Consumers with food allergies and intolerances face significant risks when eating out, especially in countries lacking specific legislation on allergen communication. In such contexts, they depend heavily on the information and practices adopted by food business operators (FBOs). This study investigated key aspects of allergen management among FBOs, focusing on (i) knowledge and decision-making in situations involving allergic reactions; (ii) cognitive, moral, and emotional determinants influencing the management of allergenic foods; and (iii) potential allergen contamination in food preparation utensils used by establishments claiming to have implemented control measures. An intentionally stratified sample of 310 FBOs from 19 cities across all five Brazilian regions participated in the survey. The questionnaire consisted of 11 knowledge questions and an extended version of the Norm Activation Model (NAM), including constructs of responsibility attribution, awareness of consequences, personal norms, and behavioural intentions towards allergen management. Environmental assessments were conducted using rapid tests for allergen residues on shared utensils from 10 selected establishments. Knowledge gaps were evident, particularly in distinguishing lactose intolerance from cow's milk allergy-only 28.0% answered correctly. The NAM analysis indicated that knowledge predicts awareness of consequences, which, together with responsibility attribution, shapes personal norms and behavioural intentions. Guilt emerged as a moral emotion mediating this relationship, further reinforcing the intention to prevent allergic incidents. In the environmental assessment, 88% of samples tested negative; however, four blenders showed contamination with egg or gluten. Despite positive intentions among participants, observed knowledge gaps and the limited scope of existing regulations suggest that standardised national legislation and evidence-based training programmes may be necessary to strengthen allergen safety in Brazilian foodservice.
The FDA has the authority to regulate tobacco products, including the implementation of graphic health warnings on cigarette packaging. This study examines the short-term effects of these front-of-package health warnings on smokers' attention, package preferences, and intentions to quit. A total of 951 smokers were recruited via Amazon Mechanical Turk. Participants completed an online survey that included demographic questions, measures of attention to warnings, package choice, and quit intention. Participants were randomly assigned to view cigarette packs with or without warnings. First, exposure to warnings increased attention to the warning area (OR = 1.747, p = 0.0109), and increased the likelihood of choosing packages without warnings as prices increased (OR = 18.244, p<0.001). Additionally, focusing on the warning content also made smokers more likely to choose packages without warnings as price increased (OR = 5.025, p<0.001). However, warnings had no significant effect on quit intentions. Warnings effectively capture attention and influence cigarette package preferences, but their impact on quit intentions was not detectable after single exposure. These findings suggest that while warnings may affect short-term purchasing behavior, they are insufficient for driving cessation. Future research should investigate the long-term impact of warnings and consider other factors influencing quitting behavior.
Despite the generally recognised best practices of breastfeeding as the best method of feeding newborns, the rate of exclusive breastfeeding in Jordan is still way below the global average. Although cultural and religious beliefs promote breastfeeding by mothers, other mothers end up quitting earlier than the advised time. It is critical to know the intentions of mothers and the barriers they encounter to develop effective nursing and policy interventions. This was a qualitative descriptive study carried out in a single hospital, which is a government hospital located in Amman, Jordan. It involved the semi-structured interviews on 15 pregnant women in their second or third trimester, and data were recorded, transcribed and analysed via content analysis. Most of the mothers were highly motivated to breastfeed because they found it to be natural, healthy and cost-effective, and they felt emotionally rewarded to do so. Nevertheless, it had serious obstacles. Mothers had fears of poor body image, poor milk supply and physical discomfort and felt that maternity leave was too short and that breastfeeding could not be accommodated within their work schedule. Lack of professional help made many mothers turn to their families or online media to get their help. Jordanian mothers are found to be highly motivated to breastfeed, yet they face long-term cultural, social and occupational barriers to exclusive breastfeeding. Although breastfeeding is widely regarded as optimal for infant feeding, exclusive breastfeeding rates in Jordan remain far below global targets. Despite cultural and religious values encouraging mothers to breastfeed, many mothers stop earlier than recommended. Understanding mothers' intentions and the obstacles they face is essential to designing practical nursing and policy interventions.
Based on regulatory focus theory and framing theory, this study employed a 2 (message framing: gain vs. loss) × 2 (regulatory focus: promotion vs. prevention) between-subjects experiment to examine American parents' willingness to vaccinate their 5- to 11-year-old children against COVID-19. Our findings indicate that the direct effect of message framing was minimal. Messages were more persuasive when framing valence was matched with participants' chronic regulatory focus. Loss-framed messages when matched with a prevention focus-and gain-framed messages matched with a promotion focus-were more effective in increasing risk perception, vaccination attitude, and intention than mismatched conditions. Furthermore, processing fluency mediated the relationship between regulatory fit and persuasive outcomes. This study contributed to the existing literature on health behavioral change and offers important practical implications for health communication practitioners and policymakers. Limitations were acknowledged, and directions for future research were proposed.
This longitudinal randomized controlled trial examined the effects of anti-vaping social media content on e-cigarette attitudes and intentions among U.S. young adults (ages 18-24; n=3,400). Targeted content was embedded directly into participants' social media feeds, with varying levels of impressions. Results indicate that increased exposure to anti-vaping messages significantly elevated perceived risk of harm (β=0.11, 95% CI: 0.03-0.20, p < .01) and social unacceptability of e-cigarette use (β=0.10, 95% CI: 0.03-0.18, p < .01), while decreasing intentions to vape (RRR = 0.59, 95% CI: 0.36-0.97, p < .05). Notably, these attitudinal shifts occurred even with relatively low ad exposure and over an extended intervention period, while controlling for the e-cigarette use status (never, former, or current) of participants. Discussion These findings support the effectiveness of digital media campaigns in influencing health-related behaviors and attitudes among young adults. Specifically, embedding anti e-cigarette content directly in the feed of young adults is shown to be effective in shifting attitudes in a space where these young adults are already engaged. Limitations include limited ad impressions and minimal change in ad awareness recall, suggesting future research should explore longer interventions and broader nicotine product messaging.
Many dietary interventions have been conducted in rheumatoid arthritis (RA) with quantitative outcomes the key focus; qualitative research exploring participant experiences remains limited. The autoimmune protocol (AIP) diet is an elimination reintroduction approach designed for autoimmune conditions. This study explored the experiences of nine adults with RA who completed an eight-week AIP dietary intervention, with semi-structured interviews conducted immediately post-intervention and again one year later. Interviews explored participants' motivations, challenges, enablers, and perceived effects of the intervention, their experiences with food reintroduction, and the degree to which dietary changes were sustained. Thematic analysis identified three themes related to initial intervention experiences. Open to change, captured initial motivations, trust in the protocol and willingness to attempt substantial dietary change. Navigating dietary transition described the mental, practical, and social strategies used to manage challenges and support adherence. Reflections on benefits and looking ahead, captured perceived health changes and intentions for future dietary practices. At one-year follow-up, three further themes were identified. Personalised reintroductions and responses highlighted how participants observed the effects of foods on RA and health. Finding and sustaining balance reflected the ongoing process of negotiating dietary structure with flexibility, particularly in social contexts. Reflections on wellbeing and future intentions encompassed perceived benefits, persistent challenges, and plans for ongoing dietary management. High initial adherence was facilitated by participant motivation and structured study support. The reintroduction protocol was perceived as burdensome, however, most participants sustained meaningful dietary change, even without ongoing formal guidance.
BackgroundRecent increases in syphilis diagnoses among heterosexual individuals are a growing public health concern. The NEXUS study aimed to qualitatively assess the contexts surrounding syphilis transmission among heterosexually-identifying individuals in England.MethodsWe conducted semi-structured interviews with heterosexually-identifying individuals diagnosed with primary, secondary, or early latent syphilis in the previous year, and with healthcare professionals (HCPs) involved in syphilis management. Participants were recruited from sexual health services across three regions in England between December 2023 and September 2024. A qualitative descriptive and interpretive approach was used. Transcripts were analysed using framework analysis, incorporating deductive and inductive coding. Service user and HCP data were triangulated to compare perspectives and enhance credibility.ResultsNineteen service users (53% male, 74% White British) and seven HCPs were interviewed. Syphilis was reported to occur in the context of condomless vaginal or oral sex. Many heterosexual individuals perceived low STI risk due to few partners, presumed exclusivity, or isolated changes in behaviour. Syphilis knowledge was limited and the infection was often viewed as rare or historical. Symptom recognition was poor, particularly for non-genital symptoms, and some service users initially sought care in non-sexual health settings, contributing to delayed diagnosis. HCPs highlighted similar gaps in awareness among non-sexual health clinicians. Following diagnosis, awareness of STI risk increased and most service users described intentions to reduce risk, although understanding of infectiousness and follow-up remained variable.ConclusionsFindings highlight gaps in awareness, risk perception, and clinical recognition of syphilis among heterosexual populations and non-sexual health HCPs. Public health strategies should emphasise syphilis as relevant to all sexually active people, raise awareness, and support earlier diagnosis by non-sexual health HCPs.
Public dementia awareness is a central pillar of international public health strategies, yet its conceptualization remains fragmented. Conceptual ambiguity in literature limits comparability and hinders the design and evaluation of campaigns and interventions. We aimed to examine how public dementia awareness is defined in population-level initiatives and to develop a literature-based conceptual model to guide future research and practice. Following the PRISMA guidelines, we conducted a conceptual systematic review on studies describing community-based dementia awareness campaigns, educational programmes or plans. Explicit and implicit definitions of awareness were extracted and synthesized using an iterative conceptual analysis process. Conceptualization of public dementia awareness was heterogeneous across studies (N = 22). Most relied on proxy constructs, such as factual knowledge, understanding, attitudes, and behavioural intentions. These elements clustered into four recurring domains: cognitive, affective, social, and behavioural. Based on the synthesis, we developed a conceptual model distinguishing antecedents of awareness, core awareness dimensions, and proximal and distal consequents at individual and societal levels. Public dementia awareness is a complex, multidimensional construct that extends beyond knowledge acquisition. The proposed model offers a framework to clarify the construct and support more consistent dementia awareness initiatives in community contexts.
The integrity of organizational information systems fundamentally relies on the psychological commitment of users to adhere to security protocols. Informational security policy (ISP) depends on users' compliance to protect their organization's information and technology assets against security threats. Drawing on the intersection of cognitive and behavioral psychology, this study examines information security policy compliance (ISPC) behavior by integrating the Task-Technology Fit (TTF) model, technology threat avoidance theory (TTAT), and the Theory of Planned Behavior (TPB). This study proposes a comprehensive research model to elucidate the cognitive factors and motivational drivers that shape an employee's behavioral intention to comply. Utilizing a partial least squares structural equation modeling (PLS-SEM) approach, we empirically tested the model with data from 288 employees across public and private sectors in Saudi Arabia. The results show that Task and technology characteristics significantly drive task-technology fit, which, along with self-efficacy, social influence, and policy effectiveness, positively predicts security compliance intentions and subsequent behavior. Conversely, compliance intention is hindered by perceived costs, while the influence of perceived security threats remains statistically insignificant. The study discusses key theoretical and applied insights, providing a roadmap for future research in the field.
This research explores how international sports federations (IFs) use new technologies to enhance at their events. It overviews the digital initiatives and tools deployed to improve in-person and remote experiences. The study analyses two main questions: which technologies IFs use most often and how they implement them to improve international sports events' quality and attractiveness. The researcher applied a mixed-methods approach by analysing 115 initiatives from Summer Olympic IFs and 65 from Winter Olympic IFs and conducting qualitative interviews with 11 IFs representatives and one academic expert. The findings show cautious optimism about Virtual Reality (VR), Augmented Reality (AR), and Artificial Intelligence (AI) for enhancing fan experiences. IFs mainly use AR for broadcast and advertising, though technical and financial constraints limit its application. VR offers immersive potential but remains niche and costly. However, AI is more widely adopted for automation and content generation but faces realism challenges. The second observation is that customer relationship management systems also play a key role in enabling federations to tailor content and services to fans' preferences. Furthermore, many IFs use data analytics to monitor fan behaviour and improve engagement through digital platforms like websites, mobile apps, and OTT services. The study also highlights that federations centralising fan data from multiple sources demonstrate higher personalised experiences. Despite financial and organisational constraints, several federations manage to implement impactful technologies with limited resources. Thus, this exploratory research brings new perspectives to the field of sport management by identifying current practices, suggesting practical recommendations and providing the basis for future studies on organisational intentions and practices about digital innovation in international sport.
Conservation communication often uses the celebrity endorsement strategy. However, robust evidence regarding its effectiveness is still limited. More importantly, practitioners do not have guidelines for selecting an ideal endorser because there is no clear consensus on what endorser attributes are most critical. We explored these issues by examining advocacy for the ivory trade ban in China through the use of two public service announcements (PSAs). The contents of the two PSAs were similar, except that one was endorsed by a sports celebrity (Yao Ming) and the other by a noncelebrity (a police officer). Based on a real-world, randomized, controlled trial intervention experiment (N = 550), we found that although the celebrity was rated as more attractive, the PSAs did not differ significantly in perceived attractiveness. The police officer produced a statistically significant but small improvement in attitude toward the ban (Cliff's delta = -0.11), with no significant differences in behavioral intentions, indicating limited practical superiority. According to the structural equation model (SEM), endorser attractiveness was positively associated with PSA attractiveness, which in turn was associated with communication behavioral intention, whereas endorser credibility was more strongly associated with conservation behavioral intention. These findings suggested that the selection of endorsers should be contextualized. In particular, if the aim is to promote widespread communication, then celebrities may be the recommended endorsers, as they have the potential to attract people's attention. If the aim is to promote attitude or behavioral change, then endorsers with high credibility levels may be more appropriate. Future studies should conduct empirical research on multiple types of celebrities and explore how endorser attributes interact with different message framings and various conservation contexts to better inform strategic communication efforts. Influencia de los atributos de los patrocinadores en la comunicación sobre la conservación Resumen La comunicación sobre conservación suele recurrir a la estrategia del patrocinio de celebridades. Sin embargo, aún hay pocas pruebas sólidas sobre su eficacia. Y lo que es más importante, los profesionales no disponen de directrices para seleccionar al patrocinador ideal, ya que no existe un consenso claro sobre qué atributos de los promotores son los más importantes. Hemos analizado estas cuestiones estudiando la campaña a favor de la prohibición del comercio de marfil en China mediante el uso de dos anuncios de servicio público (ASP). El contenido de los dos anuncios de servicio público era similar, salvo que uno contaba con el respaldo de una celebridad del mundo del deporte (Yao Ming) y el otro, de una persona no famosa (un agente de policía). A partir de un experimento de intervención en el mundo real, aleatorio y controlado (N = 550), observamos que, aunque la celebridad fue valorada como más atractiva, los anuncios de servicio público no presentaban diferencias significativas en cuanto al atractivo percibido. El agente de policía generó una mejora estadísticamente significativa, aunque pequeña, en la actitud hacia la prohibición (delta de Cliff = ‐0.11), sin diferencias significativas en las intenciones de comportamiento, lo que indica una superioridad práctica limitada. Según el modelo de ecuaciones estructurales (MEE), el atractivo del patrocinador se asoció positivamente con el atractivo del anuncio de servicio público, que a su vez se asoció con la intención de comportamiento comunicativo, mientras que la credibilidad del patrocinador se asoció más fuertemente con la intención de comportamiento conservacionista. Estos resultados sugieren que la selección de los patrocinadores debe contextualizarse. En concreto, si el objetivo es promover una comunicación generalizada, las celebridades podrían ser los patrocinadores recomendados, ya que tienen el potencial de atraer la atención de la gente. Si el objetivo es promover un cambio de actitud o de comportamiento, los patrocinadores con altos niveles de credibilidad podrían ser más adecuados. Los estudios futuros deberían llevar a cabo investigaciones empíricas sobre múltiples tipos de celebridades y explorar cómo los atributos de los patrocinadores interactúan con diferentes marcos de mensaje y diversos contextos de conservación para orientar mejor los esfuerzos de comunicación estratégica. 代言人特性如何影响保护传播效果 名人代言在保护传播中应用广泛, 但关于其有效性的有力证据仍然有限。更重要的是, 传播实践者缺乏如何选择理想代言人的明确指导, 因为目前尚不清楚代言人的特性如何影响传播效果。为此, 本研究以两则宣传中国象牙贸易禁令的公益广告为例, 探讨上述问题。这两则广告内容高度相似, 唯一区别在于一则由体育名人(姚明)代言, 另一则由非名人(警察)代言。 基于一项随机对照试验(N = 550), 研究发现, 尽管名人更具吸引力, 但不同代言人类型所代言广告的吸引力并无显著差异。与名人代言的广告相比, 观看警察代言广告的受访者对象牙贸易禁令的态度显著更为积极, 但差异幅度较小(Cliff's delta = −0.11), 且在行为意愿上未表现出显著差异, 表明代言人警察具有一定但有限的有效性。结构方程模型的结果显示, 代言人的吸引力与广告吸引力呈正相关, 而广告吸引力又与积极的传播行为意愿相关;与此同时, 代言人的可信度与保护行为意愿之间的关联更为紧密。 因此, 代言人的选择应根据具体情境而定。具体而言, 若目标是促进广泛传播, 名人因其具备吸引公众注意力的潜力, 是较为合适的代言人;若目标是促进态度或行为转变, 则具有较高可信度的代言人更为适宜。未来研究应涵盖更多类型的名人, 并探讨代言人属性如何与不同的信息框架及各类保护情境相互作用, 从而为战略传播实践提供指导。.
The aim of this study is to examine global research trends, the conceptual framework and emerging research themes relating to artificial intelligence (AI)-supported robotic assistive technologies in the field of rehabilitation, through bibliometric and thematic analyses. Furthermore, the study aims to highlight the scientific development of the field and future research directions. The study examined publications indexed in the Web of Science Core Collection database between 2002 and 2025. In accordance with the PRISMA-based systematic review process, the defined inclusion and exclusion criteria were applied, and 644 peer-reviewed articles focusing on AI-supported robotic assistive technologies in rehabilitation were included in the analysis. Bibliometric analyses were conducted using the Bibliometrix (R-Biblioshiny) software; publication trends, keyword co-occurrence networks and international collaboration patterns were evaluated. Thematic mapping and SWOT analysis were applied to determine conceptual development. The results indicate a marked increase in the number of publications, particularly after 2015. The main focus areas of the research comprise exoskeleton systems, stroke rehabilitation, motor function recovery and machine learning-based motion analysis. In recent years, biosignal-based intent recognition, human-machine interaction and explainable artificial intelligence have emerged as prominent research themes. Furthermore, it has been determined that global research leadership is increasingly shifting towards Asian countries, particularly China. AI-enabled robotic rehabilitation technologies are evolving from mechanical systems into adaptive and human-centred therapeutic solutions. This development highlights the importance of ethical governance, explainable AI and interdisciplinary collaboration; it also offers strategic insights into the future of rehabilitation technologies. Artificial intelligence-powered robotic assistive technologies can enhance rehabilitation by enabling adaptive and personalised therapy that responds to individual patient needs and motor performance.The integration of biosignal-based systems (e.g., EEG and EMG) allows rehabilitation robots to recognise patient movement intentions, supporting more natural and responsive human–machine interaction in therapy.AI-driven rehabilitation robots and exoskeletons may support improved motor recovery and functional outcomes, particularly in conditions such as stroke and neurological impairments.The growing use of AI in rehabilitation highlights the need for ethical governance, transparent algorithms and data protection to ensure safe and trustworthy clinical implementation.Interdisciplinary collaboration among rehabilitation professionals, engineers and AI researchers is essential to develop accessible, human-centred rehabilitation technologies that support inclusive and sustainable healthcare.
Resectability in non-small cell lung cancer (NSCLC) is shifting from a purely anatomic and surgical concept, based on technical feasibility of an R0 resection, to an integrated, multidisciplinary determination that incorporates tumor biology, expected benefit from perioperative systemic therapy and operative risk. Contemporary guidelines emphasize that resectability-particularly in stage III disease-should be defined by an experienced multidisciplinary team (MDT) with thoracic surgical input, alongside standardized staging and biomarker assessment to guide systemic options. Perioperative immune checkpoint inhibitor (ICI) plus chemotherapy regimens have expanded the population considered for curative-intent surgery by improving pathologic response and event-free survival, while also introducing new determinants of resectability, such as likelihood of completing multimodality therapy and managing treatment-related toxicity. Resectability in locally advanced (stage III) NSCLC is a multidisciplinary determination that complete oncologic resection is achievable with acceptable operative risk, and that surgery adds value within a multimodality plan rather than being based on anatomy alone. Key elements of resectable stage III NSCLC are: R0 resection goal with guideline-concordant nodal dissection; nodal extent drives resectability more than T stage as N3 is generally unresectable while single-station, non-bulky N2 is most commonly considered potentially resectable, whereas bulky and - or multistation N2 often argues against surgery, with persistent lack of consensus in the literature. The aim of this review is to focus on the key elements currently redefining the concept of resectability in the landscape of perioperative treatment for lung cancer, with particular regard to locally advanced disease, which represents the most challenging scenario for all professionals involved in the multidisciplinary management of lung cancer.
Timely access to curative-intent colorectal cancer (CRC) surgery is a central component of surgical quality. Yet contemporary evidence challenges historical assumptions that shorter wait times always confer better outcomes. Drawing on population-based studies which offer the most robust and generalizable data this article synthesizes what is known about the relationship between surgical delay and oncologic outcomes in CRC. We outline key conceptual considerations in defining wait-time intervals, discuss lessons from the coronavirus disease 2019 pandemic, and identify gaps for future research. Ultimately, wait times should be applied as flexible, evidence-informed quality indicators that support patient-centered, biologically sound, and operationally feasible cancer care.
Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) reduce cardiovascular and kidney events in randomized trials, yet evidence on their effectiveness in routine nephrology practice remains limited. We examined cardiovascular and kidney outcomes associated with SGLT2 inhibitor initiation in adults with chronic kidney disease (CKD) receiving specialist nephrology care. In this nationwide cohort study, we included adults with CKD receiving specialist nephrology care, identified through the Swedish Renal Registry between January 1, 2016, and December 31, 2023. Participants had baseline data on estimated glomerular filtration rate, urine albumin-creatinine ratio, and hemoglobin; those with prior kidney replacement therapy (KRT) were excluded. Follow-up continued until December 31, 2024. SGLT2 inhibitor use was identified through national pharmacy records and analyzed according to an intention-to-treat approach. Outcomes were major adverse cardiovascular events (MACE), initiation of KRT, all-cause mortality, and a composite of heart failure hospitalization or cardiovascular death. Associations were estimated using inverse probability-weighted marginal structural models to address time-dependent confounding. Among 32,856 participants (median age 73 years [interquartile range 63-79]; 36% women; mean estimated glomerular filtration rate 29.3 ± 16.8 mL/min/1.73 m2), 1,493 (4.5%) were prevalent SGLT2 inhibitor users at baseline and 3,491 (10.6%) initiated treatment during follow-up (4,984 ever-exposed, 15.2%). SGLT2 inhibitor use was associated with lower risk of MACE (odds ratio 0.80, 95% confidence interval 0.71-0.91) and KRT (0.67, 0.52-0.85). No associations were observed for all-cause mortality (0.95, 0.79-1.15) or the composite heart failure (HF) outcome (0.87, 0.65-1.16), although a lower risk was observed in the incident-user analysis (0.61, 0.38-0.98). Associations were generally consistent across prespecified subgroups. In adults with CKD managed in specialist nephrology care, SGLT2 inhibitor use was associated with lower risk of MACE and KRT, extending randomized trial evidence to a broad, real-world CKD population.
Esophageal cancer is commonly diagnosed at a locoregional stage and is typically treated with neoadjuvant chemoradiotherapy followed by esophagectomy. Despite advances in perioperative care, esophagectomy remains associated with substantial morbidity and mortality. Frailty assessment has been proposed as a tool for preoperative risk stratification, but its predictive value in patients undergoing esophagectomy remains uncertain. We conducted a retrospective cohort study of patients who underwent curative-intent esophagectomy between January 2012 and December 2024. The predictive performance of the 5-item Modified Frailty Index (mFI-5) was compared with the American Society of Anesthesiologists Physical Status (ASA-PS) classification. Receiver operating characteristic (ROC) curve analysis and exploratory multivariable logistic regression were performed to evaluate the predictive performance of mFI-5 and ASA-PS classification for 30-day mortality. A total of 123 patients underwent esophagectomy, with a 30-day mortality rate of 9.8%. Patients who died had significantly longer intensive care unit and hospital stays and a higher incidence of severe postoperative complications. ASA-PS demonstrated better discrimination than mFI-5 for predicting 30-day mortality (AUC 0.67 vs. 0.55), although the discriminatory performance of both tools remained limited. In the exploratory multivariable analysis, ASA-PS classification was independently associated with 30-day mortality, whereas mFI-5 was not. Although ASA-PS classification was independently associated with 30-day mortality, both ASA-PS and mFI-5 demonstrated limited predictive performance following esophagectomy. These findings suggest that mFI-5 and ASA-PS alone provide limited discrimination for predicting 30-day mortality and support the development of esophagectomy-specific risk prediction models incorporating objective clinical, physiological, functional, and procedure-specific variables.
Vaccine hesitancy is a persistent global health challenge. This project explored attitudes towards and utilization of COVID-19 vaccination, as well as suggestions to improve utilization within Indigenous communities in Northwest Territories, Canada. Utilizing a cross-sectional design, this project spanned two phases: 10 communities in Phase 1 (April to November 2021), and 11 in Phase 2 (August 2022-January 2023). Self-identifying Indigenous adults (≥18 years) were invited. Quantitative and qualitative data were collected via a semi-structured interviewer-administered questionnaire. In Phase 1 (n = 124; mean age = 41.6 years; 63.7% women) and Phase 2 (n = 221; mean age = 43.6 years; 66.21% women), 78.2% and 87.2% of participants had received at least one dose, respectively. In Phase 1, 67.2% reported not being concerned about the vaccine, and 61.2% believed the benefits outweighed the risks. In Phase 2, 56.2% of participants agreed all eligible individuals should be vaccinated, and 59.2% agreed the vaccine prevented serious outcomes. Bivariate analyses revealed that negative attitudes towards COVID-19 severity, vaccine safety, and effectiveness were significantly associated with lower intention to receive a COVID-19 vaccine in the future. Qualitative insights revealed factors of vaccination hesitancy, including: concerns about safety, efficacy, and necessity; a need for information; and distrust in government. Reasons for utilization included: trust in vaccine safety; perceived necessity; and employment and travel requirements. COVID-19 vaccine utilization in Indigenous communities is high, yet hesitancy persists due to safety and efficacy concerns, and distrust in government. Culturally safe strategies, improved communication, and equitable access are essential to sustaining confidence and future pandemic preparedness.
Esophageal squamous cell carcinoma (ESCC) is associated with high morbidity and mortality, and esophagectomy remains the mainstay of curative treatment. The optimal surgical technique transthoracic esophagectomy (TTE) versus transhiatal esophagectomy (THE) continues to be debated due to differences in surgical invasiveness and the extent of lymphadenectomy. This study aimed to compare clinical and oncological outcomes of TTE and THE in patients treated for ESCC. This retrospective study included patients who underwent curative-intent esophagectomy for histologically confirmed ESCC between 2015 and 2023. Patients were categorized according to surgical approach (TTE vs THE), and demographic characteristics, perioperative data, pathological findings, postoperative complications, and survival outcomes were compared between the 2 groups. Complications were classified according to the Clavien-Dindo system. Disease-free survival (DFS) and overall survival (OS) were assessed using Kaplan-Meier analysis. A total of 39 patients were analyzed (21 TTE, 18 THE). Baseline demographic features and most perioperative variables were comparable. TTE was associated with a significantly longer operative time and higher lymph node yield, whereas THE showed higher rates of intraoperative transfusion and pleural effusion. Other postoperative complications were similar between groups. The TTE approach demonstrated significantly better DFS (P = .004). No significant difference in OS was observed between the groups (P = .165). No additional clinical or pathological factors were associated with survival outcomes. TTE resulted in a greater lymph node yield and significantly improved DFS, indicating a clear oncologic advantage over the transhiatal approach.
Pesticide poisoning remains a major public health challenge in low- and middle-income countries, particularly where highly hazardous pesticides (HHPs) remain accessible and toxicovigilance systems are limited. Although Tanzania has recently initiated regulatory actions targeting HHPs, evidence regarding pesticide-specific mortality patterns and clinical outcomes remains scarce. This study assessed clinical outcomes, pesticide-specific case fatality, and mortality risk among pesticide poisoning cases reported in selected Tanzanian hospitals. A retrospective cross-sectional study was conducted using hospital records from Regional Referral Hospitals and District Hospitals in Arusha, Kilimanjaro, Morogoro, Iringa, and Mwanza regions between January 2017 and November 2024. Cases were identified through hospital poisoning records, emergency department registers, admission records, and medical files. Information on demographic characteristics, exposure type, pesticide category, and clinical outcomes was extracted using structured electronic forms. Descriptive statistics summarize poisoning characteristics and outcomes. Associations between demographic factors and clinical outcomes were assessed using chi-square tests. Binary logistic regression was used to identify predictors of mortality, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. A total of 635 pesticide poisoning cases were included in the analysis. Most patients were male (64.1%) and aged 16-35 years (61.3%). Intentional exposure accounted for 70.2% of cases, while unintentional exposure represented 20.3%. Most patients fully recovered (67.9%; 95% CI: 64.1-71.4), whereas 18.4% (95% CI: 15.5-21.6) died following pesticide poisoning. Paraquat poisoning demonstrated the highest case fatality (93.3%), followed by glyphosate (45.5%) and tefluthrin (33.3%). Compared with lower-risk pesticide exposures, paraquat poisoning was associated with markedly increased odds of death (aOR = 21.5; 95% CI: 9.4-48.2), while glyphosate poisoning was associated with elevated mortality risk (aOR = 5.2; 95% CI: 1.8-14.6). Pesticides with case fatality exceeding 10% contributed 87.3% of all recorded deaths. Mortality following pesticide poisoning in Tanzania was strongly concentrated among a small number of highly hazardous pesticides, particularly paraquat. These findings support continued restriction and removal of highly hazardous pesticides, strengthening of pesticide-specific surveillance systems, improved clinical toxicology capacity, and enhanced poisoning prevention strategies. Continued monitoring will be important to evaluate the public health impact of recent pesticide regulatory reforms in Tanzania.