Describir el enfoque diagnóstico y terapeutico de un caso de hematoma disecante intramiocárdico (hdi), una complicación poco frecuente del infarto agudo de miocardio, resaltando el valor de la imagen multimodal en su identificación y manejo. Caso clínico: Presentamos el caso de un varón de 50 años que acudió a urgencias con dolor torácico y disnea de 12 horas de evolución. El electrocardiograma reveló un infarto anterior y la coronariografía demostro la oclusión de la arteria descendente anterior, tratada mediante angioplastia. Durante su ingreso, la ecocardiografía transtorácica mostró una masa hipoecoica en el ápex, planteando el diagnóstico diferencial entre hematoma intramiocárdico, pseudoaneurisma y trombo mural. Se realizó una tomografía computarizada cardiaca, que descartó rotura completa o pseudoaneurisma, pero no permitió una diferenciación definitiva. Posteriormente, la resonancia magnética cardíaca confirmó la presencia de un hematoma contenido dentro del miocardio, sin rotura del epicardio, con áreas de fibrosis transmural circundante. Ante la estabilidad clínica del paciente y la ausencia de signos de progresión, se optó por un tratamiento conservador inicial con seguimiento clínico y por imagen estrecho. Conclusión: El HDI es una complicación infrecuente y portencialmente grave del infarto agudo de miocardio. Su diagnóstico puede ser difícil y requiere un enfoque multimodal. La resonancia magnética aporta una caracterización tisular precisa que permite diferenciar el hematoma disecante intramiocárdico de otras entidades similares, siendo clave para la toma de decisiones clínicas. En pacientes estables, un manejo conservador puede ser seguro y efectivo.
Dark cutting (DC) is a significant quality defect in beef, often linked to stress experienced by animals prior to slaughter. This study evaluated how antemortem handling affects behavior and DC incidence in Holstein (n = 101) and commercial crossbred (CC; n = 101) steers finished under the same commercial conditions in northwestern Mexico. Animal welfare and handling practices were assessed during driving, transport, lairage, stunning and bleeding, and carcass and meat traits related to DC were measured. Holsteins, originating from confined systems with high human-animal interaction, showed more backing events than CC (73 vs. 30; p = 0.03), which led operators to increase vocal encouragement (109 vs. 5; p < 0.001) and hitting (100 vs. 28; p = 0.002). Additionally, 56.4% of Holstein carcasses had L* ≤ 40 compared with 22.8% in CC (p = 0.001), whereas a greater proportion of CC carcasses exhibited ultimate pH ≥ 5.8 (46.5 vs. 20.8%; p = 0.03). Meat from Holstein steers showed lower lightness, lower redness and higher yellowness, together with a higher incidence of DC (17.8 vs. 10.9%). In conclusion, genetic background and the human-animal relationship influence responses to antemortem handling and the incidence of dark cutting.
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). Pregnant women are particularly vulnerable to COVID-19 due to physiological and immunological changes in pregnancy. Understanding their knowledge and preventive practices is essential for guiding maternal-health interventions. This study assessed the knowledge, perceptions, and adoption of preventive measures against COVID-19 among pregnant women attending antenatal care at the Federal Medical Centre (FMC), Jabi, Abuja. A descriptive cross-sectional study was conducted from July to September 2021 among pregnant women selected through multistage sampling. Using a structured, interviewer-administered questionnaire we obtained data on knowledge, perceptions and preventive practices from 120 women participated. Data was analyzed using SPSS version 28 and summarized as descriptive statistics. Awareness of COVID-19 was high (95.8%) among pregnant women. Most respondents demonstrated adequate knowledge of transmission and prevention, including hand hygiene (99.2%), avoidance of crowds (92.5%), and isolation measures (90.0%). Misconceptions persisted, particularly regarding breastfeeding. Only 35.0% agreed that COVID-19 positive mothers can safely breastfeed, while 42.5% were unsure. Vaccine willingness was moderate (54.2%), reflecting hesitancy despite overall good knowledge. We found high level of awareness and generally positive preventive attitudes toward COVID-19 among pregnant women, but gaps remain in breastfeeding knowledge and vaccine acceptance. Targeted health education and strengthened ANC counselling are needed to address misconceptions and support consistent adoption of preventive practices.
Burnout management among employees is a persistent challenge faced by healthcare organisations, which is exacerbated in developing economies with high demographic loads. The extant literature explores measures of mitigating and adapting to occupational strain and burnout. However, the epistemic relationship between job crafting, perceived organisational support, meaningful work and burnout remains ambiguous and underexplored. The present study examines how a priori interventions such as job crafting and organisational support affect meaningful work and modulate burnout in healthcare organisations. We conducted a cross-sectional study of 373 healthcare professionals from corporate and public hospitals of different operational capacities in the North Indian region. We used PLS-SEM to test our hypothesis and validate the conceptual model. This study found a significant negative relationship between job crafting and the burnout axis, mediated by meaningful work. The perceived organisational support significantly moderates the relationship. Our study provides novel insights by testing the role of two resources based on JD-R theory, such as perceived organisational support and meaningful work, in the relationship between job crafting and burnout in Global South healthcare settings. Moreover, it underscores that participatory job crafting can be an ex-ante strategy to mitigate burnout among healthcare employees.
The reverse shoulder arthroplasty (RSA) angle quantifies inclination of the inferior glenoid and, thus the correction required during reverse total shoulder arthroplasty. There are no data on the effect of two-dimensional (2D) radiographic projection on the RSA angle or on the relationships between 2D true anterior-posterior (AP) views and their three-dimensional (3D) counterparts. Digitally reconstructed radiographs of the 2D true AP view of N = 68 scapulae, a subset in controlled ante-/retroversion and extension/flexion views, and their corresponding 3D anatomic models were analyzed. The RSA angle was measured on true AP images with the glenoid in profile at the intersection of lines defined by the supraspinatus fossa and inferior glenoid rim. On altered viewing perspectives, the glenoid face was visible, and thus the anterior and posterior rims. Since it was often unclear which was anterior and posterior, for consistency the RSA angle was measured at the most medial and lateral rims, and glenoid midpoint to determine the influence of measurement location. The 3D RSA angle was measured on 3D models using semi-automated techniques. Data were analyzed to determine the effects of viewing perspective and measurement location on the RSA angle and to compare 2D true AP to 3D measures. The 2D RSA angle was 18.1 ± 7.1° (range: 1.1° to 35.3°), while the 3D RSA angle was 10.1 ± 7.3° (-8.1° to 25.7°) (P < .001). Ante-/retroversion views had large effects on the RSA angle. The lateral rim was the most susceptible to error (up to 25.8 ± 6.6°) and the glenoid midpoint was least susceptible (less than 5.6 ± 6.5°). Extension/flexion was also influential, but the magnitudes were generally much less than ante/retroversion. Trends due to viewing perspective differed between the medial rim, lateral rim, and glenoid midpoint. The glenoid midpoint maintained the flattest distribution with the smallest errors across the views. Inter- and intra-rater reliability in measuring RSA angles was good to excellent (≥ 0.754). The 2D RSA angle experiences viewing perspective errors when not measured on a true AP radiograph. The glenoid midpoint provided the most consistent and smallest maximum error, with good to excellent reliability. The 3D underestimated the 2D RSA angle on true AP images by an average of -8.0°, with similar variability. When using 2D imaging, a true AP image is desirable; otherwise, use the glenoid midpoint to minimize viewing perspective errors. Comparisons between radiographic measures and 3D preoperative planning should consider the bias between the two techniques, and 3D measures should be evaluated for their measurement techniques within the respective preoperative planning softwares to ensure consistency and reliability among manufacturers. Basic Science Study; Cadaveric Study.
Dengue virus infection is the most common arbovirus disease worldwide, and its spread has increased the relevance of less common forms, such as vertical transmission. Congenital dengue poses a diagnostic challenge due to its nonspecific presentation and overlap with late-onset sepsis. Transmission occurs during maternal viremia, especially when the infection occurs in the days leading up to delivery, and may present with fever and hematological abnormalities. We present the case of a 35-week preterm newborn, the daughter of a mother with confirmed dengue before delivery, who developed a fever and hyporesponsiveness on the seventh day. Detection of viral RNA via polymerase chain reaction in serum and cerebrospinal fluid confirmed the infection. She developed thrombocytopenia and coagulation abnormalities, with normal neurological findings and a favorable clinical course. This case highlights the importance of considering congenital dengue in neonatal sepsis when appropriate clinical settings are present. La infección por el virus dengue es la arbovirosis más frecuente a nivel mundial y su expansión ha incrementado la relevancia de formas menos habituales, como la transmisión vertical. El dengue congénito representa un desafío diagnóstico por su presentación inespecífica y superposición con sepsis tardía. La transmisión ocurre durante la viremia materna, especialmente cuando la infección se presenta en los días previos al parto, y puede manifestarse con fiebre y alteraciones hematológicas. Se presenta una recién nacida pretérmino de 35 semanas, hija de madre con dengue confirmado antes del nacimiento, que al séptimo día desarrolló fiebre e hiporreactividad. La detección de ARN viral mediante reacción en cadena de la polimerasa en suero y líquido cefalorraquídeo confirmó la infección. Evolucionó con trombocitopenia y alteración del coagulograma, con estudios neurológicos normales y evolución favorable. Este caso resalta la importancia de considerar dengue congénito ante sepsis neonatal en contextos compatibles.
Dental developmental anomalies are well documented in clinical veterinary medicine but remain rarely reported in archeological dogs. This study presents a radiologically confirmed case of an unerupted left maxillary canine associated with the absence of an alveolus for the left maxillary first molar and incisors in a dog skull from early medieval Wolin. This study aimed to determine whether the observed absence of teeth resulted from congenital agenesis, developmental arrest, ante-mortem loss, or post-depositional processes. Radiographic examination revealed a fully formed but unerupted canine, while the M1 region exhibited a smooth bony surface without reactive remodeling, periapical radiolucencies, or signs of ante-mortem tooth loss. Differential diagnosis did not support canine agenesis, ante-mortem loss, or taphonomic damage as primary explanations. The findings most strongly support a congenital or very early developmental origin of the observed alterations. The estimated age of the individual (7-10 years) and the absence of secondary pathological changes suggest that these anomalies did not significantly impair masticatory function. Owing to the single-case nature of the material, broader population-level inferences cannot be made. This case underscores the methodological importance of radiographic imaging in archeological dental research and suggests that alveolar absence should not be automatically equated with impaired survival or poor health in this individual.
Preduodenal portal vein (PDPV) is a rare vascular anomaly associated with heterotaxy syndrome, typically presenting as duodenal obstruction in left isomerism. We report a 13-month-old male with right isomerism, single ventricle physiology, and asplenia who presented with postprandial vomiting. Computed tomography revealed a PDPV anterior to the pylorus, and upper gastrointestinal contrast study confirmed mesentericoaxial gastric volvulus. Surgery consisted of gastric derotation, ante-PDPV pyloroduodenostomy, and anterior gastropexy. The patient recovered uneventfully and remained asymptomatic at 9-month follow-up. To our knowledge, this is the first report of PDPV with right isomerism complicated by gastric volvulus. Absent gastric stabilizing ligaments in asplenia, combined with PDPV-related obstruction, may predispose to volvulus. Multimodal imaging and individualized surgical management are essential in this rare setting.
La anemia y la deficiencia de hierro (DH) son condiciones frecuentes en pacientes con enfermedades cardiovasculares y se asocian a mayor morbimortalidad en cirugía cardíaca. Sin embargo, no existen datos sobre cómo es abordada esta problemática en Iberoamérica. Debido a ello, desde la Sociedad Interamericana de Cardiología nos propusimos explorar conocimientos, actitudes y conductas de médicos latinoamericanos involucrados en el perioperatorio de cirugía cardíaca. Se realizó un estudio transversal mediante una encuesta electrónica anónima distribuida entre enero y agosto de 2025, utilizando un muestreo tipo «bola de nieve». Se incluyeron médicos con actividad asistencial que involucre la atención de pacientes previa a cirugía cardíaca. Respondieron la encuesta 881 médicos de 23 países. Si bien el 83,7% manifestó que tamizaba la presencia de anemia de forma rutinaria, solo el 43,7% expresó evaluar la DH. Un 18,2% manifestó contar con protocolos institucionales sobre este tópico. El manejo terapéutico mostró notables diferencias: solo el 11,8% indicó administrar hierro endovenoso (EV) ante el diagnóstico de anemia o DH. El 46,9% de los participantes expresó tener acceso rutinario a hierro EV; sin embargo, solo el 26,6% de ellos refirió haber indicado esta intervención a pacientes en el preoperatorio de cirugía cardíaca en los 6 meses previos a responder la encuesta. Además, el 54,8% de los encuestados no había recibido formación específica y se sentía solo moderadamente preparado para manejar estas condiciones. Nuestros datos sugieren que existen brechas significativas entre la evidencia disponible y la práctica clínica en el manejo preoperatorio de anemia y DH, destacando la necesidad de protocolos institucionales y mayor educación médica especializada. Anaemia and iron deficiency (ID) are common in patients with cardiovascular disease and are associated with increased morbidity and mortality in cardiac surgery. However, no data are available on how this issue is addressed in Ibero-America. We therefore sought, under the auspices of the Inter-American Society of Cardiology, to explore the knowledge, attitudes, and practices of Latin American physicians involved in the perioperative care of patients undergoing cardiac surgery. We conducted a cross-sectional study using an anonymous electronic survey distributed between January and August, 2025, through snowball sampling. Physicians engaged in clinical practice involving the care of patients prior to cardiac surgery were eligible for inclusion. A total of 881 physicians from 23 countries responded. Although 83.7% reported routinely screening for anaemia, only 43.7% indicated that they assessed iron deficiency. Institutional protocols addressing this topic were reported by 18.2% of respondents. Marked heterogeneity was observed in therapeutic management: only 11.8% reported administering intravenous iron when anaemia or ID was diagnosed. While 46.9% of participants stated that they had routine access to intravenous iron, only 26.6% of these reported prescribing this intervention for patients in the preoperative cardiac surgery setting within the 6 months preceding the survey. Furthermore, 54.8% of respondents had not received specific training and felt only moderately prepared to manage these conditions. Our findings suggest substantial gaps between the available evidence and clinical practice in the preoperative management of anaemia and iron deficiency, underscoring the need for institutional protocols and enhanced specialised medical education.
In March 2026, China approved the first invasive brain‑computer interface (BCI) for clinical use globally. While this milestone accelerates neurotechnology translation, it exposes a neglected ethical problem: in some long-term invasive BCI cases, participants who initially consent to later device explantation may subsequently develop functional dependence on, and phenomenological incorporation of, the device. This paper examines whether such post-implantation integration can weaken the continuing moral authority of initial consent to explantation. This paper provides a normative analysis grounded in established bioethics concepts. We draw on theories of extended cognition and transformative experience, integrate findings from qualitative empirical studies of BCI user phenomenology, and engage with the neurorights discourse and Chinese regulatory developments. The analysis focuses on the moral authority of initial consent where long-term device integration may alter the participant's embodied agency, with particular attention to the implications for interpreting the right to withdraw from research. Transformative experience alone is not sufficient to distinguish implantable BCIs from other medical interventions that may also alter self-understanding. The distinctive diachronic consent problem arises when ex ante experiential ignorance is combined with extended cognition, embodied agency, functional dependence, and the possibility that explantation would remove a device experienced as part of the user's agential system. We identify a specific governance gap in China's current ethical guidelines and propose three interlocking reforms: adopting a dynamic consent model with periodic re‑consent encounters, establishing ongoing ethical review for implanted participants, and decoupling withdrawal from research from consent to explantation. An ethical algorithm to guide explantation decisions is presented. Informed consent for long-term invasive BCI use should be reconceptualised as an ongoing process where there is evidence of functional dependence or phenomenological incorporation. Initial consent remains important, but it should not be treated as conclusively authorising later explantation without post-integration reassessment.
Physical activity (PA) during pregnancy improves maternal and fetal outcomes, yet cultural factors may influence behavior. Despite its advantages, the majority of pregnant women do not follow PA recommendations during pregnancy. Therefore, this study aimed to explore experiences of PA among Sri Lankan pregnant women. A qualitative phenomenological study was conducted with primigravid women attending antenatal clinics at a tertiary care hospital in Sri Lanka. In-depth semi-structured interviews were conducted until data saturation was reached (n = 19). Data were analyzed using Braun and Clarke's six-step thematic analysis framework. Five themes emerged (1) Modification of PA with some restrictions (2) Avoidance of PA other than self-care activities (3) Increasing sedentary period (4) Focusing on psychological relaxation and (5) Time allocation for leisure activities with number of sub themes. Most participants reported a decline in physical activity compared to the pre-pregnancy period, influenced by fear of fetal harm, physical discomfort, family advice, and culturally embedded beliefs emphasizing rest. Physical activity patterns among Sri Lankan primigravid women shift toward restriction and increased sedentary behavior during pregnancy, largely driven by sociocultural influences and safety perceptions. Culturally sensitive antenatal counseling is essential to promote safe and informed engagement in physical activity.
Personal identification techniques rely on comparing ante-mortem and post-mortem evidence deemed unique to an individual. The Interpol standard of identification establishes fingerprints, DNA, and dental records as primary identification methods. Beyond dentition, odontological analysis can utilize palatal rugae, which are unique anatomical features with high potential for personal identification. However, most forensic approaches to palatal rugae rely on qualitative assessment; a quantitative evaluation of their uniqueness has been largely overlooked. This pilot study preliminarily explores the reliability of a new semi-quantitative method for palatal rugae analysis in forensic identification. Nineteen subjects were recruited, and a dental cast along with a palatal photograph were obtained for each participant. Dental cast images and palatal photographs simulated antemortem and postmortem data, respectively. Six distinct landmarks were identified in both record types, and homologous and heterologous comparisons were performed using image-processing software. Statistically significant differences were evaluated using the Mann-Whitney U test. The results demonstrated statistically significant differences between homologous and heterologous comparisons (p < 0.05) across most software-acquired parameters. These preliminary findings suggest that this new semi-quantitative method has the potential to effectively distinguish matches from mismatches, highlighting its potential utility in personal identification contexts.
Controlled donation after circulatory determination of death (cDCDD) is increasingly vital to expanding deceased organ donation globally, yet variability exists in clinical, legal, and ethical practices. This study utilized a Delphi consensus process involving 37 international experts to develop recommendations to guide the development and operation of adult cDCDD programs. Two survey rounds evaluated agreement on system requirements, donor identification, medical suitability, communication, end-of-life care, and ante-mortem interventions. Consensus was achieved on numerous recommendations emphasizing the need for robust legal frameworks distinct from end-of-life care decisions, multidisciplinary approaches for donor suitability assessment, and clear, sensitive communication led by trained donation professionals. Ensuring patient comfort and dignity during withdrawal of life-sustaining measures, alongside optimizing donation outcomes, was prioritized. Use of ante-mortem interventions was deemed to require careful balancing of benefits and burdens in line with patient and family preferences. The findings highlight international variability and underscore the importance of tailored protocols, education, and further research to establish an evidence base for ante-mortem interventions and improve clinical prediction of donation feasibility. These consensus recommendations aim to advance ethical, effective, and sustainable adult cDCDD programs worldwide.
En los últimos meses de 2025, EE. UU. ha experimentado cambios profundos y controversiales en sus políticas de vacunación. El Departamento de Salud y Servicios Humanos (HHS), bajo la dirección de Robert F. Kennedy Jr. y siguiendo un memorando presidencial de Donald Trump, ha modificado el calendario de vacunación de los Centros para el Control y la Prevención de Enfermedades (CDC). La medida principal consiste en reducir de 17 a 11 el número de enfermedades para las cuales se recomienda la vacunación sistemática y universal en niños. Numerosos especialistas en salud pública, junto con organizaciones como la American Academy of Pediatrics (AAP) y la American Public Health Association (APHA), han manifestado su preocupación ante estos cambios. En este documento se revisan los cambios en las políticas de vacunación en EE. UU. y sus posibles repercusiones en salud pública. Se presenta el esquema de vacunación incluido en la Cartilla Nacional de Vacunación en México y las principales características de las vacunas. Un análisis del comportamiento epidemiológico de las enfermedades prevenibles por vacunación de nuestro país permite plantear los riesgos de hacer modificaciones en el esquema y lograr un mayor convencimiento a los pediatras y a la población en general del impacto positivo de la vacunación, y continuar con el esquema de vacunación universal ya establecido. In the last months of 2025, the United States has experienced profound and controversial changes in its vaccination policies. The Department of Health and Human Services (HHS), under the leadership of Robert F. Kennedy Jr. and following a presidential memorandum issued by Donald Trump, has modified the vaccination schedule of the Centers for Disease Control and Prevention (CDC). The main measure involves reducing from 17 to 11 the number of diseases for which routine and universal vaccination in children is recommended. Numerous public health specialists, together with organizations such as the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA), have expressed concern regarding these changes. This document reviews the changes in vaccination policies in the United States and their potential public health implications. We present the vaccination schedule included in Mexico’s National Vaccination Card and the main characteristics of the vaccines. An analysis of the epidemiological behavior of vaccine-preventable diseases in our country makes it possible to outline the risks of modifying the schedule and to recommend strengthening awareness among pediatricians and the general population about the positive impact of vaccination, as well as maintaining the already established universal vaccination schedule.
Perinatal depression affects up to 30% of women in Kenya, yet many contributing factors remain poorly understood. We explored mental health problems, social needs, and associated risk factors among women ante- and postnatally in Kajiado County, southern Kenya, from the perspectives of women and health-care workers (HCWs). We conducted a qualitative study based on dual-perspective focus group interviews with mothers (ante- and postnatal) and HCWs in five health-care facilities (two urban and three rural) across Kajiado County (5-11 March 2025). Interviews were recorded, transcribed verbatim, translated into English when needed, and analysed using qualitative content analysis with an explorative and inductive approach. The text was divided into meaning units and manually coded in Atlas.ti ( https://atlasti.com ). Themes, subthemes and categories were articulated following a stepwise, iterative and reflexive process of abstraction and interpretation. Across five sites, 51 mothers and 39 HCWs participated. Three themes were developed relating to stress, distress and affecting mental wellbeing, (a) Women's autonomy and self-determination - mothers lacked control over resources or decision-making, while shouldering most household responsibilities, and HCWs highlighted the vulnerability of girls subjected to early marriage and female genital mutilation, often unprepared for motherhood, (b) Responsive maternal and mental health care - distance, costs, and low expectations limited access, while women feared traumatic births, miscarriage, and caesarean sections, and (c) Community knowledge and acceptance of mental health problems - mental health problems were often seen as irrationality or spiritual possession, delaying care. Stigma was particularly associated with caesarean sections, mental health problems, and HIV. Our findings describe how maternal mental health is closely intertwined with gender norms and prevailing perceptions of mental illness including stigma. Expanding maternal mental health services may be important but it is unlikely to be sufficient in isolation. Sustainable change may depend on the promotion of women's rights, increased mental health literacy at the community level, and the engagement of men. In addition, fear of traumatic birth and stigma associated with CS may need to be addressed not only at the individual level but also within the broader community context.
Although physical activity during pregnancy is recommended, many women reduce their activity levels due to misconceptions, cultural beliefs, and inadequate guidance. In Sri Lanka, limited evidence exists on physical activity patterns among pregnant women, particularly primigravida mothers. Therefore, this study aimed to assess the level of physical activity during pregnancy among primigravida mothers attending an antenatal clinic at a tertiary care hospital in Sri Lanka. A descriptive cross-sectional study was conducted in the ante-natal clinic from September'2019 to March'2020. Primigravida mothers who were in first (n1=181), second (n2=225) and third (n3=178) trimesters were recruited (N = 584) using systematic random sampling. Data collection was done through a self-administered pregnancy physical activity Questionnaire (PPAQ) and analyzed using SPSS version 25.0. Pearson chi-square tests were adopted in data analysis to find associations between socio-demographic data and PA level. Outcome variables compared among trimesters by Kruskal Wallis H test. Mean age of participants was 25.88 ± 3.18 years and their response rate were 96.4%. Mothers who did not follow international recommendation of PA were 19.3%, 29.3% and 32.0% for first, second and third trimesters, respectively. Statistically significant association was found in between PA level and the trimester (p = 0.015). Also, significant associations were observed in between PA level and the family type (p = 0.001), and the living area (p = 0.031) and the pre-pregnancy BMI (p = 0.016) in first trimester. Further, no significant association was present in between level of education and level of PA within any trimester (p > 0.05). Mean duration for total activity and energy expenditure of pregnant mothers were not significantly differ among the trimesters (p > 0.05). Most favored modes of PA were household/care giving and light intensity activity in each trimester. Nearly one-quarter of pregnant mothers did not meet the recommended level of physical activity during pregnancy. The proportion of inactive mothers increased progressively with advancing trimester. Therefore, structured education programmes demonstrating safe and appropriate physical activities according to gestational age are recommended. Particular attention should be given to inactive mothers to enhance knowledge and promote motivation to achieve recommended physical activity levels.
This study investigates the effect of universal health insurance on the health behavior of the elderly in Taiwan. Using a difference-in-differences approach, I show that universal health insurance does not lead to ex-ante moral hazard for elderly Taiwanese men or women. Instead, it reduces certain risky health behaviors among elderly women, such as drinking and smoking. Moreover, it reduces the likelihood of engaging in more than two risky behaviors. The effect varies significantly across health behaviors by education level and insurance type. My findings suggest that universal health insurance has potentially beneficial impacts on risky health behaviors, such as drinking and smoking, among elderly Taiwanese women, which may be important for policymakers in other countries and territories.
Disseminated intravascular coagulopathy (DIC) in pregnancy is a severe maternal morbidity that is associated with short- and long-term complications. However, information regarding the causes of DIC treatments and outcomes in pregnancy is based on local reports. To address this gap, two Scientific and Standardization Committees, the Women's Health Issues in Thrombosis and Hemostasis and Disseminated intravascular coagulation of the International Society on Thrombosis and Hemostasis, joined to establish an international global registry. This registry was developed to examine the current definitions, clinical presentations, and current practices around laboratory diagnosis and management of DIC worldwide. We collected data between 2018 and 2024; there were 148 data entries to the registry (13 countries), 104 of them included patients' clinical and laboratory information. Placental abruption is the leading cause for ante and intrapartum DIC, especially when associated with stillbirth. The leading etiology for postpartum DIC was uterine atony, especially following/during caesarean sections. The contribution of abnormally implanted placenta (i.e., placenta accreta and/or previa) to the development of DIC is increasing. The leading pregnancy complications associated with DIC were placental abruption in HIC and preeclampsia in LMIC. Hemostatic parameters differed between women who had a positive pregnancy-specific DIC score and those who did not meet that criterion. Women with placental-mediated pregnancy complications had a lower median pregnancy-specific DIC score than those without such complications at diagnosis of DIC and following recovery, suggesting a different mechanism of disease in the two groups.
This article presents an in-depth single-case study of Kazakhstan and examines the latent negative effects that may accompany the expanding use of artificial intelligence (AI) in the public sector. The central premise is that such risks arise less from isolated technical performance indicators of particular AI systems than from the broader architecture of legal regulation, institutional design, and centralized data infrastructures. The study combines normative-institutional analysis with secondary qualitative analysis. The normative component examines the Law of the Republic of Kazakhstan "On Artificial Intelligence," the National AI Platform, and related digital governance projects, including Smart Data Ukimet, the Digital Family Card, and sovereign large language models. The empirical component is based on a secondary qualitative analysis of 53 semi-structured interviews with civil servants. Auxiliary analytical summaries derived from the same interview subset were used only to support retrieval and thematic consolidation. The analysis therefore reconstructs primarily ex ante and design-level risk trajectories rather than providing a full ex post assessment of realized harms, although some enabling mechanisms are already observable in existing digital infrastructures. On this basis, the article develops a map of hidden AI risks adapted to the Kazakhstani context. Five main groups of risks are distinguished: political-legal and institutional risks; data- and technology-related risks; organizational and managerial risks; explainability and opacity risks; and market and environmental risks. The findings show that, in the Kazakhstani case, these risks are institutionalized ex ante through legal constructs, the distribution of administrative powers, and established data-use practices. AI is legally framed as a "tool," while a de facto redistribution of power occurs through algorithmic and infrastructural arrangements. Centralized data infrastructures, including Smart Data Ukimet, the Digital Family Card, and the National AI Platform, may intensify algorithmic stratification and systemic bias. In addition, the mass deployment of AI agents under KPI-based governance may contribute to deskilling and to the fragmentation of responsibility among developers, public agencies, and citizens. The article argues that the principal challenge of AI deployment in Kazakhstan's public sector lies not only in the accuracy, efficiency, or technical reliability of individual systems, but also in the institutional conditions under which these systems are embedded. The Kazakhstani case demonstrates how AI-related risks can be formed before large-scale harms become empirically visible, through regulatory definitions, centralized infrastructures, and governance models that redistribute authority while obscuring responsibility. The study contributes to debates on public-sector AI governance by emphasizing the need for anticipatory institutional safeguards, transparent accountability mechanisms, and stronger scrutiny of data infrastructures in highly centralized administrative contexts.
Nontraumatic ileal perforation is a cause of obscure peritonitis characterized by severe toxicity and high mortality. This burden is disproportionately greater in LMICs due to poor hygiene practices, burden of HIV infection, and other comorbidities. This study aimed at determining the prevalence, anatomic-pathologic findings, and factors associated with nontraumatic ileal perforation a multicenter cross‑sectional study at 3 selected hospitals in Uganda. This was a cross-sectional study of 149 consecutive sample participants that used a structured checklist. We conducted logistic regression analyses using SPSS v21.0 (IBM), Variables with p < 0.20 in the bivariate analysis were entered into the multivariable logistic regression model, and p < 0.05 was considered statistically significant. Nontraumaticileal perforation was more prevalent among males (20.1%; 149) and peasants/farmers (41.6%; 149) of rural residence (22.1%; 149). The majority of the study participants had typhoid perforations (79.1%; 149). Most ileal perforations occurred 20-39 cm from the ileocecal junction (76.4%; 149), a perforation size/diameter of 0.5-1cm was more common (58.1%; 149), and a single isolated perforation was more common (74.4%; 149). However, all perforations mainly occurred at the ante mesenteric border. Being an HIV-positive person was associated with greater odds of developing NTIP than was being a non-HIV-positive person. AOR 8.344, p = 0.015 (p<0.05). Additionally, patients treated with open and closed pit latrines were more likely to develop nontraumatic perforation than were those treated with water flash latrines. AOR 12.971, p = 0.004 (p < 0.05). This study established that nontraumaticileal perforation is more prevalent among male peasants living in rural areas and with typhoid fever and most of ileal perforations were due to typhoid fever.