搜索结果：Healthcare (Basel, Switzerland)

Background: Antimicrobial resistance continues to threaten effective infection management worldwide and is driven largely by inappropriate prescribing practices. In Saudi Arabia, the cities of Makkah and Al-Madinah experience intense seasonal healthcare demand due to the annual pilgrimage, creating additional challenges for rational antibiotic use. This study aimed to evaluate physicians' knowledge, attitudes, and prescribing behaviors related to antibiotics in these high-demand settings. Methods: A cross-sectional analytic study was conducted between June and August 2024 among physicians practicing in Makkah and Al-Madinah, including those participating in Hajj services. A previously validated, structured electronic questionnaire assessed knowledge of common pathogens, perceptions of antimicrobial resistance, prescribing influences, and counseling practices. The survey was distributed electronically to eligible physicians. Descriptive statistics were generated, and associations were examined using appropriate inferential tests with a 95% confidence level. Results: A total of 487 physicians participated. Most respondents (74%) correctly identified major bacterial causes of upper respiratory tract infections, and 90% acknowledged the association between prior antibiotic exposure and resistance. Nonetheless, misconceptions persisted regarding the benefit of antibiotics in viral conditions. Workload and patient expectations influenced prescribing behavior; 77% reported a greater likelihood of prescribing antibiotics during periods of high clinical pressure. While adherence to guideline-based practice was generally reported, variability existed in counseling practices and perceptions of stewardship policies. Conclusions: Although baseline knowledge was satisfactory, contextual and behavioral factors continue to influence prescribing decisions and may contribute to unnecessary antibiotic exposure, highlighting the need for strengthened antimicrobial stewardship strategies in high-demand healthcare environments.

Rozanolixizumab is indicated for the treatment of adults with generalized myasthenia gravis (MG). This retrospective, non-interventional cohort study evaluated adults with MG initiating rozanolixizumab in the USA. Patients were selected from de-identified claims data from the Komodo Healthcare Map® (July 2023-March 2025). Enrolled patients were aged ≥ 18 years with MG diagnosis, ≥ 1 rozanolixizumab medical/pharmacy claim, and continuous enrollment/plan coverage for 12 months (baseline period) before first rozanolixizumab treatment initiation (index date). The follow-up period was from 1 day post-index to last enrollment date. Treatment patterns and healthcare resource utilization (HCRU) were assessed during baseline and follow-up. A second study (July 2023-June 2024) assessed patients for 12 months post-index who had ≥ 1 efgartigimod claim ≤ 12 months prior to index. The main study included 719 patients. Patients with ≥ 365 days since rozanolixizumab initiation (n = 287) started a mean (standard deviation) 2.9 (1.8) treatment cycles in Year 1. Total MG-related HCRU incidence rates per 100 person-years were 88.0 during baseline and 82.9 during follow-up, and 86.2 versus 80.8 for outpatient, 25.6 versus 17.3 for inpatient, and 24.9 versus 14.0 for emergency room visits. Approximately half (53.7%, 386/719) of patients used corticosteroids at baseline and had ≥ 3 months' follow-up. 29.0% (n = 112) tapered their dose by ≥ 5 mg, and a further 29.3% (n = 113) discontinued corticosteroids during follow-up. In patients who had ≥ 1 claim for efgartigimod before initiating rozanolixizumab (n = 26), 19.2% tapered corticosteroids by ≥ 5 mg during follow-up, and 7.7% discontinued completely. This real-world study of patients receiving rozanolixizumab in the USA showed reductions in corticosteroid use and HCRU following rozanolixizumab initiation, including in those who switched from efgartigimod. The mean number of rozanolixizumab cycles (2.9) was lower than the mean 4.1 cycles in Phase 3 studies (patients with ≥ 1 year of follow-up), demonstrating that treatment patterns in clinical practice can be individually adjusted.

Air pollution, antimicrobial use, and population ageing are increasingly recognised as co-occurring pressures shaping population health. This study explores their ecological association with mortality patterns in the province of Messina (Southern Italy), within a One Health-informed framework. An ecological analysis was conducted using district-by-year data (2015-2024), integrating environmental monitoring (PM10, PM2.5, NO2, O3), outpatient antibiotic consumption, and cause-specific mortality rates. Multivariable regression models were used to assess associations between exposures and mortality outcomes. A post-2020 indicator was included to account for COVID-19-related disruption. Marked geographic variability in pollutant concentrations was observed, with higher levels in urban-industrial districts. Infectious disease mortality increased from 13.8 to 44.6 per 100,000 inhabitants between the pre-pandemic and post-pandemic periods. In Poisson regression models, particulate matter showed a small and non-significant association with respiratory mortality (RR = 1.02, 95% CI: 0.89-1.18), while antibiotic consumption was not independently associated with mortality (RR = 0.99, 95% CI: 0.94-1.05). The post-2020 period was associated with higher mortality estimates (RR = 1.15, 95% CI: 0.72-1.83), although with wide confidence intervals. The findings suggest the co-occurrence of environmental, demographic, and pharmaceutical pressures within the same territories, rather than demonstrating formal synergistic interaction. The observed post-pandemic increase in mortality highlights the importance of accounting for COVID-19-related disruption. These results should be interpreted as exploratory, given the ecological design and limited sample size, but support the need for integrated surveillance approaches within a One Health perspective.

Pulmonary arterial hypertension (PAH) is a rare, progressive condition associated with high morbidity and healthcare resource utilization. This study aimed to estimate the annual direct and indirect costs of PAH in Switzerland, from a societal perspective. A cross-sectional cost-of-illness study was conducted across six Swiss PAH centres between April and December 2024. Adult patients with confirmed PAH (World Health Organization [WHO] Group 1) were invited to complete a standardized questionnaire on work productivity losses, informal care, and healthcare utilization outside the enrolling centre. Clinical data on hospitalizations, outpatient visits, diagnostics, and treatments at the enrolling centre were extracted from medical records. Disease-specific costs were calculated by multiplying resource use and work losses by Swiss-specific unit costs and extrapolated to one year. Estimates were stratified by WHO functional class (WHO-FC) and ESC/ERS 2022 risk strata. Among 124 participants aged between 18 and 89 years, the mean disease-specific total annual cost per patient was €138,958. Direct healthcare costs represented 78.5% of this amount (€109,114), driven primarily by pharmacological treatment (65% of total costs). Indirect costs amounted to 21.5% (€29,844). Costs increased with disease severity, ranging from €81,957 in WHO-FC 1 to €166,569 in WHO-FC 4, and from €130,970 in ESC/ERS low risk to €291,728 in ESC/ERS high risk. The total national burden was estimated at €48.5 million annually. PAH imposes a substantial economic burden in Switzerland, largely due to treatment costs and productivity losses. These findings highlight the need for strategies to reduce disease progression and associated societal costs.

Background: Childhood vaccination remains the cornerstone of public health strategies, substantially reducing global morbidity and mortality, yet suboptimal uptake persists in many settings. In South Africa, the challenge is evident, with persistent outbreaks of vaccine-preventable diseases. Addressing localised immunisation shortfalls requires elucidating the complex interplay of factors beyond conventional access barriers. This qualitative study provides context-specific insights into the behavioural and social drivers influencing childhood vaccination uptake among caregivers in Cape Town, South Africa. Methods: Utilising an exploratory qualitative research design, thematic analysis was applied to interview data (n = 25 caregivers) collected via a purposive sampling strategy designed to capture maximum variation in experiences within targeted low-uptake subdistricts. Interpretation of the data was systematically guided by the World Health Organization's Behavioural and Social Drivers (BeSD) framework. The latter consists of four domains, namely, "Thinking and Feeling", "Social Processes", "Motivation", and "Practical Factors". Findings: Analysis across BeSD domains reflected a pattern of the intention-behaviour gap, where caregivers are motivated for vaccination but face structural and practical barriers affecting timely uptake. In the Thinking and Feeling domain, widespread conviction regarding the vital benefits of vaccination co-existed with significant anxiety concerning minor side effects (e.g., pain and fever), which sometimes precipitated missed subsequent appointments. Caregivers frequently accept immunisation as a social routine despite having limited knowledge of the diseases it prevents. Social Processes demonstrated that while decision-making authority rested primarily with mothers, compliance relied on the delegation of logistical responsibilities to extended family members. Critically, reports of poor communication, judgment, or negative attitudes among healthcare workers undermined trust and acted as barriers to sustained engagement. Within the Practical Factors domain, structural constraints frequently overshadowed high intent, with pervasive issues such as long waiting times and financial costs cited as the main reasons for missed appointments. Conclusions: Participants generally expressed strong acceptance of vaccination, but attainment of optimal coverage is constrained by systemic failures in patient-provider communication and persistent logistical barriers within the public healthcare delivery system. Strategic public health interventions must therefore move beyond addressing only attitudinal opposition to prioritise targeted efforts that mitigate structural constraints and reinforce personalised, empathetic communication to sustain caregiver confidence and adherence.

Maternal vaccination against respiratory syncytial virus (RSV) represents a major advance in early-life infection prevention. Although clinical efficacy and early real-world effectiveness are well established, sustained population-level impact depends on equitable uptake. This review synthesizes determinants influencing maternal RSV vaccination within the evolving dual-strategy landscape that includes both maternal vaccination and infant monoclonal antibody prophylaxis. A structured narrative review was conducted following PRISMA principles. PubMed/MEDLINE and Google Scholar were searched for studies published between January 2022 and February 2026. Eligible studies examined behavioral, interpersonal, structural, economic, and policy determinants of maternal RSV vaccination uptake, as well as early implementation and modelling evidence. Findings were integrated within a multilevel analytical framework. Maternal uptake is shaped by interacting determinants across individual, healthcare provider, and health system domains. Key drivers include perceived infant disease severity, vaccine safety confidence, perceived effectiveness, and prior antenatal vaccination behavior. Healthcare provider recommendation consistently emerges as the strongest facilitator. Coverage variability reflects differences in reimbursement, antenatal care integration, and national policy endorsement. The coexistence of maternal vaccination and infant monoclonal antibody strategies introduces additional comparative decision-making complexity. Early implementation data indicate heterogeneous uptake and socioeconomic gradients, while modelling demonstrates sensitivity to coverage, timing, epidemiology, and cost. Translating biological efficacy into sustained public health benefit requires coordinated behavioral, structural, and policy strategies, strong provider engagement, and context-sensitive implementation frameworks to ensure equitable coverage.

Economic evaluations guide resource allocation decisions in dentistry, where preventive interventions often involve upfront costs and long-term benefits. Discounting can strongly influence results, yet inconsistencies in rate selection and justification persist. Despite growing recognition that discount rate selection substantially influences cost-effectiveness conclusions, no systematic review has focused specifically on discounting practices in dental economic evaluations published under the CHEERS 2022 framework. We therefore reviewed discounting practices in cost-effectiveness analyses (CEAs) of dental interventions published after January 1, 2020. We systematically searched eight databases (MEDLINE via PubMed, Web of Science, EconLit, Embase, PROSPERO, Central, Scopus, CEA Registry) for full economic evaluations of dental interventions published after January 1, 2020, with time horizons >1 year. Inclusion was limited to Latin alphabet publications and empirical studies. Backward/forward citation tracking supplemented the search. Reporting quality was appraised using CHEERS 2022. Extracted data included discount rates, justifications, perspectives, model types, and intervention categories. From 2581 records, 83 studies were included. Discount rates ranged from 1.5% to 9%; 3% was most common (41%). Thirteen percent omitted discounting, and 27% provided no justification; when justified, 60% cited government guidelines. Perspectives were predominantly healthcare sector (44%), with societal only 8%. Preventive interventions accounted for 47%. Average CHEERS 2022 compliance was 80.4%. Discounting practices in recent dental CEAs remain inconsistent, potentially biasing against preventive strategies. Greater adherence to reporting standards and context-specific guideline updates are needed.

Placental malaria (PM) is a serious complication of malaria in pregnancy (MiP). It has major repercussions for mothers' and neonates' health, particularly in sub-Saharan Africa (SSA). As current preventive measures lose efficacy due to drug resistance, malaria vaccines can play a crucial role in malaria control. The main objective of this study was to generate evidence that can guide the design of social and behaviour change interventions to raise awareness of PM and improve vaccine acceptance. A facility-based cross-sectional survey was conducted; five dichotomised indicators were constructed; multivariate logistic regression was adjusted for age, education, and districts; and prespecified sensitivity analyses were done. General malaria knowledge and preventive practices were high. Many women (53.4%) reported having had experienced fever during pregnancy. Prevention behaviour was not significantly associated with age or education. Both high knowledge (aOR 0.30, 95% CI 0.16-0.57) and perceived risk awareness (aOR 0.35, 95% CI 0.18-0.68) were lower for Mpemba than for Thyolo. Biomedical healthcare services were less likely utilised by women in Madziabango as compared to Thyolo (aOR 0.47, 95% CI 0.23-0.96). Although 92% acknowledged possible harm, nearly all of them (97%) reported willingness to accept a future maternal malaria vaccine. There was a high level of maternal malaria vaccine acceptability; however, these findings suggest that local context-specific delivery strategies could be useful for effective future PM vaccine introduction.

Infectious complications remain a principal determinant of late morbidity and mortality following major thermal injury, reflecting a convergence of barrier disruption, microbial adaptation, and host immune dysfunction. The post-burn environment creates a uniquely permissive niche for pathogen persistence, characterized by altered tissue perfusion, biofilm formation, and dynamic shifts in microbial ecology toward multidrug-resistant organisms. Concurrently, profound and evolving changes in host immunity and metabolism reshape both susceptibility to infection and response to therapy. This review integrates current evidence across pathophysiology, microbiology, diagnostics, and treatment, with a focus on challenges that limit effective infection control in burn patients. Particular attention is given to diagnostic uncertainty arising from overlap between sterile inflammation and true infection, the clinical implications of biofilm-associated tolerance, and the impact of burn-specific pharmacokinetic variability on antimicrobial efficacy. We further examine emerging diagnostic and therapeutic innovations, including host-response profiling, rapid molecular detection platforms, and next-generation anti-infective strategies targeting microbial virulence, biofilm structure, and host immune pathways. Despite substantial scientific advances, translation into clinical practice remains constrained by limited burn-specific trials, heterogeneous definitions, and systemic barriers to antimicrobial development. Collectively, these challenges underscore the need for integrated, precision-based approaches that combine early source control, individualized antimicrobial optimization, and advanced diagnostic frameworks. Future progress will depend on coordinated efforts to standardize definitions, generate high-quality multicenter data, and align innovation with clinical applicability across diverse healthcare settings.

Background/Objectives: Oral health is an essential component of general health, particularly in hospitalized pediatric patients undergoing surgery. Hospitalization may disrupt oral hygiene routines and dietary habits, increasing the risk of oral health deterioration. This prospective observational study aims to develop a standardized oral care protocol for pediatric patients hospitalized for surgical procedures by evaluating changes in oral health status, oral hygiene practices, and dietary habits between hospital admission and discharge. Methods: Children aged 0-17 years undergoing surgery and hospitalized for at least three nights were enrolled. Clinical oral examinations and caregiver-administered questionnaires were performed at admission and at discharge. Oral health status, plaque accumulation, gingival condition, oral pain, hygiene behaviors, and dietary habits were assessed. Results: In total, 118 patients were included. During hospitalization, plaque accumulation significantly increased and oral hygiene practices worsened. Dietary habits changed, with fewer daily meals and a slight reduction in cariogenic food and beverage intake. Oral hygiene instructions or dental examinations were documented in only 2.5% of patients. Based on these observations, a protocol was developed targeting hospitalized patients, their families, and healthcare staff, with the aim of improving oral health conditions during hospitalization. Conclusions: Pediatric surgical hospitalization is associated with a deterioration in oral hygiene behaviors and increased plaque accumulation. The implementation of standardized protocols and the dissemination of preventive oral health knowledge may transform hospitalization into an opportunity to improve oral health in children and adolescents.

Objective: The objective of this study is to evaluate the ability of silver oxide nanoparticle (Ag2ONP)-functionalized high-efficiency particulate air (HEPA) filters and colloidal Ag2ONP suspensions to inhibit biofilm formation by major respiratory pathogens causing infections at operating rooms. Background: Respiratory infections caused by bacterial pathogens such as Streptococcus pneumoniae, Pseudomonas aeruginosa and Staphylococcus species are often associated with the formation of biofilms, which confer increased resistance to antibiotics and host immune responses. Effective strategies to prevent biofilm formation on biological surfaces and in air filtration systems are urgently needed in clinical settings. Methods: The biofilm-forming ability of each bacterial strain was assessed by crystal violet microplate assay, viable count or confocal microscopy after prior incubation of the culture medium with Ag2ONP-coated HEPA filter material or colloidal Ag2ONP suspension. Results: Both silver-functionalized filters and silver nanoparticle suspensions significantly inhibited biofilm formation by S. pneumoniae and P. aeruginosa, with near-complete suppression observed. In the case of S. aureus and S. epidermidis, the silver nanoparticle suspension showed partial inhibition of biofilm development. Conclusions: Ag2ONP-functionalized HEPA filters and colloidal Ag2ONP suspensions effectively prevent biofilm formation by major respiratory pathogens, for both Gram-negative and Gram-positive bacteria. These materials show promise for integration with air filtration and surface coating systems to reduce microbial load and transmission in healthcare environments such as operating room facilities.

Campylobacter spp. constitutes a significant global public health hazard as it is a leading cause of reported foodborne diseases. Human infection is predominantly acquired through the ingestion of contaminated food, unpasteurized milk and untreated water, prompting the widespread implementation of chemical disinfection across several sectors, from healthcare, domestic environments, and food-processing to animal husbandry. While these biocidal agents encompass multiples classes with different modes of action and efficacy, growing evidence suggests that their extensive and repeated use may unintentionally promote bacterial persistence, tolerance and adaptive responses. Although biocide resistance has been documented in several foodborne pathogens, data on biocide tolerance in Campylobacter spp. remain limited. Available studies report variable degrees of reduced susceptibility to commonly used biocides among isolates originating from poultry production, food-processing environments, and water systems. Importantly, while biocide-induced adaptive responses in Campylobacter spp. may potentially overlap with antimicrobial resistance mechanisms, the extent to which these agents drive co-selection, persistence, or dissemination requires further elucidation. Evidence remains limited on the effects of long-term and repeated exposure under realistic processing conditions, the interplay between stress-induced gene regulation and stable genetic changes, and the contribution of mobile genetic elements, biofilm formation, and microbial communities in shaping antimicrobial resistance evolution. In light of the global health burden imposed by campylobacteriosis and the rising challenge of antimicrobial-resistant Campylobacter, this review brings together current evidence on the role of biocides in shaping bacterial survival, adaptation, and resistance mechanisms.

The aims of the study were to reflect on the methodological and conceptual evolution of the Swiss Spinal Cord Injury Cohort Study, summarize its key scientific contributions, and illustrate how such a cohort can shape future directions in spinal cord injury research, care, and policy. We conducted a bibliometric analysis to examine the Swiss Spinal Cord Injury Cohort Study's publication trends, leading authors, thematic areas, influential papers, and landmark findings related to morbidity, mortality, and functioning among individuals with spinal cord injury in Switzerland. The Swiss Spinal Cord Injury Cohort Study comprises two components: the community survey, collecting self-reported data on functioning, morbidity, and mortality in chronic spinal cord injury, and the inception cohort, which enables long-term clinical and biological monitoring of newly injured individuals. Since its inception, the Swiss Spinal Cord Injury Cohort Study has generated 174 publications, primarily from the community survey, with increasing contributions from the inception cohort. Notably, 34% of publications stem from the Swiss Spinal Cord Injury Cohort Study nested projects, highlighting the study's capacity to support additional targeted research. Key themes included secondary health conditions, mental health, healthcare use, and social participation, with growing interest in lifestyle and behavioral factors. The Swiss Spinal Cord Injury Cohort Study has become a key resource for advancing spinal cord injury research. Its robust, interprofessionnal design provides a foundation for translating research into improved care, policy, and quality of life for individuals with SCI.

Background: Pertussis and influenza immunization during pregnancy protects both mother and infant through transplacental transfer of antibodies. However, global vaccination coverage among pregnant women remains suboptimal. Aim: This systematic review aimed to assess influenza and pertussis vaccination coverage during pregnancy and identify determinants influencing vaccine uptake. Methods: A systematic search of MEDLINE, SCOPUS, and grey literature was conducted for studies published between 2000 and 2023. Studies reporting actual vaccination rates for influenza and/or pertussis among pregnant women were included, while those assessing only willingness were excluded. Studies on H1N1 pandemic vaccination in pregnant women were excluded to avoid bias, as awareness levels during the pandemic differed from routine influenza vaccination. Determinants of vaccine acceptance were recorded. Study quality was evaluated using the Newcastle-Ottawa Scale. Results: Of 3251 identified records, 78 studies on influenza (N1 = 287,124 participants) and 51 on pertussis (N2 = 172,801) met inclusion criteria after removing overlapping populations. Most influenza studies (55/78) reported vaccination coverage below 50%. A key determinant of influenza vaccination uptake was physician recommendation, while maternal attitudes, parity, and previous influenza vaccination also had a significant impact. For pertussis, vaccination coverage was primarily driven by physician recommendation, with parity and maternal perceptions of vaccine safety and effectiveness further influencing uptake. Regarding quality assessment, 52.5% of influenza studies and 37.5% of pertussis studies scored above 6 on the Newcastle-Ottawa Scale. Conclusions: Maternal vaccination coverage for influenza and pertussis remains inadequate worldwide and is shaped by national strategies, healthcare provider practices, and maternal perceptions. Addressing vaccine hesitancy and improving awareness are essential to increase uptake.

Serratia marcescens is a highly adaptable Gammaproteobacterium with broad ecological distribution and growing clinical importance. Advances in whole-genome sequencing (WGS) and pangenome analysis reveal extensive genomic plasticity, driven by mobile genetic elements (MGEs) such as plasmids, transposons, integrons, prophages, and extracellular vesicles, which collectively accelerate virulence and antimicrobial resistance (AMR) evolution. S. marcescens displays a dynamic accessory genome enriched in resistance and virulence determinants, supporting persistence in diverse environments, including hospital water systems. Clinically, S. marcescens is an emerging opportunistic pathogen associated with severe healthcare-associated infections, ICU outbreaks, and multidrug-resistant "superbug" phenotypes. Its resistome includes intrinsic AmpC β-lactamase, broad efflux systems, and chromosomal determinants conferring resistance to β-lactams, polymyxins, and multiple additional drug classes, while acquired ESBLs and carbapenemases urther limit therapeutic options. Integrating genomic, evolutionary, and clinical insights underscores the urgent need for improved surveillance, mechanistic understanding, and targeted interventions against carbapenem-resistant S. marcescens (CRSM).

Despite advancements in clinical diagnostics, traditional biomarker detection methods (e.g., ELISA) remain limited due to their invasive nature, slow results, and inadequate use for continuous monitoring in low-resource settings. With the rise in chronic, infectious, and metabolic diseases, there is a pressing demand for real-time, minimally invasive diagnostic tools. Nanoengineered microneedle (MN) biosensors offer a promising solution. These painless devices can access interstitial fluid (ISF), a rich source of biomarkers, while utilizing advanced nanomaterials for high sensitivity and multiplexed detection. When combined with AI, IoT connectivity, and cloud-based analytics, MN biosensors enable personalized health data and continuous disease management. This review outlines recent advances in MN technology, including innovations in design and nanomaterial integration, as well as translational challenges like manufacturing scalability and regulatory approval. We explore how MN designs incorporating various sensing modalities can facilitate real-time monitoring of biomarkers such as glucose, lactate, and inflammatory proteins. Importantly, we discuss how these devices can improve healthcare access, reduce costs, and empower patients through everyday monitoring. This review integrates developments in MN engineering with biosensing and therapeutics, positioning biosensor-integrated MNs as pivotal in enabling continuous, minimally invasive disease monitoring and personalized therapy beyond traditional hospital environments.

Paediatric osteoarticular infections (OAIs) encompass a heterogeneous group of musculoskeletal infections associated with acute septic complications, prolonged morbidity and potentially long-term sequelae. Over the past two decades, advances in microbiological diagnostics-particularly nucleic acid amplification assays-have refined the aetiological understanding of OAIs and started a new therapeutic debate regarding the most appropriate routes of antibiotic administration. Clinicians now evaluate which children can be treated safely using oral antibiotics from the outset (oral-first), which require an initial intravenous (IV) phase before a step-down to oral therapy, and which will need IV therapy all along their care pathway. Treatment debates are particularly relevant in contexts involving constrained healthcare resources and limited hospital bed availability. This narrative review summarises the essential prerequisites for prescribing oral antibiotic therapy for paediatric OAIs and proposes a pharmacokinetic/pharmacodynamic (PK/PD) framework for guiding clinical decision-making. Key considerations include: pathogen identification and resistance profiling; contemporary bacteriological epidemiology; the comparative effectiveness of IV versus oral therapy; the availability of active oral antibiotics and their penetration into bone and joint compartments; achieving adequate systemic exposure and hitting PK/PD targets after oral administration; and the clinical limitations of oral antibiotic therapy, including patient selection criteria. We argue that oral-first and early-switch strategies are best framed as structured selection processes that integrate clinical severity and source control, pathogen/minimal inhibitory concentration constraints, the feasibility of attaining PK/PD targets orally and the reliability of follow-up. No single strategy should be seen as a universal default strategy.

Background: Incorporating sex as a biological variable (SBV) is recognized as essential for improving the reliability, reproducibility, and generalizability of pharmacological research. This principle is codified in international policies and guidelines, yet implementation remains uneven, especially in phytomedicine. Phytomedicines are a major component of healthcare worldwide, with 65% of the global population relying on them in both regulated and traditional contexts. Globally, phytomedicines are used by males, females, intersex and non-cis gender persons, all of whom may present specific safety and efficacy considerations and warrant full inclusion in pre-clinical to clinical research pipelines. However, in contemporary settings, phytomedicine lags in SBV best practices relative to Western allopathic standards for research design. Methods: We conducted a non-systematic review and in silico data mining to quantify sex/gender representation in recent preclinical and clinical phytomedicine studies, complemented by targeted case studies of sexually dimorphic safety/efficacy. We also summarize the historical role of women and gender-diverse people as users and providers within Traditional and Integrative Medical Systems (TIMSs). Results: Across rodent and human studies, females are under-represented relative to males, and sex is rarely reported for cell lines. Intentional inclusion of intersex and other gender-diverse populations is largely absent. Case studies illustrate plausible sex-associated differences in pharmacokinetics, pharmacodynamics, and adverse event profiles. TIMSs historically address women's health needs and include substantial participation by female practitioners; however, contemporary SBV practices remain less standardized than in Western allopathic pipelines. Conclusions: SBV integration in phytomedicine is needed to strengthen safety, efficacy, and regulatory-grade evidence. Practical barriers include legacy datasets without sex metadata, limited intersex animal models, and uneven resources across settings. We outline feasible, stepwise practices to improve SBV adoption in a manner compatible with TIMS contexts and recommend expanding current guidelines to better support diverse research environments while maintaining scientific rigor.

Reports on seasonal influenza vaccine (SIV) coverage in Gulf Cooperation Council (GCC) countries showed lower than targeted coverage among high-risk populations both before and after the COVID-19 pandemic and subsequent COVID-19 vaccine release. This narrative review aims to synthesise SIV coverage following the introduction of COVID-19 vaccines among at-risk groups in the GCC region. Database searches included PubMed and Google Scholar for articles assessing SIV uptake, acceptance, hesitancy, and intention to vaccinate among adults in high-risk groups in GCC countries, with data collected after the introduction of COVID-19 vaccines. SIV uptake ranged from 1.8% among pregnant women to 64.1% among dialysis patients in Saudi Arabia. Healthcare workers (HCWs) demonstrated the highest overall coverage, reaching 64.5% for annual uptake in Bahrain, with 79% of HCWs in Saudi Arabia intending to vaccinate. Prevalent barriers included low risk perception and consideration of influenza as a mild disease not necessitating SIV uptake, as well as vaccine effectiveness and safety concerns. Previous vaccination, physician advice, and policy or mandates for HCWs were identified as frequent facilitators of uptake. Suboptimal uptake was reported among most high-risk groups in GCC countries. Health Belief Model components and physician involvement appear to have a significant impact on vaccine uptake among the intended population. More emphasis should be directed toward effective risk communication and action cues methods to enhance uptake among high-risk groups. Future research is needed to cover understudied areas like the elderly aged ≥ 65 years, cancer and other high-risk groups, in addition to further studies for GCC countries other than Saudi Arabia in the post-COVID-19 vaccine period.