搜索结果：Epidemics

Purpose To compare the performance of an artificial intelligence (AI) system with that of radiologists for estimating malignancy risk of indeterminate-size nodules (5-15 mm) on low-dose CT (LDCT) within a standardized and transparent evaluation framework. Materials and Methods Teams participating in the AI study had access to a public dataset of 555 malignant and 5608 benign nodules on 4069 baseline LDCT scans from the National Lung Screening Trial (NLST) to develop AI systems. External testing was performed on 156 malignant and 312 benign size-matched nodules, all of indeterminate size, from 463 baseline scans collected from three large European lung cancer screening trials between 2004 and 2018, and the best-performing AI system (based on area under the receiver operating characteristic curve [AUC]) was selected. An observer study was conducted in which radiologists assessed 300 randomly selected nodules (100 malignant, 200 benign) from the external test set. Radiologists categorized nodules as low, intermediate, or high-risk, and the ≥ intermediate-risk threshold (intermediate or high-risk) was used to define a positive test. The selected AI system was compared with radiologists on this subset using the AUC. Results The selected AI system demonstrated superior performance to the 65 radiologists' average (AUC, 0.78 (95% CI: 0.73, 0.84) vs 0.70 (95% CI: 0.65, 0.74), P = .001). When using the ≥ intermediate-risk threshold, the AI system correctly classified 12% more malignant nodules at matched specificity and yielded 20% fewer false positives at matched sensitivity. Conclusion The selected AI system was superior to radiologists in estimating malignancy risk of indeterminate lung nodules on LDCT. ©RSNA, 2026.

Chronic kidney disease (CKD) is a common comorbidity among cancer patients and may influence treatment options and outcomes. However, the independent effect of CKD in patients with hematologic malignancies remains unclear. We conducted a retrospective cohort study using electronic medical records of 1238 adult patients diagnosed with hematologic malignancies between 2015 and 2019. Patients with CKD stages 1-3A were compared to those without CKD. The primary outcome was 5-year all-cause mortality. We used stratified Cox proportional hazards models adjusted for age, sex, and comorbidities (HIV, diabetes, hypertension, and COPD) and performed 1:1 propensity score matching without replacement. Subgroup analyses by cancer subtypes were performed. Among 1238 patients, 529 (42.7%) had CKD. CKD patients were older (67 vs. 55 years), with higher rates of hypertension (66.0% vs. 48.0%). Five-year mortality was higher in the CKD group (24.4% vs. 17.8%, p = 0.006). In adjusted Cox models, CKD was not significantly associated with mortality (HR 1.08; 95% CI: 0.82-1.43). Subgroups by stages showed no significant risk: stage 1 (HR 1.27; 95% CI: 0.76-2.13), stage 2 (HR 1.05; 95% CI: 0.77-1.43), stage 3A (HR 1.03; 95% CI: 0.60-1.78). In matched analysis (n = 758), CKD remained non-significant (HR 1.04; 95% CI: 0.77-1.41). Early-stage CKD was common among patients with hematologic malignancies and associated with higher unadjusted mortality, but not with increased mortality after adjusting for age, sex, and comorbidities. These findings suggest that early-stage CKD may not independently impact survival among patients with hematologic malignancies.

Smoking prevalence in Germany remains high (30%) and uptake of cessation services is low. E-cigarettes are promoted as a cessation aid but whether they are preferred over established methods is unknown. To improve cessation efforts, understanding the extent different characteristics of a smoking cessation program are preferred are important. This study estimated preferences and willingness-to-pay for a smoking cessation program using a discrete choice experiment (DCE). Potential participants who resided in Germany and smoked &#x2265;5 cigarettes daily (cpd) were recruited for the main study between July-September 2023. The DCE included 12 choice tasks. Attributes were cessation aids (nicotine replacement, medication, and e-cigarettes), counseling, referral by a health professional, effectiveness, and out-of-pocket costs. The study sample (N=1052) was 51.4% female with a mean cpd of 17 (SD=8.2). Mixed logit regression found counseling, referrals, and program effectiveness significantly influenced choices (p<0.001). None of the levels for cessation aids were significant. However, in subgroup analyses the use of e-cigarettes for quitting was preferred by those with prior e-cigarette use, while evidence-based cessation aids were preferred by several other subgroups. While low costs were preferred, particularly among those with no experience using cessation aids, participants were willing to pay a high cost for an effective program (&#x20ac;91.48/month). To increase engagement, smoking cessation programs in Germany should include counseling and be explicit on the evidence of cessation therapies, as program effectiveness is highly valued. Improving access to cessation aids through referrals and lower costs can increase cessation efforts. Our findings suggest that German adults who smoke are most likely to engage in cessation programs that demonstrate proven effectiveness, include counseling support, and are recommended by a health professional. The lack of preference for specific cessation aids, except e-cigarettes among prior users, indicates that better communication about the effectiveness of evidence-based pharmacotherapies is needed. Health professionals should provide clear, evidence-based guidance on all cessation methods, including transparent discussion of the current evidence regarding e-cigarettes for smoking cessation, to support informed decision-making and optimize treatment selection.

Same-admission cholecystectomy is recommended by guidelines for mild gallstone-related acute pancreatitis, yet surgery is often deferred. Endoscopic retrograde cholangiopancreatography (ERCP) is often used as an interim strategy, but its effectiveness compared with cholecystectomy is uncertain. To compare cholecystectomy, ERCP only, and no intervention in association with recurrent acute pancreatitis and other gallstone-related complications, accounting for death as a competing event. This population-based cohort study used nationwide Swedish registries (2006-2019). Adults with first episodes of gallstone-related acute pancreatitis and a length of hospital stay 10 days or less were included. Follow-up began on the day after discharge. Fine-Gray subdistribution hazard models were applied in prespecified time windows (&#x2264;7, 8-14, 15-30, 31-90, 91-365, and >365 days), adjusted for age, sex, socioeconomic factors, and comorbidities. These data were analyzed from September 2025 through January 2026. Index-admission cholecystectomy, ERCP only, or no intervention; elective postdischarge cholecystectomy was modeled as a time-varying covariate. The primary outcome was recurrent acute pancreatitis. The secondary outcome was other gallstone-related complications (acute cholecystitis and/or choledocholithiasis). Among 9593 patients (median [IQR], age 61 [44-75] years; 60.3% female and 39.7% male), 28.7% underwent cholecystectomy, 16.9% ERCP only, and 54.4% no intervention during index hospital stay. Recurrence of acute pancreatitis in the 3 groups was 3.4%, 4.9%, and 17.5%, respectively. Similar differences were seen in adjusted models (overall subdistribution hazard ratio [sHR] for ERCP only, 1.40; 95% CI, 1.02-1.92 and for no intervention, 6.06; 95% CI, 4.85-7.56 compared with cholecystectomy). The risk of recurrence peaked 8 to 14 days after discharge among patients treated with ERCP only; beyond 15 days, there was no evidence of higher recurrence after ERCP only compared with cholecystectomy. Other gallstone-related complications occurred in 1.6% in the cholecystectomy group, 19.9% in the ERCP only group, and 16.3% in the no intervention group. In this study, same-admission cholecystectomy was associated with the lowest recurrence in acute pancreatitis and the lowest rate of other gallstone-related complications. ERCP only was associated with low long-term risk of recurrence but other gallstone-related complications remained common. These findings support prioritizing same-admission cholecystectomy in all individuals with acute gallstone-related pancreatitis, provided they are fit for surgery.

Desirability of outcome ranking (DOOR), a paradigm for the design, analysis, and interpretation of clinical trials based on patient-centered benefit-risk evaluation, could help inform drug development for acute bacterial skin and skin structure infections (ABSSSIs). A multidisciplinary committee created an infectious diseases DOOR endpoint, incorporating clinical response, infectious complications, serious adverse events, and mortality, and adapted this for ABSSSI. We retrospectively applied DOOR to 2 previous ABSSSI randomized controlled registrational trials (OASIS-1 and OASIS-2), both comparing omadacycline with linezolid. We evaluated the DOOR distribution and estimated the probability of having a more desirable outcome with omadacycline compared with linezolid. For OASIS-2, we used the 36-Item Short Form Health Survey Version 2 (SF-36v2) scores as a "tiebreaker" for participants who would otherwise have the same DOOR outcome. We performed DOOR component, partial credit, and subgroup analyses. The ABSSSI DOOR demonstrated similar overall clinical outcomes between treatment arms for OASIS-1 and OASIS-2. The probability of a more desirable outcome for a participant treated with omadacycline, compared with linezolid, was 50.6% (95% confidence interval [CI], 47.4%-53.7%) and 52.1% (95% CI, 49.2%-55.0%) in OASIS-1 and OASIS-2, respectively. In OASIS-2, applying a health-related quality-of-life score as a tiebreaker did not significantly change the DOOR probability. Partial credit and subgroup analyses demonstrated similar overall results. DOOR may provide additional perspective on benefit versus risk in individual patients in ABSSSI trials. Future trials using DOOR prospectively will continue inform how to incorporate patient-centered outcomes in ABSSSI trials.

Respiratory syncytial virus (RSV) remains a leading cause of lower respiratory tract infection (LRTI) and mortality among infants and older adults globally. The recent approval of long-acting monoclonal antibodies (mAbs) and prefusion F protein-based vaccines marks a significant shift in the prevention landscape. This systematic review aims to synthesise current evidence regarding the efficacy and real-world effectiveness of RSV interventions. We searched PubMed, Scopus, and Web of Science for randomised controlled trials and observational studies published between January 1, 2018, and September 8, 2025, that evaluated palivizumab, nirsevimab, and RSV vaccines in infants, pregnant women, and older adults. The primary outcome was RSV-associated lower respiratory tract infection (RSV-LRTI) hospitalisation. Pooled efficacy and effectiveness were estimated using random-effects meta-analysis. This study is registered with PROSPERO, CRD420261285934. In infants, palivizumab demonstrated effectiveness against RSV-LRTI hospitalisation up to 180 days post-discharge that varied substantially by analytical approach: OR-based studies yielded a pooled effectiveness of approximately 81% (95% CI: 57%-91%), while rate-ratio-based cohort studies produced a non-statistically significant estimate of 34% (95% CI: -17%-63%). Nirsevimab showed pooled efficacy/effectiveness of approximately 80-85% through 150-180 days post-dose, with consistent results across OR-based (84%, 95% CI: 78%-88%) and rate-ratio-based analyses (79%, 95% CI: 72%-85%). Maternal vaccine efficacy within 180 days after birth was 72% (95% CI: 61%-79%) against severe RSV-LRTI compared to 67% (95% CI: 53%-77%) against RSV-LRTI hospitalisations. In older adults, vaccination demonstrated robust protection during the first RSV season following vaccination, with a pooled vaccine effectiveness of 77% (95% CI: 69%-82%) against RSV-LRTI hospitalisations. Prophylactic strategies demonstrate effectiveness in reducing the burden of RSV-associated diseases. Both palivizumab and nirsevimab provide robust protection against RSV-LRTI hospitalisation in their respective target populations. Additionally, both maternal and older adult vaccinations are effective in reducing RSV-associated diseases. General Research Fund, AIR@InnoHK.

Within six years, poison centres reported 1,783,858 cases, and one in ten (177,921 cases) involved deliberate self-poisonings. Rates varied across countries, ranging from 8% in France to 23% in the Netherlands. Cases with deliberate self-poisoning remained stable between 2017 and 2020, with an increase observed from 2021 to 2022. Females accounted for 70% of cases, rising to 84% among children/adolescents of 5-17&#x2009;years. Rates among children/adolescents of 5-17&#x2009;years increased significantly after 2020 in all countries, largely due to a strong increase among females. Substances involved varied by country, but alcohol, benzodiazepines, and antidepressants dominated in adults, while paracetamol and ibuprofen dominated among children/adolescents of 5-17&#x2009;years. Common trends in deliberate self-poisoning, particularly in different age groups, are highlighted and challenges of cross-national data harmonisation in European poison centres are demonstrated. Deliberate self-poisoning represented a substantial proportion of poisoning cases, with a sharp rise after 2020, especially among children/adolescent females using readily available over-the-counter non-prescription medicines. These findings underscore the need for targeted prevention strategies and demonstrate the value of coordinated data collection. Expanding collaboration across additional countries could enhance monitoring, strengthen trend analyses, and inform public health interventions.

Few studies have evaluated whether modifiable aspects of red blood cell (RBC) transfusions are associated with recipient outcomes in very-low-birth-weight (VLBW) infants. To determine whether blood donor, RBC modifications and storage, or transfusion thresholds and characteristics are associated with serious adverse outcomes in VLBW infants undergoing transfusion. Transfusion in Preterm Infants was a prospective birth cohort study that recruited VLBW infants (<1500 g at birth) between April 1, 2019, and December 31, 2023, at 5 university-affiliated and 3 community birth hospitals in the US. Electronic medical record data linking blood donor and component data to infants were obtained and linked with Vermont Oxford Network outcome data, with additional outcome review by site. The analysis was completed in January 2026. RBC transfusion and transfusion characteristics, evaluated up to the first outcome event. The primary outcome was a composite outcome of severe intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), late-onset sepsis, severe bronchopulmonary dysplasia (BPD), retinopathy of prematurity, or death (and secondary individual outcomes), with follow-up through 90 days or death. Blood donor characteristics (sex, age, and hemoglobin), anticoagulant preservative solution and/or unit characteristics, transfused volumes, transfusion number, and infants' pretransfusion hemoglobin values were evaluated using multivariable generalized estimating equation regression models to account for correlation within hospital, adjusted for illness severity. The study enrolled 2605 VLBW infants, and 1283 (586 [45.7%] female; 713 [55.6%]&#x2009;<27 weeks' gestational age) received RBC transfusion. Median pretransfusion hemoglobin level was associated with higher odds of the composite outcome (odds ratio [OR] per 1 g/dL increase, 1.15; 95% CI, 1.07-1.25; P&#x2009;<&#x2009;.001). In contrast, use of additive solution (AS)-1 or AS-5 vs the reference of citrate phosphate dextrose adenine or citrate phosphate dextrose as the anticoagulant preservative solution was associated with lower odds of the composite outcome (OR, 0.72; 95% CI, 0.53-0.97; P&#x2009;=&#x2009;.03). There were no significant associations with other examined modifiable factors and the composite outcome. Among secondary outcomes, anticoagulant preservative solution was associated with lower risk of BPD (AS-1 and AS-5, OR, 0.48; 95% CI, 0.33-0.69; AS-3, OR, 0.65; 95% CI, 0.56-0.77) and higher risk of NEC (AS-3, hazard ratio [HR], 5.33; 95% CI, 1.22-23.29). Transfusion dose was associated with higher risk of mortality (HR per 5 mL/kg, 1.25; 95% CI, 1.17-1.35), and donor age was associated with a lower risk of mortality (HR for age &#x2265;60 years, 0.63; 95% CI, 0.44-0.92). Shorter postirradiation storage duration (<1 day) was associated with lower risk of NEC (HR, 0.44; 95% CI, 0.22-0.89). Female donor sex was associated with lower risk of IVH (HR, 0.60; 95% CI, 0.36-0.99). In this cohort study of VLBW infants, pretransfusion hemoglobin and anticoagulant preservative solution were associated with a composite of morbidities and mortality, unlike other modifiable blood banking practices. For individual outcomes, select donor and blood banking factors were identified that may be modifiable targets for further evaluation.

Despite evidence regarding the severity of occupational accidents involving biological material (OAIBM) during dental instrument cleaning, these risks remain underestimated by many workers. Few studies, however, have focused on the epidemiology of OAIBM during dental instrument cleaning. Thus, this study aimed to identify, analyze, and estimate the incidence rate of OAIBM during dental instrument cleaning by dental care professionals in Brazil. Notifications registered between January 2015 and July 2020 were then extracted from the Notifiable Diseases Information System (SINAN), a Brazilian government agency responsible for reporting and investigating infectious diseases. Reports of OAIBM were analyzed by dental care professionals (dentists, oral health assistants [OHA], and oral health technicians [OHT]) from all 26 Brazilian states and the Federal District. The mean incidence rate of OAIBM among dental care professionals in Brazil during dental instrument cleaning was 314.5 cases per 100,000 professionals. Of these cases, 88.2% involved OHTs, and most affected individuals were female (94.4%). Serum, blood, or plasma accounted for most exposures (71.8%), and 85.1% of exposures were percutaneous. Gloves were the most commonly used personal protective equipment (PPE) at the time of the accidents. Therefore, this study highlights the role of the dentist as the leader and technical authority, responsible for providing resources, standardizing processes, training the team, and supervising performance to ensure occupational safety, quality processing, and contributions to patient safety.

Long COVID, characterized by symptoms that remain or emerge in the months after acute COVID-19 infection, is a multisystemic condition with highly variable patient presentations. Phenotyping studies have reported divergent symptom clusters, increasingly used to design trials and interpret biomarker data. However, robustness of these clusters across analytic methods remains uncertain. We analyzed data from 6&#x2009;031 adults with&#x2009;&#x2265;&#x2009;90&#x2009;days of illness from a patient-led international survey. Participants reported presence/absence of 162 symptoms, post-exertional malaise severity and demographics. We applied three unsupervised machine learning approaches to the same symptom matrix, evaluating the resulting clusterings for concordance, robustness to subsampling, and relationship to symptom burden, post-exertional malaise severity, age and gender. Each method produced clinically plausible symptom clusters, but concordance across methods was low. All three approaches identified a high-symptom-burden group enriched for post-exertional malaise severity, and lower-symptom-burden groups with older mean age and a lower proportion of women. Symptom count consistently correlated with higher post-exertional malaise severity and a greater proportion of women. Manifold analysis revealed that the overall symptom space was largely continuous, lacking clear cluster boundaries. The strong dependence of patient clusters on algorithm choice suggests that single-method Long COVID phenotyping may produce incomplete or unstable subgroup definitions. Clustering methods may impose artificial boundaries on a smoothly varying symptom landscape, especially in studies capturing fewer symptoms. Phenotyping efforts should assess clustering robustness and avoid overinterpreting single-method results. Our multi-method analysis highlights the importance of considering the full breadth of patient symptoms when evaluating treatments.

The COVID-19 crisis gave rise to measures such as physical distancing, sheltering in place, and social bubbles that impacted sexual lives profoundly. One group particularly badly impacted by COVID-19 containment, and at risk of sexual and mental health consequences as a result, comprised gay, bisexual and other men who have sex with men -- many of whom were more likely to live alone, to have had multiple partners before the epidemic, and some of whom were lacking in peer support for their mental health. This study investigated how members of this group living in Flanders (Belgium) experienced sex and sexuality during the COVID-19 epidemic. We conducted 29 in-depth interviews with gay, bisexual and other men who have sex with men who practised consensual nonmonogamy and/or sociosexuality, and used reflexive thematic analysis to analyse the data. Interviewees provided a nuanced and emotionally resonant account&#xa0;of sex as a pathway to intimacy, rather than just a physical act. In their descriptions, Intimacy was framed as a protective factor against the mental health challenges exacerbated by pandemic isolation.

Evidence linking components of particulate matter with diameters &#x2264;2.5 &#x3bc;m (PM2.5) to the incidence of cardiovascular disease (CVD) remains scarce and inconsistent. The aim of this study was to investigate the associations of long-term exposure to PM2.5 components with incident CVD risk, considering both absolute concentrations and relative proportions. This study included 487,037 participants from the China Kadoorie Biobank who were free of CVD or cancer at baseline. Three-year moving average concentrations of PM2.5 and its components (black carbon [BC], organic matter, chloride [Cl-], nitrate [NO3-], sulfate [SO42-], and ammonium [NH4+]) were geocoded to participants at 1 &#xd7; 1 km resolution according to their community recruitment clinic locations. Time-varying Cox proportional hazards models were used to evaluate the associations between PM2.5 components and incident CVD risk. Substitution models were used to estimate the effects of reallocating PM2.5 component proportions while keeping total PM2.5 mass constant, thereby evaluating changes in CVD risk associated with shifts in component composition. Over a median 15.1-year follow-up, a total of 196,224 CVD cases, including 72,747 of ischemic heart disease, 74,594 of ischemic stroke, 17,553 of hemorrhagic stroke, and 54,306 of other cerebrovascular diseases, were documented. Long-term exposure to PM2.5 components was associated with increased risk for CVD and its major subtypes. For total CVD, the HRs per IQR increase were 1.15 (95% CI: 1.13-1.17) for BC, 1.17 (95% CI: 1.15-1.18) for organic matter, 1.28 (95% CI: 1.25-1.32) for Cl-, 1.29 (95% CI: 1.24-1.33) for NO3-, and 1.23 (95% CI: 1.20-1.25) for SO42-. Higher proportions of Cl-, SO42-, and BC were associated with an increased risk for ischemic stroke, and the aforementioned inorganic ions were also positively associated with ischemic heart disease. Substituting 1% of any other PM2.5 component with Cl- was associated with a 3% to 8% higher risk for total CVD, whereas substitutions with BC were associated with a 1% to 8% higher risk for ischemic stroke, and substitution with SO42- was associated with a 2% to 5% higher risk for ischemic heart disease. Long-term exposure to PM2.5 chemical components was positively associated with CVD risk. Critically, CVD risk was influence by compositional shifts, with a particularly hazardous profile characterized by higher proportions of Cl-, BC, or SO42-. These findings underscore the importance of implementing targeted, health-oriented control strategies that prioritize specific PM2.5 components.

Acute respiratory infections (ARIs) such as influenza-like illness (ILI) and severe acute respiratory infection (SARI) are leading causes of morbidity among children aged under 5 years (under-5) in Bangladesh. In Cox's Bazar, the ARI burden is compounded by high&#x2002;population density and seasonal monsoons; yet under-5-specific evidence on virus seasonality and clinical features remains limited. This study aimed to assess the seasonality and clinical characteristics of ILI and SARI among children under-5 in Cox's Bazar, Bangladesh, between 2021 and 2023, with additional analyses to support interpretation of detection findings. Prospective hospitalized based surveillance was carried out from January 2021 up to December 2023 at&#x2002;the District Head Quarter Hospital Cox's Bazar. Children under-5 with ILI (fever &#x2265;38&#xb0;C and a cough, symptom onset &#x2264;10 days) or SARI (ILI with hospitalization or severe manifestations) were recruited. Nasopharyngeal and throat swabs were processed for testing by a multiplex real-time reverse-transcriptase polymerase chain reaction for influenza A/B (H3N2/Victoria), SARS-CoV-2, and&#x2002;respiratory syncytial virus (RSV). Demographic, clinical, and&#x2002;geographic information was recorded. Analyses included descriptive statistics, chi-square tests, and multivariable logistic regression. Among 968 children&#x2002;(median age 9 months; 60.7% ILI, 39.3% SARI), pathogens were detected in 12.4% (95% confidence interval [CI]: 10.4-14.7%). Among the limited pathogens tested, influenza comprised most positive cases (65%); A(H3N2) was identified in 5.0%, and&#x2002;B(Victoria) in 3.1%. SARS-CoV-2 and RSV were detected&#x2002;only occasionally (2.5% and 1.9%, respectively). The monsoon season (June-September) was the peak detection period, with A(H3N2) being dominant&#x2002;in June and July and B(Victoria) dominating from August to September. Positivity was higher among SARI cases&#x2002;(25.8%) than ILI cases (16.4%) in the months of peak activity. Clinical severity indicators associated with detection were SARI (adjusted odds ratio [aOR] 3.42, 95% CI: 2.28-5.13), breathlessness (aOR 2.87, 95% CI: 1.84-4.48), age&#x2002;&#x2265;6 months to <2 years (aOR 1.92, 95% CI:1.21-3.05) and fever &#x2265;101.5&#xb0;F (aOR 1.68, 95% CI: 100-276). The highest positivity rate observed was 24.0%. Most&#x2002;(87.6%) were negative for the tested pathogens. Among the viruses tested, influenza contributes to seasonal under-5 ARIs in Cox's Bazar, but the large negative proportion indicates that most cases were caused by pathogens not included in the limited testing panel (e.g. rhinovirus, adenovirus, parainfluenza, or bacteria). Markers of severity and&#x2002;age are associated with influenza positivity. Expanded&#x2002;multiplex testing and surveillance are required to inform vaccination and interventions in this high burden setting.

Pain perception is a major limitation of office hysteroscopy and may lead to premature suspension of the procedure. Current guidelines do not routinely recommend local analgesia, and the effectiveness of paracervical block during office hysteroscopy performed with a vaginoscopic approach remains insufficiently investigated. The primary objective was to assess whether paracervical block is associated with reduced pain perception during office hysteroscopy with a vaginoscopic approach. The secondary objective was to evaluate its impact on procedure suspension. his retrospective observational cohort study included patients undergoing diagnostic and/or operative office hysteroscopy between January 2018 and January 2022. Paracervical block was administered without speculum or tenaculum. Confounders were addressed using multivariable regression and propensity score matching. A total of 2,028 patients were analyzed. In patients who did not receive PB, nulliparity was associated with severe pain (aOR 2.87, 95% CI 1.20-6.85) and procedure suspension (aOR 3.07, 95% CI 1.27-7.39), and cervical canal stenosis with markedly increased odds of both severe pain (aOR 23.17, 95% CI 10.44-51.40) and suspension (aOR 25.10, 95% CI 11.19-56.30). In patients receiving PB, nulliparity was no longer significantly associated with either outcome, and the effect of cervical canal stenosis was substantially attenuated (aOR 2.68, 95% CI 1.57-4.58 for severe pain; aOR 3.70, 95% CI 2.07-6.62 for suspension). Overall, in this large retrospective cohort, paracervical block performed through a vaginoscopic approach was associated with reduced pain perception and procedure suspension in selected patients. In a large retrospective cohort, paracervical block performed via a vaginoscopic approach was associated with reduced pain perception during office hysteroscopy.The use of paracervical block was associated with substantially lower odds of procedure suspension, particularly in nulliparous women and in patients with cervical canal stenosis.Paracervical block may be considered as part of a structured pain-management strategy in patients with anticipated difficult cervical access, pending confirmation by prospective randomized trials.

An obstetrical fistula is an abnormal communication between the vagina and adjacent tubular structures, usually the bladder and rectum. If timely and effective treatment is not given, women with a fistula face lifetime embarrassment, isolation, social stigmatization, and marital separation. Although early detection and management of obstetrical fistula often result in improved treatment outcomes, most women do not have access to care due to either the cost, stigma, or lack of awareness. This study aimed to determine the pooled prevalence and predictors of healthcare seeking for obstetrical fistula in sub-Saharan Africa. As this is a systematic review and meta-analysis protocol, the primary data sources will be electronic databases and grey literature. We will systematically search PubMed, Cochrane Library, and Google Scholar to retrieve eligible primary studies. Per our protocol, we apply the CoCoPop (Condition, Context, and Population) mnemonic framework:&#x2022;Inclusion Criteria: Observational studies (cross-sectional, case-control, cohort) investigating healthcare seeking for obstetric fistula and its determinants; conducted in sub-Saharan Africa (SSA) countries; published in the English language between 2015 and 2025.&#x2022;Exclusion Criteria: Studies conducted outside of SSA, studies lacking an abstract or full text, qualitative studies, conference summaries, and studies where the primary outcome variable is not formal clinical healthcare-seeking behavior. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Library, Google Scholar, and gray literature were used to search for eligible articles. The quality of the studies was assessed using the Joanna Briggs Institute critical appraisal checklist. All studies on obstetrical fistula care seeking conducted in English from 2015 to 2025 and in sub-Saharan Africa were included. The required data were extracted from each article using Microsoft Excel 2016 (Microsoft, Redmond, WA) and exported to Stata (version 16; StataCorp LLC, College Station, TX). Forest plot and I2 statistics were performed for heterogeneity. A funnel plot and Egger regression test were performed to check for publication bias. Subgroup analysis and meta-regression analysis were performed to identify potential sources of bias. Because this manuscript is a systematic review and meta-analysis protocol, there are no empirical results to report at this stage. The protocol establishes our plan to extract, transform, and pool data using STATA version 17 to determine the pooled magnitude and effect sizes (OR/RR) of predictors once the full review is completed. As a protocol, final study conclusions are not yet available. However, this upcoming systematic review and meta-analysis is designed to provide a comprehensive, pooled magnitude of healthcare-seeking behavior and its multi-level socio-ecological predictors. The final findings will provide robust empirical evidence intended to guide policy makers, program implementers, and healthcare providers in optimizing maternal health interventions across sub-Saharan Africa.

Unhealthy alcohol use is prevalent in chronic liver disease (CLD). This randomized controlled trial evaluated the efficacy of telehealth stepped alcohol treatment (SAT) in three healthcare systems. Participants (N=157) with CLD and unhealthy alcohol use (>7 drinks/week or &#x2265;4/day for women; >14/week or &#x2265;5/day for men; or heavy episodic drinking, using timeline follow back), were enrolled at a safety-net and 2 Veterans Affairs hepatology clinics from 3/1/2022-2/28/2024. Participants were randomized to SAT (N=81; Step 1: three motivational interviewing sessions, Step 2: addiction medicine referral if no drinking reduction at month 3) or usual care (UC; N=76); evaluated at months 3 and 6. Alcohol use reduction was analyzed using bivariate tests and multivariable modeling. Baseline characteristics were: median age 61, 86% male, 48% with cirrhosis (37% decompensation), and 78% with alcohol use disorder. Compared to UC, SAT had no difference in percentage of alcohol use below moderate level (primary outcome) but had greater reduction in drinks/week from baseline to month 3 (estimate -0.66, P=0.03) and month 6 (estimate -0.67, P=0.03) (secondary outcome). The 6-month effect of SAT (vs UC) on alcohol use reduction remained significant (P=0.02), controlling for covariates. At month 6, 30-day abstinence rates were 29% for SAT and 18% for UC (P=0.14). Baseline motivation to reduce alcohol use was positively associated with treatment response. SAT was not superior on the primary outcome, yet reduced alcohol use more than UC at six months in this difficult-to-engage population and may be valuable in hepatology.

Dengue remains a major public health challenge in tropical regions, where viral genetic diversity, vector ecology and human mobility contribute to recurrent outbreaks. In 2024, Brazil experienced its largest recorded dengue epidemic, with intense transmission across the Northeast region. This study characterizes the epidemiological, genomic and phylogeographic features of dengue virus (DENV) circulation during the 2024 outbreak in Alagoas, northeastern Brazil. Of 6102 suspected cases analysed by molecular diagnostics, 1607 (26.3%) were confirmed as DENV infections. Epidemiological analyses revealed widespread transmission across 79 municipalities, marked seasonality with peak incidence between March and August, and a disproportionate burden among adolescents and young adults. DENV-1 and DENV-2 were the predominant serotypes, accounting for 57.1% and 42.6% of confirmed cases, respectively; three DENV-3 infections and one DENV-1/DENV-2 co-infection were also identified. Whole-genome sequencing yielded high-quality genomic data supporting phylogenetic and phylogeographic analyses. DENV-1 sequences belonged to genotype V, classified into lineages E.1 and D.1.1, while DENV-2 sequences clustered within genotype II (lineage F.1.1.2) and genotype III (lineage C.1.1). Time-scaled phylogenetic analyses revealed multiple independent introductions of both serotypes from distinct Brazilian regions, followed by sustained local transmission and lineage expansion. Infections among non-residents, including an international case, further underscore the role of population mobility in viral dissemination. Collectively, these findings indicate that the 2024 outbreak was driven by recurrent viral introductions combined with the persistence of locally established transmission chains, highlighting the value of integrated genomic surveillance for outbreak preparedness and public health response.

Workplace accidents represent a significant health problem for workers. In 2022, the EU recorded over 3,000 workplace deaths and nearly 3 million non-fatal accidents. The aim of this paper is to provide an in-depth analysis of multiple fatal accidents in Italy in recent years, analyzing their occurrence patterns and causal factors to increase useful information for risk management. The statistics come from the INAIL Database and the Infor.MO National Surveillance System, which collects detailed information on accident dynamics and uses a multifactorial model to analyze the causes of injuries. In this system, the in-depth analysis of multiple fatal accidents was conducted on a cluster of 181 events that occurred between 2008 and 2022. Data sources show that road accidents are a significant cause of multiple injuries. Other recurring accidents include collapses, fires, explosions, and asphyxiation in confined spaces. The construction and manufacturing sectors are the most affected. The main causes, highlighted particularly in the Infor.MO system, include poor worker training, inadequate workplace organization, and a lack of safety devices. To reduce workplace accidents, especially those with dramatic consequences such as multiple accidents, the importance of a stronger organizational safety culture is reiterated, in which training enables workers to understand risk analysis and gain greater awareness of hazards.

We conducted an age-period-cohort (APC) analysis to distinguish age, period and cohort effects underlying temporal trends in: low birth weight (LBW: <&#x2009;2500 grams), early term deliveries (ETD: 37-38&#xa0;weeks), induction and c-section using US birth records from 1994-2019 for all singleton, first, full-term (37-44&#xa0;weeks gestation) births (n&#xa0;=&#xa0;8&#x2009;194&#x2009;523). Using the APC-interaction method, we estimated age, period and cohort effects as odds ratios with 95% confidence intervals (CI). Age and period effects were observed for all outcomes. Pregnant women/people 40-44&#xa0;years had increased odds of LBW (OR 1.23, 95%CI 1.19-1.26), ETD (OR 1.24, 95%CI 1.23-1.26), induction (OR 1.05, 95%CI 1.04-1.06) and c-section (OR 2.28, 95%CI 2.26-2.30) compared to the total population. Odds of LBW (OR 1.14, 95%CI 1.13-1.16), ETD (OR 1.11, 95%CI 1.10-1.12) and induction (OR 1.71, 95%CI 1.70-1.72) were higher in 2019 compared to the study period average. Cohort effects not explained by age and period effects were observed for women 40-44&#xa0;years in 2019 indicated by higher odds of ETD (OR 1.08, 95%CI 1.05-1.10), induction (1.10, 95%CI 1.07-1.12) and c-section (OR 1.09, 95%CI 1.06-1.11). These findings suggest obstetric management of pregnant women&#xa0;&#x2265;&#xa0;40&#xa0;years changed in recent decades in ways not expected based on age and temporal trends alone.