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Postoperative insomnia is one of the common complaints caused by spinal metastatic cancer surgery. It affects patients' functional recovery, greatly reduces their quality of life, and adversely impacts disease prognosis. Compared with traditional pharmacological treatments, acupuncture is an alternative therapy for postoperative insomnia. However, standardized, high-quality randomized controlled trials on electroacupuncture for postoperative insomnia in patients with spinal metastasis (SM) are scarce, and there is a lack of clear inclusion criteria for this specific population. Postoperative insomnia in patients with SM has distinct clinical characteristics compared with general cancer-related insomnia, necessitating targeted investigation. This study aims to evaluate the efficacy and safety of electroacupuncture in the treatment of postoperative insomnia in patients with SM, and to provide high-level clinical evidence for the inclusion of electroacupuncture in the clinical management plan of postoperative insomnia in patients with SM. This is a study protocol for a randomized controlled trial. We will randomly assign 196 patients with insomnia after spinal metastatic cancer surgery to the acupuncture group (n=98) or the control group (sham acupuncture group; n=98). All participants will be treated on the first day after surgery and receive 12 sessions in total (30 min per session, 3 sessions per wk for 4 weeks). The primary outcome is the change in Pittsburgh Sleep Quality Index score from baseline to post treatment (wk 4). The secondary outcomes include actigraphy records (sleep efficiency, number of sleep awakenings, total sleep time, sleep latency, and wake after sleep onset), Insomnia Severity Index, Spine Oncology Study Group Outcomes Questionnaire 2.0, and Patient Health Questionnaire-9. All results will adhere to the intention-to-treat principle and will be evaluated at baseline, posttreatment (wk 4), and follow-up (wk 12). This study was funded in June 2023 (supported by the Project of Shanghai Municipal Health Commission, National Natural Science Foundation of China, etc). Recruitment will start in mid-2026 and end in December 2027. Data collection will be completed in October 2027, and data analysis is expected to be finished in December 2027. The results of this study are anticipated to be published in the first half of 2028. This study is designed to rigorously assess the therapeutic value of electroacupuncture for postoperative insomnia in patients with SM. If proven effective, electroacupuncture is expected to become a safe and feasible alternative or complementary therapy for this population, reducing reliance on hypnotic drugs and improving patients' quality of life and prognosis. The results will fill the gap in current clinical evidence for electroacupuncture in the treatment of spinal metastatic postoperative insomnia and provide a basis for the optimization of clinical treatment strategies.
Long-term exposure to indoor fungal bioaerosols is a recognised risk factor for respiratory illness, particularly in damp and poorly ventilated housing. However, the diversity and seasonal variability of these fungal communities are poorly understood. As part of the West London Healthy Home and Environment Study (WellHome), this study aimed to characterise the composition, diversity, and temporal dynamics of indoor fungal bioaerosols in urban UK homes, as compared with outdoor air, to inform future exposure baselines and policy development. In this prospective, community-based observational study, 118 households were recruited across West London, UK, via community networks and partner organisations, prioritising families with children aged 5-17 years with asthma or allergies, from diverse socioeconomic backgrounds. Sampling occurred between Oct 3, 2022, and June 14, 2024. Participant data were collected via questionnaires completed by household members, capturing demographics, building characteristics, and respiratory health. Passive-air samplers were used in living rooms for 28 days during two seasonal campaigns, with concurrent outdoor sampling at four fixed community sites. Fungal bioaerosols were identified by ITS2 amplicon sequencing and quantified using broad-range quantitative PCR targeting the 18S rRNA gene. Diversity indexes and temporal dynamics were analysed using ecological statistics and generalised additive models. 118 households were enrolled, comprising 504 residents (263 women, 237 men, and four not reported). Among 504 participants who self-identified, the largest groups comprised individuals identifying as Black African (n=47), Somali (n=46), White British (n=42), and African (n=38), with additional representation from mixed race ethnic backgrounds (n=29), Black British (n=27), White (n=22), and Black Caribbean (n=18), alongside several other ethnicities each represented at lower frequencies. Of 118 households, 104 completed both seasonal campaigns and 14 completed one, yielding 262 air samples (222 indoor and 40 outdoor). DNA was successfully recovered from all samples, identifying 2027 fungal genera. Indoor environments showed significantly higher richness (mean 646 vs 495 amplicon sequence variants; p<0·0001) and Shannon diversity (4·21 vs 3·53; p<0·0001) than outdoors. Community composition differed markedly (permutational multivariate ANOVA p<0·0001), with Penicillium, Aspergillus, and Wallemia enriched indoors. Indoor fungal communities presented stronger seasonal cycling (R2=0·203) than outdoor communities (R2=0·012). Fungal burden across all homes had a median 11 043 genomic equivalence (GE); IQR 4598-20 579 GE. The highest levels were observed in homes with visible mould; one household showed elevated Aspergillus exposure linked to repeated asthma hospitalisations in a sensitised resident. Indoor fungal bioaerosols are more diverse and dynamic than outdoor communities in urban UK homes. These findings establish foundational exposure data and highlight the need for incorporating fungal bioaerosol monitoring into public health policy to mitigate mould-related health risks. UK Research and Innovation (UKRI) Strategic Priorities Fund (SPF) Clean Air Programme.
In river-dependent regions such as the Brazilian Amazon, severe droughts can disrupt care continuity by isolating municipalities and fragmenting supply chains. We assessed how four major droughts affected tuberculosis and HIV care cascades in Amazonas state. We analysed monthly data (Jan 1, 2001, to Dec 31, 2024) from all 62 municipalities of the Amazonas state, Brazil, grouped into nine river basins and stratified by sex when available. Droughts were defined by the relative maximum cumulative water deficit value being below -2·0 or river discharge at or below the fifth historical percentile. We prespecified four major drought episodes affecting Amazonas at a monthly resolution: May to June, 2005; May to June, 2010; August, 2015, to April, 2016; and October, 2023, to February, 2024. Outcomes were primary-care consultations, tuberculosis and HIV notifications, treatment interruption, and disease-specific mortality. Additionally, we did a prespecified subgroup analysis stratified by sex for both diseases' indicators to assess whether drought-associated deviations differed systematically between men and women. We fitted Bayesian hierarchical negative binomial models to estimate counterfactual trajectories and summarised effects as incidence rate ratios (IRRs) and excess events per 100 000 population. The 2015-16 drought coincided with widespread consultation deficits (statewide peak IRR 0·78 [95% credible interval 0·68-0·89]) and pronounced increases in HIV treatment interruption across all basins (statewide peak IRR 6·01 [2·12-15·33]), particularly among men (Rio Negro peak IRR 5·57 [3·02-9·78]). By contrast, the 2023-24 drought coincided with increased care consultations statewide (peak IRR 1·63 [1·25-2·11]) but persistent treatment interruption and mortality signals, including female-predominant increases in HIV treatment interruption in Rio Negro (peak IRR 2·87 [1·27-5·63]) and female mortality statewide (1·97 [1·05-3·39]), with additional basin-level mortality increases in Alto Solimões, Baixo Amazonas, and Médio Amazonas. Tuberculosis notifications increased mainly in 2023-24 in specific basins, especially in Baixo Amazonas (peak IRR 2·09 [1·54-2·76]), Médio Amazonas (1·74 [1·30-2·28]), and Baixo Solimões (1·60 [1·24-2·07]). Severe droughts were associated with basin-specific disruptions in tuberculosis and HIV care cascades in the Brazilian Amazon, with clearer signals in adherence-dependent and downstream outcomes than in case detection. Strengthening resilience will require anticipatory, continuity-focused strategies that safeguard treatment access during climate-related transport constraints. Fundação de Amparo à Pesquisa do Estado do Amazonas and Brazilian National Council for Scientific and Technological Development.
Advances in chemotherapy have increased survival in biliary tract cancer patients, and reports of the effectiveness of neoadjuvant therapy are emerging. Accordingly, developing optimal drainage strategies under chemotherapy is important. We aimed to clarify suitable drainage methods and assess the prognostic value of the time to first reintervention (TTFR) following chemotherapy induction. We retrospectively analyzed 81 patients with malignant hilar biliary obstruction (MHBO) who underwent biliary stenting followed by chemotherapy between April 2012 and October 2023. TTFR following chemotherapy induction and drainage- and survival-related factors were evaluated. The median follow-up, survival, and TTFR were 425, 479, and 167 days, respectively. TTFR was correlated with overall survival (r = 0.60, p < 0.01). Univariable analyses identified prechemotherapy cholangitis and stenting above the sphincter of Oddi (SO) as factors associated with shorter TTFR, whereas multivariable analysis revealed stenting above the SO as the only independent factor (hazard ratio [HR] 0.44, p = 0.01). Among 52 non-endoscopic sphincterotomy (EST) patients, prechemotherapy cholangitis (HR 2.05, p = 0.04), stenting above the SO (HR 0.47, p = 0.04), and multiple drainage segments (HR 0.42, p = 0.04) influenced TTFR in univariable analyses. No significant factor was detected among 28 patients undergoing EST. The TTFR was comparable between above- and across-SO placement groups up to 2 months, but superior in the above-SO group at 6 months (69%-73% vs. 27%-42%). TTFR following chemotherapy induction is a prognostic factor in MHBO patients. Stenting above the SO may prolong TTFR, particularly in those without prior EST or expected to continue chemotherapy beyond 2 months. Trial Registration: N/A.
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Necator americanus infection is now rare in developed countries but remains an important cause of iron-deficiency anemia and abdominal symptoms in individuals with relevant epidemiological backgrounds. A 59-year-old Filipino man with long-standing unexplained iron-deficiency anemia was admitted to our hospital for epigastric pain associated with choledocholithiasis. Although biliary enzymes improved after endoscopic treatment, his abdominal pain persisted. Subsequent gastrointestinal investigations, including upper gastrointestinal endoscopy, colonoscopy, and small-bowel capsule endoscopy, revealed multiple parasites distributed throughout the gastrointestinal tract. Image-enhanced endoscopy using narrow-band imaging clearly improved visualization of the parasites compared with conventional white-light imaging, facilitating their identification and endoscopic removal. Genetic analysis of the extracted worms confirmed N. americanus infection. The patient was treated with pyrantel pamoate, which resulted in the resolution of abdominal symptoms and improvement of iron-deficiency anemia. Follow-up stool examination confirmed eradication of the parasite. This case highlights the importance of considering hookworm infection in patients with persistent iron-deficiency anemia and abdominal pain, even in developed countries. In addition, image-enhanced endoscopy and capsule endoscopy are valuable diagnostic tools for detecting hookworms and assessing their distribution within the gastrointestinal tract.
Alongshan virus, a segmented RNA virus in the Jingmenvirus group of flaviviruses, was first identified in 2017 in China in patients with tick-borne encephalitis-like illness. Alongshan virus has since been detected in ticks and mammals in several European countries. In this study, we aimed to characterise the temporal and geographical distribution of Alongshan virus in Austria through nationwide tick surveillance combined with serological and molecular screening in individuals with suspected tick-borne encephalitis or tick exposure. In this nationwide molecular and serological observational study, we conducted a PCR-based screening of ticks collected across Austria in 2024, using flagging, animal hosts, and citizen submissions. We also collated genomic data from stored nucleic acid extracts from ticks collected in Austria in 2005 and 2013 in previous surveillance studies and stored extracts of paired tick-human samples collected between 2015 and 2018. Alongshan virus-positive tick samples were subjected to whole-genome sequencing and phylogenetic analysis. In addition to tick samples, blood samples from Austrian patients with reported tick bite or suspected tick-borne encephalitis, submitted to the National Reference Center for Human Arbovirus Infections, Austria, were screened for Alongshan virus infection and subjected to serological and molecular testing. 2952 ticks were collected between Feb 1, 2024, and Dec 6, 2024, from 29 (83%) of 35 NUTS-3 regions in Austria; the median detection rate for Alongshan virus was 1·2% (IQR 0·4-3·5). In addition, 1816 archived tick samples were analysed, with three testing positive for Alongshan virus. For the virus-positive samples, phylogenetic analysis showed that sequences from Austria grouped within the European clade, with Austrian sequences from the same region showing high sequence similarity. 1361 human serum samples collected between March 1, 2023, and May 16, 2025, were assessed for anti-Alongshan virus IgG antibodies. Two individuals had high antibody titres against Alongshan virus proteins VP1a and VP2. Our study shows detection of Alongshan virus in archived tick samples dating back to 2005, representing the earliest documented occurrence of the virus to date and suggesting that Alongshan virus has been circulating in Austria for at least two decades. The detection of Alongshan virus-specific antibody titres in two individuals suggests past infection and previously unrecognised exposure. These results highlight the need for continued molecular surveillance of tick populations and serological monitoring in humans to define the epidemiology and public health relevance of Alongshan virus in Europe. One Health surveillance and Vector monitoring for cross-border pathogens (OH SURVector) and UNITED4Surveillance.
Diabetic peripheral neuropathy (DPN) is a length-dependent, symmetric sensorimotor polyneuropathy with a substantial global and regional burden. Current pharmacologic options are largely symptomatic and do not modify the disease. Lymphovenous bypass (LVB), a supermicrosurgical procedure established for lymphedema, may modulate lymphatic-immune-microvascular dysfunction relevant to DPN. The primary objective is to determine whether LVB combined with standard of care (SOC) improves small-fiber and autonomic function compared with SOC alone at 6 months. Secondary objectives are to evaluate the effects of LVB on large-fiber function, neuropathic pain, ulcer healing, quality of life, and relevant biomarkers, as well as to characterize the safety profile of LVB. This is a SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials)-aligned, single-center, randomized, controlled, parallel-group superiority trial with a 2:1 allocation (LVB+SOC vs SOC alone). Randomization is stratified based on the presence or absence of active diabetic foot ulcers, as defined by the International Working Group on the Diabetic Foot and Infectious Diseases Society of America criteria. In total, 60 adults aged 20 to 80 years with confirmed DPN will be enrolled. LVB involves lymphatic-venous anastomosis to venules ≤0.8 mm. SOC consists of guideline-based glycemic and risk-factor management, pain control, and standardized wound care. Outcome assessors and statisticians are blinded. The primary outcomes are changes in clinical neuropathy burden and pain severity at 6 and 12 months. Secondary outcomes comprise objective measures of somatic and autonomic physiology, histopathological nerve fiber density, biological serum markers, and longitudinal ulcer epithelialization parameters. Data analysis will use mixed-effects models for repeated measures, with a sample size of 60 adults providing 80% power to detect a conservative between-group effect size of Cohen d=0.70. Recruitment commenced in February 2026 and is planned to continue through July 31, 2027, with follow-up through July 31, 2028. As of May 2026, we have enrolled 3 participants. The first participant has been treated, and a second participant is scheduled to undergo treatment. Data analysis and reporting are anticipated between late 2027 and early 2028. No outcome data are included. This trial tests a mechanism-based, nonpharmacologic adjunct targeting lymphatic-immune-microvascular dysfunction in DPN. If effective, LVB could inform phenotype-directed treatment algorithms and motivate multicenter evaluation and health economic analyses.
During peroral endoscopic myotomy (POEM) for achalasia, endoscopic esophagogastric junction (EGJ) opening is generally considered a sign of successful myotomy. However, in clinical practice, the EGJ may appear to open immediately after submucosal tunneling, even before myotomy is performed. We defined this phenomenon as pseudo-dilation and evaluated changes in EGJ appearance during POEM. This retrospective study included 65 consecutive patients who underwent POEM between February and June 2025. Endoscopic images obtained at three stages-before POEM, after submucosal tunneling, and after myotomy-were evaluated using a three-tier Endoscopic Junctional Dilation (EJD) grade. Differences in EJD grade across procedural stages were analyzed using the Friedman test, with post hoc Wilcoxon signed-rank tests and Bonferroni correction. The Bickenböller statistic was used as a complementary analysis. Two certified endoscopists independently evaluated all images, and interobserver agreement was assessed using Cohen's κ and weighted κ. The EJD grade increased significantly after submucosal tunneling compared with before POEM (p < 0.001). A significant difference was observed between the post-tunneling and post-myotomy stages (p = 0.002); however, most patients showed no change in EJD grade, and the overall distribution of grades remained unchanged (p = 0.124). Overall, pseudo-dilation occurred in 95.4% of patients. Interobserver agreement in EJD grade assessment was substantial to perfect across all procedural stages (κ = 0.889; weighted κ = 0.940). Pseudo-dilation of the EGJ was commonly observed immediately after submucosal tunneling during POEM. N/A.
While the Updated Sydney System classifies Helicobacter pylori density together with inflammatory scores, the clinical relevance of bacterial load remains uncertain. This study aimed to assess the association between histological H. pylori density and the severity of gastric inflammatory activity. We performed a retrospective analysis of 1680 treatment-naive patients from a Chinese cohort (2022-2023). H. pylori density was categorized as low or high grades, with marked neutrophilic infiltration as the primary outcome. Multivariable logistic regression adjusted for potential confounders. Among 2298 biopsy sites from 1680 patients (median age 52 years; 48.2% female), high H. pylori density showed no significant overall association with marked inflammation (all p > 0.050). While a significant inverse association was observed in non-atrophic antral single-site biopsies (adjusted odds ratio 0.52; 95% confidence interval 0.28-0.93), it was not reproduced in multi-site analyses. Increasing age was associated with a lower prevalence of severe antral inflammation. Histological H. pylori density might therefore not be a reliable marker of neutrophilic activity, although a significant inverse association observed in a single-site subgroup was not reproducible and may reflect sampling variability. N/A.
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Burnout and poor well-being are serious problems in the workforce all over the world. Especially in academia, high pressure is evident. Therefore, addressing burnout is essential for enhancing academic staff well-being. Acceptance and commitment therapy (ACT), which aims to enhance psychological flexibility skills comprising present moment awareness, value-based actions, and differentiation of thoughts from self, has been found to be a promising approach to enhance workers well-being and work satisfaction. The purpose of this study was to first develop and describe our acceptance and commitment therapy-based WELLS course, aimed at supporting academic staff well-being and working life skills, offered to academic staff. The second aim was to report the mixed methods study design protocol to explore the participants' experiences of the effects of the course. We will conduct a single-arm, nonrandomized, and mixed methods study with baseline, postintervention, and 6-month follow-up assessments. We will use an explanatory sequential design in which qualitative data are used to explain and deepen the quantitative findings. The quantitative part of the study aims to recruit 300 participants from the University of Helsinki. Questionnaire data will be collected from the participants 3 times: at the beginning, at the end, and 6 months after the course for well-being-related measures such as burnout and working life skills such as time management and psychological flexibility. The participants will be clustered based on their initial burnout risk score using latent profile analysis. Differences in participants' dropout, participation forms, and changes in well-being and working life skills during the course will be analyzed with mixed ANOVA. Qualitative data will be collected from reflective journals written at the end of the course, participants' written goal statements, and interviews among willing participants. Reflective journals will be analyzed with qualitative content analysis, and interviews will be analyzed using thematic analysis. As of March 2026, a total of 265 participants had enrolled in the course and given their consent to participate in the research. The current data are being analyzed, and the results are expected to be published in late 2026 or early 2027. If the intervention proves successful, it may serve as an important tool for improving academics' well-being, working life skills, and engagement by understanding how this intervention can help academic staff members with different initial burnout levels. In addition, it can help to understand and solve individual challenges related to well-being in the academic workplace.
Balance impairments are common in people with Multiple Sclerosis (PwMS), yet brain activity during ecologically valid balance tasks is poorly understood. To compare hemodynamic responses and postural control between PwMS and healthy subjects(HS) during a task forcing a greater reliance on vestibular cues. In this cross-sectional study, 18 PwMS (median[IQR] age: 44.0(17.5) years, EDSS: 2.0(1.0)) and 18 age-sex-matched HS underwent fNIRS recordings while standing on a foam with eyes closed. Oxy- and deoxyhemoglobin changes were recorded over frontal, occipital, and temporo-parietal cortices, while body sway Area was measured using a stabilometric platform. A linear mixed-effects model tested Group, Brodmann area(BA), hemisphere Side and body sway Area effects. PwMS showed greater sway than HS (1965.9[2027.8]mm²; 1306.7[572.2]mm², p=.04). A significant four-way interaction emerged between Group, BA, Side, and Area (F(df1,df2) =16.76,p<.0001; conditional-R²=0.89). HS exhibited larger responses than PwMS in bilateral BA40 (HS-PwMS; left:0.45±0.14 µM,p=.003; right:0.57±0.14 µM,p=.003), and BA21-22 (left:0.58±0.14 µM,p=.0002; right:0.45±0.14 µM, p=.003). Associations between sway Area and cortical activity were stronger in HS, with significant slopes in BA21-22, BA40 bilaterally and left BA18 (p<.01). Temporal-parietal activity is a key contributor to maintaining balance control. PwMS showed weaker hemodynamic responses in sensory-challenging conditions less associated to postural instability compared to HS, suggesting altered cortical involvement in balance control. Protocol code: 20190119. Date of ethical approval: 2020/10/19).
Most people with dementia reside in the community and are cared for by family members. Family caregivers play an essential role in supporting their loved ones with dementia and require adequate education and support to address their care needs. In recent years, there has been growing interest in the use of chatbot technologies in health care, particularly to provide education and support for caregivers. However, evidence on the development, use, and effectiveness of these technologies in dementia care remains limited. This systematic integrative review aims to synthesize evidence on chatbot applications as an educational and supportive tool for family caregivers of people with dementia. A systematic integrative literature review will be conducted following a validated framework. The findings will be reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy will be structured around 3 broad concepts: "dementia," "caregiver," and "chatbot applications." Full-text articles based on empirical studies published in English from inception to 2026 that address the design, development, or evaluation of chatbot applications for family caregivers of people with dementia will be included. Editorials, study protocols, review articles, opinion and perspective papers, technical notes, and non-English publications will be excluded. Covidence software will be used to manage study screening. At least 2 independent reviewers will screen titles, abstracts, and full texts and extract data using a pretested data extraction form. Methodological quality will be assessed using Mixed Methods Appraisal Tool (version 2018), and data relevance will be evaluated using a 2-point scale (high or low). The literature search will commence in May 2026, and the findings are expected to be published as a systematic integrative review, with submission planned for January 2027. This systematic integrative review aims to synthesize evidence from qualitative, quantitative, and mixed methods studies to provide a comprehensive understanding of how chatbot interventions are conceptualized, developed, and evaluated within dementia caregiving contexts. In addition, this review will identify key barriers and challenges as well as ethical and safety concerns associated with the design, development, and implementation of chatbot applications for family caregivers of people with dementia. PROSPERO CRD420261288076; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261288076. PRR1-10.2196/91741.
In Vietnam, economically disadvantaged women face compounded risks due to gender inequality, financial instability, and limited access to mental health care. Community health stations (CHSs), the frontline entry point into the health system and the most accessible primary care facilities, typically lack trained mental health providers, further exacerbating an already existing treatment gap. While evidence-based treatments for depression exist, most interventions address either mental health or economic hardship separately, limiting their effectiveness in resource-constrained settings. This study aims to evaluate the effectiveness of Livelihood Integration for Effective Depression Management (LIFE-DM), an integrated intervention combining group-based psychotherapy with microfinance and livelihood support, compared with enhanced treatment as usual (E-TAU), among low-income women. We hypothesize that LIFE-DM participants will show greater program participation and improvements in mental health, psychosocial, and economic outcomes relative to E-TAU. A matched-pair cluster nonrandomized controlled trial was conducted at 4 CHSs in Da Nang, Vietnam, with 2 sites allocated to LIFE-DM and 2 to E-TAU. A total of 166 low-income women aged 18 to 55 years who screened positive for depression (9-item Patient Health Questionnaire score ≥10) were enrolled. LIFE-DM participants received group behavioral activation treatment and were offered microfinance loans, vocational training, and personal finance support. E-TAU participants were offered free antidepressant treatment and referral as usual to the Women's Union for livelihood support. Primary outcomes are severity of depression symptoms and remission rates at 6- and 12-month follow-up. Secondary outcomes include economic variables such as income and employment status, as well as functioning, quality of life, self-efficacy, behavior activation, and program participation. The data were collected using in-person surveys, clinic logs, and program records. Analyses will follow an intention-to-treat approach using longitudinal regression models with propensity score weighting and adjustment for clustering. This study was funded prior to implementation, and the data were collected from February 2014 to September 2015. Participant recruitment has been completed, with 166 women enrolled across 4 CHSs. Data analysis is in progress, and the findings are expected to be disseminated in 2027. This study is among the first to rigorously evaluate an integrated mental health and livelihood intervention targeting both depression and poverty among economically disadvantaged women. If effective, LIFE-DM may offer a scalable, community-based model for improving mental health and economic well-being among vulnerable women in low-resource settings.
Aims: Finnish gambling policy, long based on a state-controlled monopoly, is set to shift to a license-based regime in 2027. The study investigates the Corporate Political Activity (CPA) strategies and discursive frames used by gambling industry actors, comparing their application among actors and phases of the legislative process in the context of Finland's gambling policy reform. Methods: In total, 36 formal statements were analyzed, including submissions to the public consultation (n = 19) and parliamentary hearings (n = 17). A deductive content analysis was conducted, based on the previous CPA frameworks. Results: The results indicate that gambling industry actors proposed alternative policies and sought to prevent certain parts of the legislation from being enacted. Discursive framings shifted throughout the legislative process: legal rights dominated consultations, while unintended effects, especially increased unlicensed gambling, became more salient in parliamentary hearings. Clear differences emerged among actors. International actors prioritized policy substitution and framed the proposed legislation as excessive and harmful to their legal rights, whereas the state monopoly operator did not prevent enactment of regulations. A further difference concerned proposals to replace some harm-reduction measures with more restrictive alternatives. Conclusions: The growing influence of the gambling industry may risk deprioritizing the prevention and reduction of gambling harm in future gambling policy.
Histological subtype is an important pathological factor in risk stratification for lymph node metastasis (LNM) in T1 colorectal cancer (CRC); however, conventional predominant-type assessment may miss minor poorly differentiated components in T1b CRC. We aimed to develop a T1b-specific risk stratification framework incorporating a reproducible worst histology (WH) approach. We retrospectively analyzed 488 patients with pathologically confirmed pT1b CRC who underwent surgical resection with lymph node dissection. Histological evaluation was performed using three approaches: dominant histology (DH), WH, and WH focusing on poorly differentiated adenocarcinoma (WH-por). For each approach, independent risk factors for LNM were identified. Patients without these factors were defined as the low-risk subgroup, and LNM rates were compared with the conventional Japanese Society for Cancer of the Colon and Rectum (JSCCR) criteria. In patients with T1b colon cancer, the WH-por approach demonstrated favorable performance for identifying LNM risk compared with the DH and WH approaches. In contrast, in rectal cancer, the WH approach performed better than the WH-por approach. In the colon cohort, the LNM rate in the low-risk subgroup was 1.7%, compared with 4.1% under the JSCCR criteria. In the rectal cohort, the corresponding rates were 8.0% and 8.6%, respectively. A WH-based approach improves LNM risk stratification in T1b CRC and may help identify carefully selected patients at low risk of LNM, supporting more individualized clinical decision-making, including careful consideration of the necessity of additional surgical resection.Trial Registration: N/A.
International collaborative research in Africa has raised ethical challenges for decades. The proposed newborn hepatitis B vaccine trial in Guinea-Bissau is the latest case to crystallise concerns around potential exploitation of disadvantaged populations, drawing comparisons to Tuskegee and other research abuses. We argue that the decision to stop the trial was appropriate, but that the reasons most invoked in public debate are incomplete. The trial was designed to happen during a defined window before Guinea-Bissau's planned rollout of the universal birth-dose vaccination in 2027-28, when randomisation between the WHO-recommended birth dose and the existing local standard of care remained possible. Under what conditions, if any, could such research-comparing a local versus global standard of care during health policy transition-be ethically justified? We propose four conditions and assess the proposed trial against them. The trial potentially satisfies some of our proposed conditions but does not meet others owing to an absence of maternal hepatitis B screening despite high background prevalence, methodological shortcomings that threaten the interpretability of results, and governance deficiencies, including an absence of sponsor-country ethics review (required by the Declaration of Helsinki). We treat this trial as a cautionary tale offering important lessons for future research in low-resource settings undergoing policy transitions.
Heavy cannabis use may impact neurocognitive functions, particularly prefrontal and limbic systems responsible for risk/reward processing and executive function, which are essential for certain health behaviors, such as HIV prevention. Rigorous research into the effects of cannabis on neurocognitive functions remains limited, particularly among populations with a high burden of HIV. This study aims to (1) evaluate associations between cannabis use and neurocognition, (2) evaluate associations between cannabis use and engagement in HIV status-neutral care outcomes (eg, pre-exposure prophylaxis persistence, viral suppression), and (3) assess whether cannabis use motivations modify associations between cannabis use and engagement in HIV status-neutral care outcomes. This longitudinal cohort study is enrolling a community-based sample of individuals aged 16 to 29 years residing in Chicago using multiple recruitment strategies. Participants complete 3 in-person assessments annually over 2 years that include (1) computer-assisted questionnaires, (2) neurocognitive assessments (functional magnetic resonance imaging, executive function tasks), and (3) biospecimen collection. Triangulation approaches combine objective and self-reported measures. The Frontal Lobe Outcomes and Well-Being (FLOW) Study was funded by the National Institutes of Health in April 2023, with data collection commencing in October 2023. As of April 2026, 148 participants have been enrolled and completed baseline assessments, with 63 participants completing their first follow-up appointment and 4 participants completing their second follow-up appointment. Following a temporary administrative pause from March to August 2025 and subsequent federal review confirming regulatory compliance, the study resumed operations in July 2025. Recruitment is currently ongoing, with data collection expected to continue through June 2027. Preliminary analyses are pending completion of longitudinal data collection. This study addresses critical knowledge gaps by examining potential associations between cannabis use, neurocognition, and HIV. While geographic specificity, structural barriers, measurement challenges, and sample size constraints present some limitations, our methodological approaches-including longitudinal design, triangulation of both objective and self-reported measures, and rigorous neurocognitive assessments-strengthen the investigation. Findings will advance understanding of how cannabis use impacts neurocognition and HIV-related health behaviors, potentially informing targeted interventions that address both substance use and HIV transmission.