LRRC15-binding peptides and further highlights LRRC15 as a valuable CAF biomarker for cancer imaging applications.
Accurately measuring vaccination coverage is crucial for programmatic and policy decision making, however accurate measurement of coverage can be challenging. We aimed to understand the extent of, and reasons for, inaccurate vaccination card records in a rural, low-income setting in Jigawa state, Nigeria. We conducted an explanatory sequential mixed-methods study in Kiyawa Local Government Area, Jigawa State, from September 2022 to July 2023, using data from the INSPIRING Jigawa trial (ISRCTN39213655). Quantitative data was gathered from surveyed women aged 16-49 in sampled compounds, who presented their child's vaccine card. Vaccine documentation was defined as inaccurate when the vaccine card is discordant with caregiver report. Adjusted logistic regression identified factors associated with inaccuracies. We conducted in-depth interviews with healthcare workers and focus groups with community members, analyzing transcripts using conventional content analysis, and triangulated findings with quantitative results. Records for 4258 children under five-years, from 3232 women, were examined. Of these children, 441 (10.4%) had vaccine cards that were deemed inaccurate by their caregivers. Inaccuracies were primarily attributed to cards being filled despite the child not receiving the vaccine, misplacement or loss of vaccine cards, vaccine stock-out when cards had already been filled, and vaccine card stock-out when the vaccine had been administered. Our adjusted logistic regression results show the following variables were associated with reporting inaccurate vaccine cards (under or over-reporting): any education compared to none (adjusted odds ratio (aOR): 1.33, 95%CI: 1.03, 1.75), having co-wives compared to no co-wife (aOR: 0.78, 95%CI: 0.62, 0.98), and child's age: 12-24 months compared to < 12 months (aOR: 2.70, 95%CI: 1.94, 3.75) and 25 months and above compared to < 12 months (aOR: 2.30, 95%CI: 1.69, 3.12). Our qualitative findings highlighted maternal lack of knowledge of vaccination schedule and forgetfulness about the vaccination schedule as common reasons for vaccine card inaccuracy. We identified health system failures and caregiver barriers leading to inaccurate reports in vaccine cards. It is essential to sensitize caregivers and healthcare providers on the importance of accurately documenting vaccines and validating immunization recording systems. Not applicable.
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Treatment for mucopolysaccharidosis II (MPS II; Hunter syndrome) via enzyme replacement therapy with intravenous idursulfase (Elaprase) has been available for over 15 years. This treatment has led to survival of more patients into adulthood and a concomitant rise in the need for transition of care from paediatric to adult care teams; however, implementation of transition pathways is not standardized. This cross-sectional, non-interventional, multi-country qualitative interview study recruited patients with MPS II (n = 13), caregivers of patients with MPS II (n = 23) and healthcare professionals (n = 24) across six countries (Canada, Colombia, Germany, Mexico, the UK and the USA) to investigate approaches to transition of care in MPS II. Data were collected via a sociodemographic questionnaire, a clinical characteristics form and semi-structured interviews. The interviews identified four overarching themes: transition of care approaches and their drivers, components of a successful transition programme, challenges or barriers to transitioning to adult care and suggested improvements to transition of care. Transition pathways showed high variability within and between countries. Participants reported essential items for successful transition, including continuity of care, a key contact person and empowering patients as early as possible in the process. Proposed improvements for transition included additional educational/support resources, psychological support and implementation of protocols to guide a standardized approach. Our study highlights the need for the establishment of common standards for the transition of care from paediatric to adult services for patients with MPS II. Based on the interview responses, we have proposed additional considerations for patients with neuronopathic MPS II. The findings may inform the development of effective transition practices for MPS II and other rare diseases, to optimize the transition of care experience for patients, caregivers and healthcare professionals.
High-quality pharmacoepidemiological research is essential for credible real-world evidence (RWE). This expert consensus-based review explores how pharmaceutical Quality Management Systems (QMS) developed for studies using primary data collection (e.g., clinical trials, registries) can be adapted to support studies utilising secondary data to generate RWE, in line with regulatory expectations. The aim was to identify fit-for-purpose considerations for proportional oversight, data integrity, and regulatory-grade evidence generation. An international working group (WG) comprising RWE experts from industry, academia, and independent consultancy (including QMS specialist) assessed which elements of QMS frameworks developed for primary data collection are applicable to RWE studies utilising secondary data sources and those elements where adaptation would be required. Using the Nominal Group Technique, the WG identified and prioritised relevant quality systems and adaptation needs. In parallel, a targeted literature review of guidance and reports from International Coalition of Medicines Regulatory Authorities (ICMRA) member sites (focusing on the EU, USA and UK) assessed guidance against prioritized quality systems. Of 21 quality systems identified, 12 were considered most relevant to RWE studies utilising secondary data, with ten requiring contextual adaptations. The literature review identified 26 publications referencing one or more of these systems; quality manuals (69.2% (n = 18)) and quality control (34.6% (n = 9)) were most frequently addressed, whilst other systems were inconsistently covered; vendor management was not explicitly addressed. Overall, this review highlights the need for fit-for-purpose adaptation of existing QMS frameworks to support regulatory-relevant, scientifically robust RWE generated from secondary use of existing data sources.
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Anti-programmed cell death-(ligand) 1 (anti-PD-[L]1) agents are approved for advanced and early-stage cancers. While they may offer clinical and economic benefits in the neoadjuvant and/or adjuvant setting, their population-level impact in Italy has not been thoroughly evaluated. This study aims to estimate health and productivity outcomes of introducing anti‑PD‑(L)1 agents for neoadjuvant and/or adjuvant therapy in early‑stage cancers in Italy (melanoma Stage IIB/C, melanoma Stage III, renal cell carcinoma, triple‑negative breast cancer and resectable non‑small‑cell lung cancer) over a 10-year horizon. We developed a model synthesising outputs from five indication-specific Markov models comparing two worlds: one without anti-PD-(L)1 agents use in the neoadjuvant and/or adjuvant settings versus one with their use. Italian-specific population and incidence inputs were used, with clinical and quality-of-life data from individual trials, from a societal perspective with 3% annual discount. Outcomes included total life years (LYs), recurrence- free (RF)/event-free (EF)/disease-free (DF) LYs, quality-adjusted LYs (QALYs), number of recurrences/events, metastatic treatments, total deaths and deaths after first event/recurrence. Productivity gains were estimated using a human capital approach. Between 2025 and 2034, 118,329 patients with early-stage cancer were estimated to be eligible for anti-PD-(L)1 agents in Italy. Compared with no early-stage use, neoadjuvant/adjuvant use was associated with increased total LYs (+ 20,458, + 5%), RF/EF/DF LYs (+ 60,631, + 19%), QALYs (+ 21,093, + 6%) and fewer recurrences/events (- 20,209, - 33%), metastatic treatments (- 25,220, - 38%), total deaths (- 7137, - 24%) and deaths after first event/recurrence (- 8021, - 32%). Productive years gained were 35,897 (+ 30%). Our study suggests that the use of anti-PD-(L)1 agents in early-stage cancers is associated with substantial health and societal gains in Italy. Expanding their use across approved indications translates trial benefits into fewer recurrences, deaths and productivity losses, informing national planning and access decision.
Automated tools quantifying multiple sclerosis (MS) imaging biomarkers often require non-routine MRI sequences and lack MS reference data. We developed an open-source quantitative report (QReport) that integrates validated 3D T2-FLAIR quantification methods with multi-centre MS and healthy reference models, and presents outputs in a structured graphical report to support contextualised interpretation of clinically relevant biomarkers. 2516 cross-sectional 3D T2-FLAIR scans from people with MS (pwMS) and healthy controls (HC) were retrospectively collected from 14 centres within Magnetic Resonance Imaging in MS (MAGNIMS) and affiliated sites, as well as open-source datasets. Validated T2-FLAIR-based algorithms quantified total and regional lesion count (LC), lesion volume (LV), brain volume (BV), and brain age gap estimation (BrainAGE). Distributions in pwMS and HC were estimated using quantile regression. A QReport was designed to present biomarkers and reference models in graphical formats. Four neuroradiologists assessed agreement between QReport outputs and their visual assessment, and evaluated its usefulness, in 22 cases. We analysed scans from 1723 HC (age, mean ± SD: 54.5 ± 16.0; range: 18-75; F/M: 949/774) and 793 pwMS (age, mean ± SD: 43.0 ± 11.1; range: 18-75; F/M: 538/255) across 14 centres. The QReport presents single-subject measures contextualised against the 95th, 50th, and 5th percentile distributions in pwMS and HC, and includes BrainAGE. In 94% of evaluations, QReport outputs demonstrated Moderate-to-Complete agreement with visual assessment and were rated as useful in 82%. We developed an MS QReport requiring only 3D T2-FLAIR, integrating validated quantification algorithms and incorporating BrainAGE within a clinically interpretable framework.
Variability in the clinical presentation of patients with type 2 diabetes (T2D) is high and underlines the need for more personalized patient care. This nationwide study aimed to describe characteristics, treatment patterns, and disease progression of Finnish patients with T2D (N = 302,987), and to identify patient clusters with distinct progression patterns based on the occurrence of diabetes-related complications. The study included all adult patients with incident T2D in Finland between 2010 and 2019. Data were collected from national health and social care registers, data lakes, and a private healthcare provider between 1996 and 2021. Patient clusters were identified based on disease progression, defined by the occurrence of 22 pre-defined end-points, using likelihood-based growth mixture modeling. Five patient clusters with stable (C1; n = 133,951), mild (C2; n = 52,819), moderate (C3, n = 43,488), rapid (C4; n = 10,159), and extremely rapid progression (C5; n = 1973) were identified. The mean number of end-point complications per patient at baseline ranged from 0.2 to 2.3 across clusters and remained stable in C1-C3 over the first 5 years. In C5, the number increased to 5.5 and 7.2 during the first and third follow-up years, respectively, with a similar but more modest annual increase observed in C4. Cardiovascular complications increased more rapidly in C5 and C4 than C1-C3. T2D medication use was more common in milder clusters, whereas 31.4% and 48.2% of patients in C4 and C5, respectively, had no T2D medication. The rate of certain infections and values of creatinine, hemoglobin, and erythrocytes, increased with cluster severity. Diagnosis of several other new conditions, particularly cardiovascular complications, at or soon after incident T2D diagnosis predicts poor prognosis. The results further support a comprehensive approach in diabetes care, including evaluation and treatment of cardiovascular diseases alongside glycemic control. It is well known that people with type 2 diabetes can experience the disease in different ways, with wide variation in symptoms and disease progression. To support more personalized care, clinically useful tools that can predict how the disease will develop are needed. The researchers analyzed nationwide health register data from Finland, including all patients who received their first diagnosis of type 2 diabetes between 2010 and 2019. Their goal was to group patients into clusters with different long-term disease progression patterns, based on the development of diabetes-related complications after diagnosis. In total, the study included 302,987 patients with type 2 diabetes. These patients were divided into five clusters showing either stable (cluster 1), mild (cluster 2), moderate (cluster 3), rapid (cluster 4), or extremely rapid (cluster 5) disease progression. Further analysis showed that having additional conditions diagnosed at, or shortly after, the onset of diabetes was linked to a worse prognosis. Notably, 18.6% of patients did not purchase any diabetes medication during the follow-up period. This proportion was particularly high in patients allocated to cluster 4 (31.4%) and cluster 5 (48.2%). This study shows that patients with type 2 diabetes can be classified into meaningful groups with different progression patterns. This approach may help clinicians make timely and cost-effective decisions, focusing resources on patients most likely to benefit from early and intensive treatment.
Research suggests long-term developmental implications of prenatal opioid exposure (POE) that may contribute to healthcare and educational service utilization patterns, such as lower utilization of preventative healthcare services, higher utilization of emergency department and inpatient services, and higher utilization of supportive educational services. However, research on how families navigate these services, including challenges and benefits, is limited. Parents and caregivers of children with POE worked with the study team to design, collect, and descriptively analyze mixed-method data. Data were collected through a survey (n = 148) and two focus groups (n = 15) from a convenience sample, 75% in West Virginia and Massachusetts. The vast majority of children in the sample received some type of supportive service, with Early Intervention (80%) and/or Individualized Education Plans (39%) being the most commonly reported. Additionally, children commonly received outpatient services such as occupational therapy (35%) or mental health counseling (31%), among others. Caregivers expressed navigating significant challenges in trying to access services for their children with POE, from a fractured and complex system to providers who do not see their child's struggles or believe they are connected to POE. Utilization patterns did not vary between children with just POE and children with exposures to additional substances prenatally. Based on families' reported experiences, investments in professional development for pediatricians and educators, a clinical understanding of the long-term implications of POE, best practices beyond the NICU, more integrated screening and services, and greater access to mental health services are top priorities.
Lack of access to rehabilitation perpetuates health inequities in equity-denied groups, but evidence on populations most affected by inequitable access to rehabilitation is fragmented. We conducted a scoping review using the Joanna Briggs Institute methodology to identify groups experiencing inequities, barriers to access, the methods used to study (in)equitable access and the interventions used to address it. We searched MEDLINE (via Ovid), Embase (via Ovid) and CINAHL (via EBSCOhost) for studies investigating equitable access to rehabilitation. We screened titles, abstracts, and full texts against predefined eligibility criteria. Out of 3,674 articles identified, 209 studies met the inclusion criteria. Data were extracted on study characteristics (e.g., country of origin), target populations, methodology, barriers to access, and intervention types. The extracted data were organized and categorized using the PROGRESS-Plus equity framework and the Candidacy 2.0 conceptual framework. The majority of included studies were conducted in the USA (n=115), Australia (n=32), and Canada (n=26). Most included studies compared access between groups (e.g., Black/White) (n=130), explored barriers to access (n=26), or examined the impact of rehabilitation policies (n=22). The most commonly reported barriers were the cost of services (n=12) and transportation (n=11). There is an abundance of literature demonstrating disparities in access, with very little research focused on improving access. More robust data infrastructure, including data on structural determinants of health would provide a more nuanced understanding of access to rehabilitation for equity-denied groups.
Immune responses elicited by natural infection of the coronavirus SARS-CoV-2 (COVID-19) show significant heterogeneity in the magnitude and quality of memory T and B cell responses. However, little is known about the contributing factors. In this study, we investigated the early immune factors that contribute to this variability using RNA-seq, targeted proteomics, and flow cytometry analyses. Specifically, we sought to investigate associations between early immune responses and SARS-CoV-2 memory immunity in a longitudinal cohort of 46 individuals hospitalized for COVID-19 from May 2020 to March 2021. These participants returned for follow-up visits up to one-year post-hospitalization where we characterized antibody titers, antibody neutralization, antibody durability, and cellular memory T and B cell responses with multiple assays. Additionally, using integration analysis of Omic measurements, we identified common genes, proteins, and cellular pathways associated with differential memory response outcomes. Our data suggests that high levels of inflammatory proteins, and co-stimulatory molecules during the early stages of COVID-19 lead to enhanced memory T and B cell responses and improved durability. Alternatively, molecules that have a negative effect on dendritic cell maturation including TNFSF11 and FLT3LG correlated with suboptimal memory immune responses. Importantly, we were able to identify early markers that are positively and negatively associated with durable antibody responses in infected participants. This study provides a unique and thorough examination of both innate and memory immunity in the same patients over time, offering valuable insights into the long-term durability of SARS-CoV-2 immunity.
This study aimed to quantify respiratory muscle strength in infantry recruits during the Phase 1 Combat Infantry Course (CIC) to identify if respiratory muscle weakness was present. Seventy-six British Army infantry recruits volunteered to participate in the study with 36 participants completing the full data collection period. The strength of participants' inspiratory and expiratory muscles was assessed at weeks 1, 6, and 12 of the course. Mean inspiratory and expiratory muscle strength increased during the 12-week course by 13.8% and 11.5%, respectively. However, of the recruits remaining in the course at week 12, ~20% produced inspiratory and expiratory values below their age predicted value. The exact cause of the increase in respiratory muscle strength is unknown. Likely contributory factors include an increase in volume and/or intensity of physical exercise and a training adaptation resulting from progressive load carriage training. It was concluded that there are individuals with respiratory muscle strength below age predicted values at the end of the 12-week CIC; the impact of this finding on military task performance should be explored.