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Adequate Water, Sanitation, and Hygiene (WASH) facilities are essential for menstrual hygiene management (MHM) and school retention among adolescent girls. Many Nigerian schools lack such infrastructure, which has been associated with menstruation-related absenteeism and compromised menstrual wellbeing among adolescent girls. This study assessed WASH facility adequacy in secondary schools in Nasarawa West Senatorial Zone and examined associations with girls' school attendance during menstruation. A cross-sectional study was conducted among 1,250 female students across 25 secondary schools in Keffi, Nasarawa, and Kokona LGAs. WASH adequacy was assessed using a structured observational checklist, scoring 12 facility components (water availability, toilet conditions, privacy, lighting, handwashing facilities, and disposal systems). Student attendance during menstruation was assessed via structured questionnaire using a four-point frequency scale (always, sometimes, rarely, never), with absenteeism defined as reporting sometimes, rarely, or never attending during menstruation. Chi-square analyses with cluster-robust standard errors examined associations between WASH adequacy and menstruation-related absenteeism. WASH conditions were critically inadequate, approximately 40% of schools had functional water sources, 28% had water available during assessment, and 16% had separate girls' toilets. Privacy features, handwashing facilities with soap, and covered disposal bins were each present in 16% of schools. No school provided private changing spaces, sanitary waste disposal systems, emergency sanitary supplies, or MHM education materials. Private schools scored marginally higher than public schools (1.2&#x2009;&#xb1;&#x2009;0.3 vs. 0.9&#x2009;&#xb1;&#x2009;0.3). Only 36.8% of students consistently attended school during menstruation. Absenteeism was strongly associated with inadequate WASH facilities (&#x3c7;&#xb2; = 48.3, p&#x2009;<&#x2009;0.001), with pain or cramps (32%), lack of pads (23.2%), and fear of staining (19.2%) as the most frequently reported reasons. WASH facilities in Nasarawa West secondary schools are grossly inadequate and associated with menstruation-related absenteeism. Urgent interventions including improved water supply, private toilets, disposal systems, and access to menstrual materials are required to support girls' menstrual health and educational equity. Many girls in Nigerian secondary schools miss school during their periods because their schools lack basic water and toilet facilities. This study looked at the condition of water, sanitation, and hygiene (WASH) facilities in 25 secondary schools in Nasarawa West, Nigeria, and asked 1,250 female students about their school attendance during menstruation.We found that school WASH facilities were extremely poor. Only 4 in 10 schools had a working water source, and only 1 in 6 had separate toilets for girls. None of the 25 schools had a private changing space, sanitary waste disposal system, or menstrual health education materials. Private schools were slightly better equipped than public schools, but both fell far short of acceptable standards.Nearly two-thirds of students (63.2%) missed school at some point during their period. The most common reasons were period pain, lack of sanitary pads, fear of staining their clothes, and lack of clean toilets or water. Girls in schools with poorer WASH conditions were more likely to miss school.These findings show that menstrual health is being ignored in school planning in this part of Nigeria. To keep girls in school, urgent action is needed to improve water supply, build private toilets, provide sanitary pads, and include menstrual health in school programmes.

The fossorial vole Arvicola terrestris scherman (ATS) is a pest rodent in Central Europe that is subject to cyclical infestations, the frequency of which is steadily increasing in a global context of climate and environmental change. Due to the significant economic, agricultural, and sanitary issues associated with ATS outbreaks, research is being conducted to better understand the physiological, behavioral, and environmental characteristics of these phenomena. The work presented here consisted of comparing ATS males from summer and winter in terms of anatomical, systemic, and testicular gene expression parameters. Interestingly, two reproductive morphs of males with the same anatomical characteristics in terms of overall body weight and coat length were observed during the winter period. One morph is typical of this seasonal breeding species, showing significant winter regression of its reproductive organs, while the other morph is atypical, appearing to having preserved the male reproductive tissues and function. Histological and RNAseq analyses of the testicular tissue clearly define the distinct characteristics of these animals, confirming the maintenance of reproductive capacity in some winter males. Knowledge of these physiological changes is an important factor in defining relevant control strategies.

Community-Led Total Sanitation (CLTS) seeks to eliminate open defecation by empowering households to adopt improved sanitation and hygiene behaviours. While widely integrated into national sanitation strategies of low- and middle-income countries, limited evidence exists on how implementation processes drive behaviour change. This study aimed to evaluate the implementation fidelity, reach, dose, adaptation, and mechanisms of impact of a CLTS intervention in Chiradzulu District, Malawi. We conducted a retrospective mixed methods process evaluation between January 2022 and February 2023, using 1,151 household surveys, 36 in-depth interviews, and 28 focus group discussions with community members and implementers. Outcomes assessed were latrine and handwashing facility (HWF) availability, with logistic regression used to explore associations with intervention exposure. All planned activities were delivered, but fidelity was variable ranging from low fidelity for training delivery to high fidelity for household engagement. Intervention reach was suboptimal, with limited household contact and low recall of hygiene campaigns. Combined exposure to both community and household-based activities significantly increased odds of latrine ownership (OR&#x2009;=&#x2009;1.63, CI&#x2009;=&#x2009;1.55-1.72) and HWF presence (OR&#x2009;=&#x2009;1.39, CI&#x2009;=&#x2009;1.03-1.86). CLTS programmes should strengthen intervention fidelity, integrate affordable climate resilient facilities, and strengthen household-based engagement to enhance sustainability and impact.

Disadvantaged access to water, sanitation, and hygiene (WASH) is acknowledged as a risk factor for non-partner sexual violence (NPSV), particularly in the context of low- and middle-income countries (LMICs). However, gaps in knowledge regarding the associations between inadequate WASH and NPSV persist. Demographic and Health Surveys from 31 low- and middle-income countries (2013-2021) were used for the analysis of 259,208 women aged 15-49 years. For the experience of NPSV in the last 12 months, its associations with source of drinking water (private [reference], public, open source) and type of toilet facilities (private [reference], shared, no facilities) were estimated using three-level logistic regressions. Overall, 0.5&#xa0;% had a recent experience of NPSV. After adjusting for sociodemographic characteristics, women who used public (Adjusted odds ratio [AOR]&#xa0;=&#xa0;1.27, 95&#xa0;% confidence interval [CI]&#xa0;=&#xa0;1.06-1.52) or open source for drinking water (AOR&#xa0;=&#xa0;1.37, 95&#xa0;% CI&#xa0;=&#xa0;1.02-1.84) were more likely to experience NPSV. Similarly, women who used shared toilet facilities (AOR&#xa0;=&#xa0;1.16, 95&#xa0;% CI&#xa0;=&#xa0;1.01-1.34) and who had no facilities (AOR&#xa0;=&#xa0;1.40, 95&#xa0;% CI&#xa0;=&#xa0;1.17-1.68) had greater risk for NPSV. The interaction was only marginally significant (p-value&#xa0;=&#xa0;0.07). The findings support the need to expand WASH-related programs, which can contribute to the prevention of sexual violence and empowerment of women in LMICs. National and global advocacy is essential to resolve discriminatory climates that condone and facilitate violence against women in water-related contexts.

Fecal-oral diseases remain a major public health challenge in sub-Saharan Africa, where sanitation infrastructure is limited and cultural barriers hinder improved practices. Compost latrines are promoted as ecological solutions, but their acceptability is uncertain. This study assessed household knowledge, attitudes, and practices regarding fecal-oral disease prevention in Nyamugo, Democratic Republic of the Congo, and explored perceptions of compost latrine acceptability. The aim was to identify enabling factors and barriers, including cultural and economic determinants, to inform integrated interventions. A mixed methods cross-sectional design was used. Quantitative data were collected from 432 households through structured questionnaires, and qualitative insights were obtained via focus groups and key informant interviews. Chi-square and logistic regression analyses examined associations between knowledge, attitudes, and practices indicators and sociodemographic variables. Both significant and nonsignificant results were reported for transparency. Households demonstrated partial knowledge of fecal-oral diseases. Cholera was widely recognized (367/412, 88.9%), while hookworm and poliomyelitis were rarely mentioned. Preventive methods such as sanitation (285/412, 69.2%) and hand hygiene (224/412, 54.4%) were the most frequently cited, with education significantly increasing the odds of sanitation knowledge (odds ratio [OR] 2.1, 95% CI 1.4-3.2). Attitudes revealed strong recognition of fecal hazard prevention (397/422, 94.2%), yet compost latrine acceptability remained low (178/422, 42.2%). Regression confirmed that higher education increased favorable attitudes (OR 1.9, 95% CI 1.2-3.0). Qualitative findings highlighted persistent cultural taboos, with latrines described as "impure" or "shameful." Practices were inconsistent. Although 88% (380/432) of the households owned latrines, only 30.3% (115/380) maintained them hygienically, and open defecation persisted in 31.7% (137/432). Larger household size predicted open defecation (OR 1.8, 95% CI 1.2-2.7), while education was associated with improved hygiene (OR 2.3, 95% CI 1.4-3.6). Compost latrines were not used. Diarrheal episodes in children younger than 5 years were reported in 38.7% (167/432) of the households, with unimproved water sources significantly increasing risk (OR 2.4, 95% CI 1.5-3.8). Qualitative testimonies reinforced these findings, emphasizing poverty, lack of infrastructure, and cultural resistance as barriers. This study confirms a persistent gap between knowledge and practice in fecal-oral disease prevention. Cultural taboos and economic constraints limit compost latrine adoption, even among educated households. Nevertheless, participants expressed openness to adoption if external support-through subsidies, training, and sensitization-was provided. Public health interventions should integrate financial support, cultural dialogue, and infrastructure strengthening to sustainably reduce diarrheal disease burden. Future research should assess the long-term impacts of compost latrine adoption, explore cost-effectiveness, and evaluate behavior change strategies.

Low- and middle-income countries (LMICs) account for a large share of global infant deaths, but there is a lack of evidence on the pooled estimate of infant mortality and its predictors in LMICs. Therefore, this study aimed to assess the pooled incidence of infant mortality and its associated factors in LMICs. We used clustered data extracted from the recent Demographic and Health Surveys (DHS 2018-DHS 2024) of all LMICs. A total of 1,404,826weighted numbers of recent live births were included in the study. A lognormal shared gamma frailty model was employed. We used the Akaike information criterion (AIC), Bayesian information criterion (BIC), and log-likelihood values for model comparison. An adjusted time ratio ([Formula: see text]) with a 95% confidence interval (CI) in the final model was used to select variables that had a significant association with time to infant death. The data were analyzed via R software version 4.3.1. A total of 1,404,826 live births were included in the final analysis. By the end of the follow-up period, 72,569 infants (5.17%, 95% CI: 5.13-5.21) had died before their first birthday. The pooled estimate of the IMR in LMICs was 39 per 1000 live births (95% CI: 32.68-44.95). Maternal education, family size&#x2009;&#x2265;&#x2009;5, being a multiparous mother, being delivered at health facilities, being a female infant, immediate initiation of breast feeding, living in Europe & Central Asia, and living in West & East Asia were significantly associated with a lower risk of infant death. Conversely, maternal age 25-34, maternal age 35-49, unimproved toilet facilities, poor and middle wealth indices, maternal age at birth &#x2264;19, birth interval of <18 and 18-23 months, multiple births, 2nd birth order, small birth size, low and medium Human Development Index (HDI), low and medium literacy rate, low-income and lower-middle income countries, rural residence, living in West Africa, South & Central Africa, and South Asia were significantly associated with a higher risk of infant mortality. The infant mortality rate (IMR) in LMICs remains high compared with that in WHO targets and shows significant regional variation. West Africa and South Asia had the highest pooled estimate of infant deaths. Variables such as maternal age, education, wealth index, age at first birth, parity, family size, child sex, birth interval, multiple pregnancy, birth order number, perceived child size at birth, place of delivery, residence, country's literacy rate, income group, and HDI value were identified as significant predictors of time to infant death. Therefore, public health interventions that enhance health facility delivery, optimal birth spacing, maternal education, and immediate breastfeeding are crucial to reduce the incidence of infant mortality in LMICs.

China's Rural Sanitary Toilet Interventions (2015-present) is a government-led initiative aimed at replacing unhygienic rural toilets with sanitary facilities. This study explores the impact of this policy on pesticide reduction and analyzes the mediating role of health literacy. Based on survey data from 4,277 rural households in 10 provinces, this study employed a three-step method and bootstrap resampling for mediation analysis, used alternative models for robustness checks, and conducted heterogeneity analysis. The significant reduction in pesticide use due to the Rural Sanitary Toilet Interventions project remained robust across different model specifications. Heterogeneity analysis revealed that the policy had a particularly pronounced effect on reducing pesticide use in the lower-middle-income group, while no significant differences were observed in other income groups. The effect was significant in non-plain areas but not statistically significant in plain areas. Mediation analysis confirmed that health literacy played a crucial mediating role in the relationship between policy implementation and the reduction in pesticide use. These findings emphasize the importance of tailoring policies to different income levels and geographical conditions for targeted interventions, as well as the necessity of integrating health education with agricultural practices to promote sustainable agricultural behaviors. This study contributes to the literature by bridging the gap between public health and agricultural sustainability, offering valuable insights for policymakers seeking to promote eco-friendly agricultural transitions.

There is growing evidence that migraine is associated with attentional abnormalities, both during and between attacks, potentially affecting the cognitive processing of sensory stimulation. However, the underlying neurophysiological mechanism remains poorly understood. This study aimed to investigate whether top-down and bottom-up attentional mechanisms, as indexed by alpha- and gamma-band oscillatory activity measured with magnetoencephalography are altered in patients with episodic migraine without aura during the interictal phase. In a cross-sectional study (conducted in 2016-2017 in Lyon area of France) with a comparison of matched groups, 19 patients with migraine without aura and 19 healthy participants performed an attentional task involving visually cued auditory targets and distracting sounds to evaluate conjointly top-down and bottom-up attention mechanisms. Magnetoencephalography was used to record anticipatory alpha activity (power increase and decrease) and distractor-induced gamma activity as markers for top-down (inhibition and facilitation) and bottom-up attention, respectively. Compared to healthy participants, patients with migraine exhibited a significantly less prominent alpha power increase in visual areas in anticipation of the auditory target (permutation tests, cluster significance p&#x2009;=&#x2009;0.043), indicating a reduced inhibition of task-irrelevant visual areas. In contrast, there was no significant group difference regarding the alpha power decrease in the relevant auditory cortices in anticipation of the target (permutation tests, cluster significance, p&#x2009;>&#x2009;0.310), nor regarding the distractor-induced gamma power increase in the ventral attention network (permutation tests, cluster significance p&#x2009;>&#x2009;0.999). These results suggest an impairment of top-down attentional inhibitory processes in migraine, as reflected by the altered alpha modulation in the visual cortex. This relative inability to suppress irrelevant sensory information may underlie the self-reported increased distractibility and contribute to sensory disturbances in migraine. In addition to the well&#x2010;known recurring headache, people with migraine are often overly sensitive to lights, sounds, and smells, even when they do not have a headache. We used brain recordings to study how attention works differently in people with migraine and those without. We showed that patients with migraine have more problems reducing activity in brain visual areas that are not needed when completing a sound&#x2010;based task, which might help explain why patients with migraine can be overwhelmed by sensory inputs in real life.

Chondrosarcoma (CHS) is the second most common primary malignant bone tumor and remains resistant to conventional therapies, underscoring the need to discover novel therapeutic targets. Cancer/testis antigens (CTAs), a class of tumor-associated proteins, represent attractive antigens for cancer immunotherapies such as adoptive T cell therapy. However, the expression profile of CTAs and their associated targetable immunopeptides presented in the Human Leukocyte Antigen-I context (pHLA) remain unknown in CHS. This study aims to characterize the CTA expression profile according to the tumor immune phenotype and clinical outcomes, and to identify the most relevant pHLA to target in CHS. We analyzed the CTA expression profile in tumors from 63 conventional CHS patients and in healthy tissues using GTEx and HPA databases to identify CHS-associated CTAs. Cox proportional hazards models combined with hierarchical clustering were used to correlate CTA expression with the overall survival of patients. The tumor immune phenotype was estimated based on immune gene expression signatures using a deconvolution method and a Pearson correlation coefficient matrix. The CTA-derived pHLA were characterized using immunopeptidomic profiling based on HLA-I immunoprecipitation and mass spectrometry in grade 2 and 3 CHS models. NetMHC was used to predict the binding affinity of identified pHLA to the HLA-A*02:01 and HLA-A*01:01 alleles. We identified a poor prognosis CTA signature predominantly associated with a non-inflamed tumor immunophenotype. Immunopeptidomic profiling revealed broad pHLA repertoires, including previously well-characterized CTAs from PRAME, CTAG2 and the MAGE-A family, as well as newly identified candidates with strong predicted HLA-binding affinity from CTAs such as HHIPL2, DBF4, BRIP1, CBX2 and DIAPH3. This study provides the first atlas of pHLA in CHS and suggests specific antigenic targets for TCR-T cell therapies and targeted therapies such as antibody-drug conjugates.

Improving urban sanitation requires understanding user preferences and willingness to pay (WTP) for sewer connections. This study evaluates WTP for sanitation attributes in low-income communities (LICs) of Dhaka, Bangladesh, comparing contingent valuation (CVM) and hedonic pricing (HPM) methods. A cross-sectional study was conducted in 5 LICs, surveying 1000 households and conducting spot checks of toilet facilities. WTP was analyzed using logistic regression models for CVM and generalized linear models (GLM) for HPM, adjusting for socioeconomic factors and cluster-level correlations. The estimated WTP for a sewerage connection varied substantially between the valuation methods. The CVM produced a mean WTP of BDT 87 (95% CI: 79, 95), while the HPM yielded a significantly lower mean WTP of BDT 74 (95% CI: -223, 226). CVM assessments revealed key differences between landlords and tenants. Higher-income individuals were more willing to pay a monthly sewerage bill, but this willingness sharply declines as the bill amount increases, especially among tenants. Over 90% of respondents were willing to pay, considering their neighbors' agreements and the health benefits for their families. Results from the HPM showed that significant determinants of monthly rental costs included the number of rooms in the household, where each additional room increased WTP by 1549&#x2009;units (P&#x2009;<&#x2009;.001). Household roof materials also played a crucial role, with significant positive impacts observed for roofs made of kaccha/bamboo/jute/wood (400&#x2009;units, P&#x2009;<&#x2009;.001), and cement/concrete/tiled (461&#x2009;units, P&#x2009;<&#x2009;.001). Additionally, specific toilet attributes such as concrete pan materials significantly increased tenant WTP (1002&#x2009;units, P&#x2009;<&#x2009;.001). Findings highlight that socioeconomic factors influence WTP, emphasizing the need for data-driven urban sanitation policies. Policymakers should integrate these insights to design affordable, inclusive, and sustainable sanitation interventions for LICs. Comparison of Willingness to Pay Techniques for Sanitation Services in urban Dhaka, Bangladesh Improving urban sanitation requires understanding user preferences and willingness to pay (WTP) for sewer connections. This study evaluates WTP for sanitation attributes in low-income communities (LICs) of Dhaka, Bangladesh, comparing contingent valuation (CVM) and hedonic pricing (HPM) methods. A cross-sectional study was conducted in five LICs, surveying 1,000 households and conducting spot checks of toilet facilities. WTP was analyzed using logistic regression models for CVM and generalized linear models (GLM) for HPM, adjusting for socioeconomic factors and cluster-level correlations. From the CVM analysis we found that, higher-income individuals showed greater WTP for sewerage but were sensitive to cost increases, especially tenants. Over 90% of respondents expressed WTP, influenced by neighbor participation and perceived health benefits. From HPM analysis we found that, rental values were significantly influenced by household size, roof materials, and toilet attributes. Each additional room increased WTP by 1,452.16 units (p<0.001). Households in Dholpur (-1,013.95 units, p<0.001) and Mohajer Colony (-743.62 units, p<0.001) had lower WTP. Improved toilet features, such as concrete pan materials (+687.47 units, p<0.001) and outside locks (+255.09 units, p<0.001), significantly increased WTP. Findings highlight that socioeconomic factors influence WTP, emphasizing the need for data-driven urban sanitation policies. Policymakers should integrate these insights to design affordable, inclusive, and sustainable sanitation interventions for LICs.

In East and Southern African cities, pit latrines are the most common household sanitation system and often require manual emptying. City authorities in the region have begun to formalize service providers, and, along with service providers, require cost data and analysis to optimize service delivery and reduce costs to minimize public funding contributions toward a large funding gap. We analyzed financial and operational data from 23 formal service providers and 260 households in Malawi and Uganda. Total Annualized Cost per Household (TACH) was calculated to understand unit costs and cost structures, and scenario modeling was used to analyze cost drivers. Manual emptying is higher TACH than mechanical emptying at full capacity utilization because of higher labor costs. TACH varies between households due to different annualized sludge emptying rates. Service providers report operating below full capacity, increasing TACH and not justifying vehicle ownership over rental. Households prefer low-volume and low-price emptying to manage budgets, but this increases TACH unless service providers coordinate to maximize capacity. Options are discussed for city authorities and service providers to minimize TACH and improve vertical equity between emptying methods and horizontal equity between households, including replacing direct user-payments with frequently collected citywide payments and managed emptying services.

In January 2025, the Escherichia coli National Reference Center of France detected an outbreak of hemolytic uremic syndrome (HUS) in adults, caused by Shiga toxin-producing E. coli negative for locus of enterocyte effacement (LEE). The outbreak included 18 confirmed cases of E. coli infection, 5 probable or possible cases detected by in-house specific PCR, and 2 additional cases from Scotland and Belgium. Whole-genome sequencing identified the outbreak strain as O77 g:K92:H18, belonging to phylogroup D; the strain harbored the Shiga toxin 2 gene variant stx2d-073-C165-02 and a 134-kb plasmid with enterotoxin genes (estb-STb2 and eltAB). Epidemiologic investigation implicated raw-milk cheese as the contamination source. The strain represents a singular hybrid pathotype of Shiga toxin-producing and enterotoxigenic E. coli, expressing a K92 capsule with known cross-immunogenicity to Neisseria meningitidis group C, which could explain the absence of pediatric cases. Related strains have been identified in international databases since 2005, suggesting global emergence.

Research in embodied cognition has consistently shown a close link between action verb processing and action observation, often attributed to shared sensorimotor representations. However, it remains unclear whether this action-language coupling is modulated by social context. The present research addressed this gap by examining the influence of gender stereotypes on action-language processing. In Experiment 1 (N = 40, 20 female), participants performed a primed action-language task in which pictures of stereotype-consistent (e.g., woman knitting) or stereotype-inconsistent (e.g., man knitting) actions preceded action verbs. Response times revealed that stereotype-consistent primes weakened the standard facilitation effect between action observation and language processing, but only for female participants. Experiment 2 used a larger online sample (N = 181, 48 female) and replicated the modulation of the congruence effect, this time across both genders. Together, these findings indicate that socially shared stereotypes can actively moderate embodied action-language interactions, likely through attentional and/or predictive mechanisms, or through the activation of broader, supra-categorical semantic representations via stereotype-congruent cues.

Diarrhoea remains a major public health concern among children under five in developing countries due to inadequate sanitation and limited access to clean water. Evidence on specific factors contributing to diarrhoea in Murambi Sector, Gatsibo District, Rwanda, is limited. This study assessed the prevalence of diarrhoea and its associated factors among children under five. A cross-sectional study was conducted with 339 children under five. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0, applying bivariate and multivariable logistic regression. Statistical significance was set at p < 0.05. Among the participants, 56.6% were female. The prevalence of diarrhoea was 14%. Factors significantly associated with diarrhoea included having an improved toilet, presence of a handwashing facility, and washing hands before feeding a child (p < 0.05). Improved sanitation and hand hygiene practices are essential to reduce diarrhoea among children under five in Murambi Sector. These findings support interventions aimed at promoting household hygiene and enhancing access to sanitation facilities.

The bacterial determinants of Group A Streptococcus (GAS) associated with either invasive (IGASI) or non-invasive (NIGASI) infections remain controversial. From 2014 to 2018, French children hospitalized for an IGASI were enrolled in a prospective multicenter study aimed at identifying bacterial virulence factors and predisposing immunologic and genetic factors. During the same period, age- and date-matched control children with NIGASI were enrolled. Whole genome sequencing was performed for all GAS isolates. The 27 specific single nucleotide polymorphisms characterizing the M1UK lineage were searched among the emm-1 isolates. A total of 192 GAS isolates were sequenced: 94 from the IGASI group and 98 from the NIGASI group. The emm-1 genotype predominated in the IGASI group (36% vs. 11% in NIGASI group, P&#x2009;<&#x2009;.05) and was followed by emm-4, emm-12, and emm-3 (12%, 11%, and 10% respectively). In the NIGASI group, emm-89 predominated (21% vs 7% in the IGASI group, P<.05). Among the 45 emm-1 isolates, 12 (27%) carried the mutations characterizing clone M1UK in both groups (7 in IGASI group and 5 in NIGASI group). The superantigenic toxins SpeA and SpeJ, SIC protein, and FCT type 1 pilus predominated in the IGASI group but were linked to emm-1 strains. Insertions/deletions in the covS regulator gene were observed in 5 invasive isolates versus 1 non-invasive isolate. Genotype emm-1 GAS strains remained the main cause of invasive infections in French children, associated to specific GAS virulence factors, and should be monitored together with the rapid spread of the M1UK lineage. emm-1 GAS strains remained the main cause of invasive infections in French children, and 27% were from the M1UK lineage. The superantigenic toxins SpeA and SpeJ, SIC protein, and FCT type 1 pilus were significantly associated with invasive infections but were linked to emm-1 strains.

Achieving universal access to safe drinking water and sanitation remains a major challenge in Uganda, where persistent socioeconomic and spatial inequalities limit progress toward Sustainable Development Goal 6. While previous studies have largely focused on localized settings, national-level evidence applying the WHO/UNICEF Joint Monitoring Programme (JMP) service ladder framework is limited. This study aimed to address this gap. This study used secondary data from the 2018&#x2013;2019 Uganda Malaria Indicator Survey. A total of 8,925 households were included, with data drawn from the Household Recode file. The dependent variables were household sources of drinking water and types of toilet facilities and these were classified according to the WHO/UNICEF JMP service ladder framework into safely managed, basic, limited, unimproved, and no service categories. Independent variables comprised a range of individual and household-level characteristics. Descriptive statistics were used to summarize key variables, while chi-square tests examined bivariate associations between the dependent and independent variables. Multivariable ordinal logistic regression was then applied to estimate the adjusted effects of the determinants on water and sanitation service levels. All analyses accounted for the complex survey design and sampling weights and were conducted using Stata version 18. Most Ugandan households relied on basic drinking water services (67.8%), while safely managed water remained low (8.8%) and was almost absent in regions such as Karamoja. Sanitation access was dominated by limited services (49.7%), with only 43.6% achieving safely managed sanitation. The significant determinants associated with JMP service levels were identified. Higher education, household wealth, male headship, and residence in central and western regions strongly increased the likelihood of accessing higher service levels. Rural areas and refugee settlements consistently exhibited the lowest service levels, reflecting structural deficits in infrastructure, affordability, and service reliability. This study shows that safely managed drinking water and sanitation remain limited in Uganda, with persistent inequalities driven by education, wealth, gender, and region. Targeted investments and pro-poor, equity-focused policies are urgently needed to improve service levels in underserved rural areas and refugee settlements. Strengthening infrastructure, reducing affordability barriers, and supporting context-specific water and sanitation programming will be essential for accelerating progress toward universal and safely managed services.

Podoconiosis is a preventable Neglected Tropical Disease (NTD) that results in significant lower limb swelling and chronic disability. Its management can be done at home by regularly washing feet with clean water and soap and using protective footwear. This study aimed to explore podoconiosis patients' experiences with access to water, sanitation, and hygiene (WASH) and to identify barriers and facilitators of home-based management (HBM).&#xa0;In this qualitative phenomenological study, participants were recruited following a screening conducted in Butaro Sector (Rwanda) to identify individuals with lower limb lymphedema. Randomly selected individuals underwent a clinical assessment, and only those confirmed to have podoconiosis were invited for an interview. In-depth interviews, supplemented by observation and photographs, were conducted. Transcripts were inductively coded using Dedoose (version 9.0.80) and analyzed through thematic analysis.&#xa0;Overall, 26 interviews were conducted across all five cells of Butaro Sector. Poverty and physical discomfort were major barriers in accessing WASH and HBM essentials, with many relying on family or neighbors for support. Shame, laughter, and discrimination from community members further hindered access to WASH. However, some participants found a financial solution in selling animal and household waste. Moreover, participants demonstrated little or no knowledge about podoconiosis which influenced their treatment choices. Many attributed the disease to witchcraft, blood infection, or God's will. Common care choices included traditional healers, self-care, or health centers.&#xa0;These findings demonstrate the need to integrate community education into podoconiosis management programs to address misconceptions and stigma while promoting income-generating activities to ensure consistent access to HBM essentials.

The use of new nicotine products (NNPs), particularly vapes, by pupils has been increasingly reported in schools. This paper reports the findings of a qualitative exploration of the impact of NNPs on schools by eliciting the views of 14-16-year-old pupils and school staff, as part of a wider study investigating the marketing and use of NNPs in Scotland. Qualitative study using 16 focus groups with pupils conducted February-March 2025, and in-person and telephone interviews (nine individual and two paired) with school staff. Four schools in Scotland based in areas of differing socioeconomic status and two levels of urbanity. 77 S3 (14-15 years) and S4 (15-16 years) pupils who vaped or were at risk of vaping. School staff (n=13) with a senior teaching or pastoral care/guidance role. Focus groups with pupils and interviews with staff exploring perceptions of NNPs, particularly vapes, on schools, and what mitigating actions might be needed. The qualitative data underwent thematic analysis. Pupils reported widespread use of vapes and to a lesser extent nicotine pouches, and described practices and behaviours, including truancy and missing classes as pupils sought other environments for their vaping, that were impacting on the life of the classroom and the wider school environment. The school staff outlined a number of approaches they had adopted to counteract disciplinary and other issues arising from vape use within schools, including instigating regular patrols, monitoring of toilet facilities and visiting neighbourhood shops, but acknowledged that they had little knowledge of nicotine pouches. They also perceived that they were not as knowledgeable as to the risks of NNPs and did not feel as comfortable addressing this issue within the classroom as they did compared with tobacco-related teaching. Young people reported behaviours related to NNP use that were having a detrimental impact on the schools. Staff had developed various approaches to address these issues and were having to allocate significant time and resource, especially to vaping-related issues. Staff require knowledge and awareness training in relation to other NNPs, as well as specific guidance on the risks of vaping and nicotine use.

Hospital restrooms are a weak link in infection control due to high pathogen loads, poor ventilation, and limitations of conventional disinfection. This study developed a smart toilet featuring a novel electrolytic disinfection technology to assess its clinical efficacy in decontaminating restroom surfaces and air, while exploring its potential for microbial control within hospital settings. A prospective controlled experimental study was conducted in four inpatient public restrooms at Zhongnan Hospital of Wuhan University between July and August 2025. The intervention utilized an onsite electrolysis device that electrolyzed a diluted sodium chloride solution to produce neutral electrolyzed water containing hypochlorous acid as the primary biocidal agent. Bench tests confirmed that a concentration of 40&#x202f;mg/L achieved a 100% kill rate against E. coli within 9&#x202f;min. The system was integrated into smart toilets. Surface samples (n&#x202f;=&#x202f;216) and air samples (n&#x202f;=&#x202f;72) were collected at 0, 5, and 30&#x202f;min after use. Disinfection qualification rate, bactericidal efficacy, and natural microbial decay were compared against routine cleaning. The surface qualification rate was 53.7% before and 61.1% after the intervention, a difference that was not statistically significant (p&#x202f;>&#x202f;0.05). The toilet seat (5&#x202f;min after use) and inner bowl (30&#x202f;min after use) both reached 100% compliance, whereas the flush button demonstrated limited and inconsistent bactericidal efficacy. The air sterilization rate reached 89.7% at 30&#x202f;min, which was significantly higher than the natural decay rate of 49.8% in the control group (p&#x202f;<&#x202f;0.05). This smart toilet with novel electrolytic disinfection technology improves environmental hygiene in hospital restrooms and overcomes key limitations of manual cleaning. Nevertheless, the flush button remains a high risk site because it is not directly subjected to disinfection, thereby necessitating design optimization.