Manga are imaginative graphic novels that often feature adventurous, motivational, and inspirational storylines. Manga genres are broadly categorized by their primary intended audience, as defined by age and gender. The two most popular are Shōnen, targeting male adolescents ages 12 to 17, and Seinen, targeting young male adults ages 18 to 30. These popular genres sometimes present content that depicts risk-taking behavior, such as substance use, which may have adverse effects on young readers. This study documents and compares substance use-related content in Shōnen and Seinen. The study sample consisted of 500 randomly selected chapters from a set of top-selling Shōnen and Seinen series. We used Fisher's exact test to compare prevalence rates between the two genres. We found that 150 out of the 500 chapters (30%) had at least one depiction of substance use, related dialogue, or paraphernalia, with tobacco-related content comprising the majority of these depictions. Shōnen had more tobacco-related content than Seinen (p < 0.01), though the latter had more depictions of ashtrays (p < 0.01). Our sample presented no content related to vaping or prescription drug misuse. The nature and extent of this substance use-related content are generally consistent with current societal norms in Japan. Future research should examine whether young readers' exposure to this content changes their beliefs, attitudes, and behavioral intentions.
Reading on paper reportedly improves story comprehension compared to its digital version, although the underlying neuroscientific mechanisms remain unclear. We used a format of Japanese manga stories as visual narratives told in halves, each of which depicted the same events from the different perspectives of two protagonists. We examined how the medium used to read the first halves, either on a paper book (Paper preparatory condition) or on an electronic tablet (Tablet preparatory condition), facilitated reading of the second halves for the memorized stories, which they read on an electronic display with continuous empathy ratings. Magnetic resonance scanning was conducted during the latter reading and during answering two sets of questions: Set 1 that could be answered after reading the first half alone, and Set 2 that required comprehension from both halves. Behavioral results showed prospective effects of reading manga stories on a paper book or an electronic tablet, such that the response times were prolonged in Set 2 for the Tablet condition. By comparing the results of Sets 1 and 2 with correct answers for each story, we found significant response time differences for the Tablet condition alone. Moreover, for the Paper condition, activations in the left frontal regions significantly decreased while reading the second halves, and those in the right frontal regions also decreased in Set 1. Furthermore, core left frontal activations were highest in Set 2 for the Tablet condition, while supportive right frontal activations correlated with individual accuracy rates in Set 2 for the Tablet condition, indicating that excessive integration processes support improved performances required by correct answers. The present results demonstrate stronger prospective effects of reading on paper books, such that linguistic and narrative-structural integration processes are facilitated and led to saved excessive activations.
This study investigates smoking depictions in the globally popular manga ONE PIECE over its 27-year publication period and its associations with tobacco control measures implemented in Japan. Time-series study. Volumes 1-110 (1121 episodes) of ONE PIECE published between August 1997 and December 2024. Smoking scenes were identified and quantified by panel-based content analysis. Prevalence of smoking panels relative to the total number of panels per volume. The overall prevalence of smoking panels was 4.7%, with a significant downward trend (p<0.001). Smoking depictions of Sanji, the only smoker among the 10 core characters in the series, accounted for 54% of the total of 5076, and his smoking portrayal significantly declined over the 27-year publication period (p=0.007). Interrupted time series analyses demonstrated statistically significant slope changes indicating decreasing trends in Sanji's smoking depictions following the implementation of the revised Health Promotion Act (p<0.001). Despite this decline, smoking behaviour and tobacco product depictions continued to appear in the series. Policies with adolescent-focused, legally binding implications for smoking environments were associated with reductions in the smoking depictions of a core character. Given the global reach of Japanese manga among young audiences, strengthening regulations on smoking depictions and enhancing media literacy education for adolescents may be necessary to reduce the risk of smoking initiation.
Breast cancer continues to be the primary cause of mortality from cancer in women globally, highlighting the urgent necessity for early and accurate identification. Although mammogram is the gold standard for screening, several challenges still exist, such as low contrast, varying sizes of masses, and irregular mass shapes. To address these limitations, we propose MANGA-YOLO, a novel learning model for breast mass detection inspired by the Mamba and transformer architecture. Our model integrates Mamba-Inspired Attention with Contextual Awareness (MACA) to improve feature extraction by capturing long-range dependencies and enhancing contextual understanding. Additionally, we introduce a Spatial and Channel Group Attention (SCGA) module, which combines convolutional spatial refinement with group self-attention. This enriches feature representation by strengthening boundary sensitivity and emphasizing global information through a series of attention modules, thus improving the detection of masses with diverse sizes. These improvements enable more precise detection of small, low-contrast, and irregularly shaped masses. The proposed approach is evaluated on three mammography datasets - INbreast, VinDr-Mammo, and CBIS-DDSM - achieving 0.881, 0.69, and 0.664 for mAP50 metric, respectively. The results show the outperformance of our method over existing state-of-the-art models. It suggests that MANGA-YOLO offers a more robust and efficient approach to automated breast mass detection, potentially improving early diagnosis and clinical decision making. The code is available at https://github.com/Kien-Trang/MANGA-YOLO.
BACKGROUND: The use of digital tools in healthcare remains limited in many countries, although their use by healthcare professionals is key to the effective implementation of digital health. In 2023, Burkina Faso introduced the Minimal Digital Ecosystem (MDE), a set of eight digital tools designed to support healthcare providers in clinical care, free-service management, pharmaceutical supply, and quality assessment. This study aims to identify factors associated with the use of MDE tools among healthcare professionals. METHODS: We conducted a cross-sectional study in four districts of Burkina Faso (Ziniaré, Ténado, Manga, and Sapouy). Spatially representative health facilities were selected using Moran autocorrelation, and purposive sampling was applied to recruit health professionals. Data were analysed through chi-square tests and multivariate logistic regression. RESULTS: Factors varied across tool categories. Use of service delivery tools (REC-PCIME and REC-Maternité) was significantly associated with secondary education (aOR = 3.47; 95% CI: 1.68–7.20). Perceived ease of use strongly influenced E-SantéCom adoption (aOR = 98.51; 95% CI: 1.77–5492.15). Men were more likely to use NetSIGL 2.0 (aOR = 3.07; 95% CI: 1.76–5.36), while access to more than four tablets reduced its use (aOR = 0.56; 95% CI: 0.35–0.91). Geographic disparities were observed for E-Qualité, with almost no uptake in Manga (aOR = 0.01; 95% CI: 0.00–0.18). For E-Flux financier, secondary education was again a major predictor (aOR = 7.66; 95% CI: 1.45–40.38). Finally, use of E-Gratuité and individual electronic care record tool (FIS) was associated with male gender (aOR = 18.04; 95% CI: 5.14–63.30) and more than 10 years of professional experience (aOR = 12.05; 95% CI: 1.59–91.46). CONCLUSION: MDE tools use in Burkina Faso is shaped by both individual factors (gender, education, experience, and perceptions) and structural factors (equipment availability and geographic disparities). Targeted strategies are needed to strengthen digital health use and ensure equitable integration within primary healthcare.
Alzheimer's disease (AD) is a progressive neurodegenerative disorder which results in cognitive decline and memory loss, characterized by the accumulation of amyloid beta (Aβ) plaques and neurofibrillary tangles in the brain. Despite numerous efforts to develop animal models of AD across various species to understand its pathological characteristics and underlying mechanisms, the model that accurately mimics the pathological phenotypes of AD remains elusive. In this study, we aimed to induce sporadic AD pathological progression in non-human primates (NHP) through the repeated administration of Aβ oligomers (AβO) via the CBCT-guided intra-cisterna manga (ICM) injection. Cynomolgus monkeys were administered AβO twice a week for four weeks, and then euthanized one week after the final injection. We found that AβO-injected NHP developed AD pathologies, including Aβ deposition, synaptic impairment, and neuroinflammation in the CA1 area of the hippocampus. Additionally, the levels of hyperphosphorylated tau were significantly increased in the cerebrospinal fluid (CSF) of AβO-injected NHP. Our results demonstrate that repeated AβO injection via the ICM route induces several early-stage AD-like neuropathological alterations, including intracellular Aβ accumulation, tau phosphorylation, and synaptic dysfunction. The present study indicates that repeated ICM administration of AβO could be good approach to reproduce a translational NHP model of AD, enabling the study of AD pathogenesis and pre-clinical testing of potential therapeutic candidates for AD.
Determinar los cambios en el parámetro de atenuación controlada (CAP, controlled attenuation parameter) en pacientes sometidas a cirugía bariátrica. Se revisaron e incluyeron los expedientes de pacientes con obesidad a las que se realizó la medición del CAP mediante elastografía previo a la cirugía bariátrica y 6 meses después de esta. Se analizó la normalidad de los datos y se compararon con la prueba t de Student pareada o con la prueba de Wilcoxon; para la asociación del grado de esteatosis pre- y posquirúrgico se utilizó la prueba de χ2. Se consideró estadísticamente significativo un valor de p < 0.05. Se incluyeron 33 mujeres con una edad media de 45.76 años ± 10.1 años, de las cuales 17 fueron tratadas mediante bypass gástrico y 16 con manga gástrica. Se observó una reducción de 11 kg/m2 (10-12,5 kg/m2). Los niveles de CAP preoperatorios fueron de 282 ± 52 dB/m, y a los 6 meses de la cirugía bariátrica fueron de 238 ± dB/m (p = 0.0006). El grado de esteatosis se redujo en 20 pacientes (60.7%), no cambió en 9 (27.3%) y aumentó en 4 (12%). Se demostró que la cirugía bariátrica tiene un impacto positivo en la disminución de los niveles de CAP en pacientes con obesidad y enfermedad hepática esteatótica asociada a disfunción metabólica. To determine the changes in controlled attenuation parameter (CAP) levels in patients undergoing bariatric surgery. The records of patients with obesity who underwent CAP measurement using the elastography prior to bariatric surgery and 6 months after it were reviewed and included. The normality of the data was analyzed and compared with the paired Student’s t test or Wilcoxon test. The association of the degree of pre- and postsurgical steatosis was analyzed using the χ2 test, considering p < 0.05 a statistically significant value. 33 female patients with a mean age of 45.76 years ± 10.1 years were included, 17 were treated by gastric bypass and 16 with gastric sleeve. A reduction of 11 kg/m2 (10-12.5 kg/m2) was observed. The preoperative CAP levels were 282 ± 52 dB/m, and 6 months after bariatric surgery were 238 ± dB/m (p = 0.0006). The degree of steatosis decreased in 20 patients (60.7%), unchanged in 9 (27.3%) and increasing in 4 (12%). Bariatric surgery was shown to have a positive impact on reducing CAP levels in patients with obesity and metabolic dysfunction associated steatotic liver disease.
A series of 7-Azaindole Linked Imidazole 1,2,3-Triazole hybrids were synthesized and assessed for their anticancer activity across five distinct cancer cell lines: DU-145 (prostate cancer), MCF-7 (breast cancer), HCT 116 (colon cancer), HeLa (cervical cancer), and HepG2 (liver cancer). In the series, compound 7j demonstrated significant efficacy against human breast cancer cells, specifically MCF-7. Cell cycle analysis demonstrated that this compound caused cell cycle arrest at the G2/M phase and triggered apoptosis. The findings were additionally validated through Hoechst staining and the Annexin V-FITC assay. The molecular docking study was conducted using the crystal structure of the epidermal growth factor receptor with ligands 7 g and 7j, which demonstrated optimal binding energy values and notable binding interactions, such as hydrogen bonds, π-π stacking, and various hydrophobic interactions, suggesting their binding efficiency in a favourable manner.
In Burkina Faso, the Minimal Digital Ecosystem (MDE)-a suite of 9 integrated digital tools-was introduced to support key health system functions, including care delivery, financial management, medication oversight, governance, and data use. However, evidence regarding the maturity of its real-world implementation and the determinants influencing its adoption remains scarce. This pragmatic mixed methods study aims to (1) measure MDE implementation maturity across 4 dimensions (adoption, fidelity, penetration, sustainability), (2) identify multilevel determinants using the Consolidated Framework for Implementation Research (CFIR 2.0) and Normalization Process Theory (NPT), and (3) examine associations between implementation degree and primary health care (Centre de Santé et de Promotion Sociale [CSPS]) performance. We use a sequential explanatory design (quantitative → qualitative) in 4 districts covering 72 CSPSs. Phase 1 involves a cross-sectional survey of all eligible health workers, facility managers, and community health workers (estimated 612 respondents nested within facilities) using CFIR- and NPT-informed questionnaires. Following psychometric validation (exploratory/confirmatory factor analysis; reliability assessment via Cronbach α and McDonald ω), we will fit multilevel models with CSPS random intercepts and district fixed effects to (1) quantify between-facility implementation variance, (2) test associations with CFIR and NPT determinants, and (3) examine relationships with CSPS performance indicators. Phase 2 involves purposive sampling of facilities with varying implementation profiles for interviews, focus groups, and observations, analyzed using reflexive thematic analysis to explain quantitative patterns. Ethics approval was obtained from Burkina Faso's National Ethics Committee (number 2023-06-136). The study was funded in June 2022 (Gates Foundation, Grant INV-056021) and is being conducted across 72 primary health care facilities in 4 districts (Manga, Sapouy, Ténado, and Ziniaré) in Burkina Faso. Qualitative data collection commenced in November 2025 and was completed in January 2026. Quantitative data collection took place from January 2023 to October 2025. As of May 2026, qualitative data collection was completed, and quantitative analyses had commenced. Psychometric analyses are underway. By addressing key evidence and measurement gaps in digital health implementation, this protocol will (1) generate context-specific guidance on implementing and institutionalizing a complex digital health ecosystem and (2) provide validated, ready-to-use instruments to quantify implementation at the CSPS level. Together, these outputs will help policymakers and program managers define and track "implementation success," informing-and accelerating-the scale-up and optimization of the MDE in resource-constrained settings.
To describe the association between severe intracranial hemorrhage or ischemia following pediatric in-hospital cardiac arrest (IHCA) and clinical outcomes. Retrospective cohort study. ICUs that participated in the ICU-RESUS (NCT02837497) trial. Children enrolled in ICU-RESUS with return of circulation following IHCA who had a head computerized tomography (CT) within 7 days of cardiac arrest. None. Radiology reports from CT scans post-IHCA were categorized for the presence ischemia and hemorrhage. The primary exposure was severe intracranial hemorrhage or ischemia, and the primary outcome was unfavorable neurologic outcome (defined as death or change in Pediatric Cerebral Performance Category ≥1 from baseline resulting in hospital discharge PCPC 4-5). Of the 1000 patients in ICU-RESUS with return of circulation, 180 had a CT, and 73 (40.5 %) had severe hemorrhage or ischemia. Patients with severe hemorrhage or ischemia had longer duration of CPR (33 [8-50] vs 12 [5-31] minutes, p < 0.001), more epinephrine doses (5 [2-14.5 vs 3 [2-8.5], p = 0.031), more often received eCPR (59 % vs 39 %, p = 0.010), had higher post-arrest lactate levels (mmol/L) (14.1 [9.3-19.6] vs 10.5 [6.3-15.3], p = 0.018) and lower post-arrest pH (7.1 [7-7.3] vs 7.2 [7.1-7.3), p = 0.003) than patients without severe hemorrhage or ischemia. Severe hemorrhage or severe ischemia was more common among patients with unfavorable compared to favorable outcome (56 % vs 21 %, p < 0.001). All 7 patients with severe hemorrhage and ischemia died. The presence of severe intracranial hemorrhage or ischemia on head CT within the first 7 days post-IHCA was associated with unfavorable outcomes, and all patients with both died. However, severe hemorrhage or ischemia post-IHCA is not always a poor prognostic feature, as some patients do survive with favorable neurologic outcome. Neuroimaging findings should be taken in context with the rest of a patient's clinical course and not in isolation.
The burden of viral co-infections among COVID-19 patients is underexplored in low-resource settings such as Burkina Faso. This study aimed to determine the prevalence and associated factors of respiratory viral co-infections among laboratory-confirmed COVID-19 patients. A cross-sectional study was conducted from January 1 to December 31, 2023, across 13 sentinel sites in Burkina Faso. Patients presenting with influenza-like illness or severe acute respiratory infection had nasopharyngeal and/or oropharyngeal swabs collected and tested for SARS-CoV-2 and other respiratory viruses using multiplex real-time RT-PCR. Descriptive statistics, univariate, and multivariate logistic regression analyses were performed to identify predictors of viral co-infections. Among 201 SARS-CoV-2-positive patients enrolled (median age: 1 year; interquartile range: 0.5-7). Co-infections was identified in 48.8% (95% CI: 41.8-55.6) of cases and a single co-infections was detected in 33.8% (95% CI: 27.5-40.6) of patients. Human rhinovirus (17.9%), adenovirus (14.4%), respiratory syncytial virus (11.4%), and influenza A/B (9.9%) were most frequently detected. In multivariate analysis, children aged 6 months to 14 years had higher odds of co-infection (aOR 2.7; 95% CI: 1.2-5.9; p = 0.013). Fever (aOR 2.6; 95% CI: 1.3-5.5; p = 0.008) and hospitalization (aOR 4.3; 95% CI: 1.6-12.0; p = 0.005) were also independently associated with co-infection. Viral co-infections were frequent among SARS-CoV-2 positive patients, particularly in children and hospitalized individuals. Strengthening multiplex diagnostic capacity and integrated respiratory virus surveillance in resource-limited settings may improve clinical management and inform public health response strategies.
Comprehensive Sexual and Reproductive Health and Rights (SRHR) knowledge is critical for reducing unintended pregnancies and sexually transmitted infections (STIs) among adolescents in low-resource settings. We assessed SRHR knowledge gaps among rural, out-of-school adolescents in Burundi and examined associations with intentions for safer practices (eg, condom use). We purposively sampled and surveyed 767 out-of-school adolescents aged between 10 and 19 years from the rural settings of Ngozi health district in northern Burundi examining their SRHR knowledge and practice. We employed the Rasch model of the Item Response Theory (IRT) to examine overall SRHR knowledge and by gender, assuming that the test was administered an infinite number of times and supplemented this model with a multiple linear regression to detect factors affecting knowledge. Determinants of intentions for safer sexual practice were investigated using logistic regression. First, although the test drew on basic SRHR skills, it appeared to be difficult for the study population. Indeed, participants needed a minimum underlying competence θ>2.4 on -4 to 4 scale (with θ>2.4 indicating in the IRT model high difficulty while average knowledge corresponds to θ≈0) to succeed the whole exam and θ>0 to attempt 14/15 questions. The most challenging topics related to condom use, menstruation versus pregnancy, contraception and STIs. Younger females had slightly better knowledge than males, but this has crossed over past 16 years. Second, SRHR knowledge was higher among adolescents who completed primary education and those whose parents or siblings are educated. Further, the long distance to a youth health centre and the lack of prior SRHR information decrease knowledge. Finally, adolescents who have higher SRHR knowledge are more likely to report intentions for safer sexual health practices. Rural and out-of-school adolescents have lower than expected SRHR knowledge. Those who have never heard about SRHR and those whose parents and/or siblings have lower or no education are worse off. SRHR knowledge determines intentions for sexual health behaviours (eg, condom use, seeking HIV testing). Tailored SRHR programmes for rural adolescents should address misconceptions on condoms/contraception.
Topoisomerases (Topo) are important targets in cancer chemotherapy due to their essential role in regulating DNA topology. Clinically used topoisomerase inhibitors, including poisons and catalytic inhibitors, produce anticancer effects by interfering with these processes. However, their long-term clinical use is often limited by drug resistance, cardiotoxicity, and myelosuppression, highlighting the need for safer and more effective alternatives. This review evaluates Topo II inhibitors at various stages of clinical development. Literature published between January 2020 and January 2026 was collected from PubMed, Scopus, Embase, Web of Science, ClinicalTrials.gov, and Google Scholar using relevant keywords. The article highlights recent advances in the design, structural optimization, and biological evaluation of small-molecule Topo II inhibitors reported over the last five years. Particular emphasis is given to the development of catalytic inhibitors and multitarget agents aimed at overcoming limitations associated with conventional topoisomerase inhibitors. The transition from traditional Topo poisons to catalytic inhibitors and multitarget compounds represents a promising strategy to reduce toxicity and address resistance. Integrating medicinal chemistry, computational modeling, and preclinical pharmacology may facilitate the development of safer, more selective, and clinically translatable Topo II inhibitors for cancer therapy.
Cervical cancer remains a major cause of morbidity and mortality in Nigeria despite being preventable through timely screening and vaccination. While awareness of cervical cancer is increasing, uptake of human papillomavirus (HPV) testing remains low due to structural and socioeconomic barriers. This study assessed the readiness and affordability of HPV-based cervical cancer screening among sexually active women in Gombe State, Nigeria. A cross-sectional study was conducted among 640 women attending gynecology and sexual health clinics across three levels of healthcare facilities. Data were collected from consenting participants, using a structured interviewer-administered questionnaire assessing socio-demographics, knowledge, attitudes, risk exposures, and willingness to pay for HPV testing. Descriptive statistics, Chi-square tests, and multivariable logistic regression were used for analysis. Overall, 91.6% of respondents expressed willingness to undergo HPV screening, yet actual uptake and HPV vaccination were extremely low (8.7% and 8.9%, respectively). While 82.6% identified HPV as a cause of cervical cancer, only 22.6% knew the eligible vaccination age. Self-sampling was preferred by 83.3% of respondents, and nearly all preferred female providers. None of the socio-demographic or risk factors significantly predicted willingness to screen (P > 0.05). Knowledge gaps, service unavailability, and affordability were major constraints. Despite high willingness, structural barriers and inadequate detailed knowledge hinder cervical cancer prevention in Gombe. Strengthening service availability, expanding self-sampling options, subsidizing HPV testing, and intensifying community education are essential to translate readiness into action and accelerate progress toward Health Organization cervical cancer elimination targets.
The extensive genetic diversity of HIV presents major challenges to treatment and prevention. We aimed to estimate the global and regional distribution of HIV-1 subtypes and recombinants during 1990-2024. We conducted a systematic literature review by searching PubMed, Embase, Global Health, and CINAHL for country-specific HIV-1 subtyping data published between Jan 1, 2022, and Jan 22, 2025, and a global survey of the Global HIV Molecular Epidemiology Collaboration for unpublished data collected between 2016 and 2024. We included primary HIV-1 subtyping data with ≥20 samples and known country and years of sample collection during 1990-2024. We excluded publications and survey responses that had no or incomplete subtyping data, were restricted to specific HIV-1 variants, included superinfections, or used secondary data. These data were combined with HIV-1 subtyping data previously collected between 1990 and 2021. Data were aggregated by country for six time periods (1990-99, 2000-04, 2005-09, 2010-14, 2015-19, and 2020-24). Proportions of HIV-1 subtypes, circulating recombinant forms (CRFs), and unique recombinant forms (URFs) were calculated by country and period and were weighted using UNAIDS country estimates of numbers of people living with HIV to estimate regional and global HIV-1 variant proportions. The systematic review is registered with PROSPERO, CRD42017067164. HIV-1 subtyping data were available for 1 395 222 samples from 154 countries during 1990-2024. In 2020-24, subtype C accounted for 48·7% (95% CI 48·3-49·1) of global HIV-1 infections, followed by subtype A (11·5%; 10·9-12·1), subtype B (10·3%; 10·0-10·5) URFs (5·3%; 4·4-6·3), CRF02_AG (5·1%; 4·5-5·8), CRF01_AE (5·1%; 4·8-5·4), other CRFs (3·9%; 3·3-4·5), subtype G (3·1%; 2·1-4·1), subtype D (3·0%; 2·7-3·3), and CRF07_BC (2·1%; 2·0-2·1). Subtypes F, H, J, K, and L combined accounted for 1·1% of infections and unspecified recombinants for 0·9% (0·7-1·0). HIV-1 variants are differentially distributed across regions, with subtype C dominating in southern Africa; Ethiopia, Eritrea, and Djibouti; and south Asia; subtype A in east Africa and eastern Europe and central Asia; subtype B in North America, Latin America, and western and central Europe; CRF01_AE in southeast Asia; and CRF07_BC in east Asia. Central Africa exhibited the greatest HIV-1 diversity. Global HIV-1 variant distributions were broadly stable during 2000-24, but notable regional changes included increases of HIV-1 recombinants in western and central Europe and of CRF07_BC in east Asia. Global and regional HIV-1 genetic diversity is complex and evolving, affecting the efficacy of diagnostic and viral load assays, emergence of drug resistance, and vaccine development. Continued surveillance of spatiotemporal trends in HIV-1 genetic diversity is essential. Nuffield Department of Population Health, University of Oxford, UK.
In light of the public health emergency brought about by the novel coronavirus, health authorities actively promoted vaccination against SARS-CoV-2. The COVID-19 pandemic has brought to the forefront critical questions concerning individual freedoms and the right to consent or decline vaccination. To better anticipate and manage future epidemics, it is essential to engage in thoughtful philosophical and ethical reflection-particularly regarding the legitimacy and implications of vaccine passport policies. This study aimed to assess COVID-19 vaccine acceptance and hesitancy in Sub-Saharan Africa, identify reasons for refusal, and examine the ethical legitimacy of imposing a "green pass" for vaccination for foreign travel. A meta-analysis was conducted from January 2021 to April 2025 in sub-Saharan African countries, in five databases (PubMed, Science Direct, Google Scholar, African Journal Online, and HINARI) to identify studies related to acceptance and hesitancy toward COVID-19 vaccines in the general population and among healthcare professionals. This study was registered under the PROSPERO database (CRD420251060375) and used the PRISMA guidelines. The "proportional effect size" of acceptance and hesitancy was calculated using a random-effects meta-analysis with STATA 17 software. Funnel plots and Egger's tests were used to assess publication bias. A total of 40 studies involving 107,478 participants across 23 African countries were included. The pooled rates of vaccine acceptance and hesitancy were, respectively: 54.73 [95 % CI: 50.54 %-58.89 %], and 34.96 % [95 % CI: 27.95 %-42.30 %]. Eastern Africa had the highest acceptance rate (60.44 %), and lower rate observed in West Africa (52.22 %). Reasons for hesitancy included misinformation, distrust of new vaccines, fear of side effects, suspicion of authorities, and opposition to mandatory vaccination certificates. The pandemic has brought to the fore fundamental issues relating to the right to accept or refuse vaccination. To prepare for the management of future epidemics, it is necessary to reflect on the ethics of requiring a vaccine passport.
The biocompatibility of restorative materials is critical due to their close contact with vital tissues. Resin-modified glass ionomer cements have been developed to improve mechanical properties; however, their cytotoxic effects remain controversial. In this study, five glass ionomer-based restorative materials with different formulations were tested: four resin-containing materials (Ionosit Baseliner, Nord Liner, Glass Line, and Ionoseal) and one conventional glass ionomer cement (Ketac Molar Easymix). A total of 35 samples (7 specimens for each material) evaluated with standardized discs (5 × 2 mm). Extracts were prepared according to ISO standards and applied to L929 mouse fibroblast cells at four concentrations (100%, 75%, 50%, 25%) for 24 and 48 h, and cell viability was assessed using the MTT assay. Absorbance was measured using a spectrophotometer at the appropriate wavelength. Cytotoxic responses varied depending on the material type, concentration, and exposure time. At 24 h and 100% extract concentration, the mean cell viability was 7.14% for Glass Line, 28.69% for Ketac Molar Easymix, 7.37% for Ionosit Baseliner, 86.96% for Nord Liner, and 83.61% for Ionoseal. After 48 h, the corresponding values ​​were 8.03%, 18.34%, 7.32%, 61.62%, and 55.78%, respectively. Glass Line and Ionosit Baseliner showed the highest cytotoxicity, while Nord Liner and Ionoseal showed relatively better cytocompatibility under the tested conditions. The cytotoxic responses of glass ionomer cements varied according to material composition, concentration, and exposure time. Among the tested materials, Nord Liner and Ionoseal demonstrated more favorable cell viability profiles under the tested in vitro conditions. These findings highlight the importance of material composition in restorative procedures performed close to pulp tissues.
Senegal has a high burden of hepatitis B virus (HBV); however, HBV molecular epidemiology is sparse, and coinfection with hepatitis delta virus (HDV) is poorly investigated. A blood donor panel was evaluated to characterize circulating HBV genotypes, HDV prevalence, and assess the performance of ultrasensitive HBsAg Next, HBV DNA, anti-HDV Total Ig, and HDV RNA diagnostic assays. Pre-screened, non-transfused specimens (n = 320) were tested for HBV and HDV biomarkers on the Alinity i platform. Comparator HBsAg testing was assessed with Elecsys HBsAg II. Specimens reactive for HBsAg and/or anti-HDV were tested for HBV DNA and HDV RNA. Specimens with sufficient viral load underwent next-generation sequencing. Phylogenetic inference was assessed with maximum likelihood trees and recombination analysis conducted on basal sequences. Testing revealed reactive results for HBsAg (87.2%), anti-HBc (92.8%), anti-HBs (6.9%), HBeAg (3.8%), and anti-HDV (1.3%). HBsAg Next Qualitative and Elecsys HBsAg II concordance was 311/319 (97.5%), with n = 8 (2.5%) samples not detected by Elecsys HBsAg II. Confirmatory testing verified HBsAg positivity for the 8 discordant specimens. Sequencing (n = 104) resulted in >70% genome coverage for n = 74 specimens and phylogenetic analysis identified HBV Quasi-subgenotype A3 (QSA3) (40.5%), A basal (1.4%), D (5.4%), E (52.7%), and 2 HDV GT5 genomes. Recombination analysis revealed two HBV QSA/E 3 recombinants. This study provides, to our knowledge, the first HBV sequences from Senegal in 20 years and highlights a predominance of genotypes E, QSA3, and notably two unique QSA3/E recombinants. The improved detection of HBsAg Next Qualitative on samples with low levels of HBsAg highlights the importance of ultrasensitive assays.
Non-communicable diseases (NCDs) are the leading cause of premature mortality in Africa, with Burundi facing a growing double burden of malnutrition effects: undernutrition and rising obesity rates. Despite recent policy efforts, including national strategies and increased health spending, the country's health system remains under-resourced and vulnerable to nutrition-related health challenges. This study aimed to assess the extent of implementation of public policies aimed at creating healthy food environments in Burundi using the Food Environment Policy Index (Food-EPI), and to identify policy gaps and priorities for addressing the double burden of malnutrition. From December 2022 to February 2024, the Healthy Food Environment Policy Index (Food-EPI) tool was used to benchmark 56 policy and infrastructure indicators against Good Practice Statements. Documentation was reviewed, and evidence was validated by a panel of 24 experts from government, academia, and civil society through two workshops. Experts scored the level of policy implementation using a five-point Likert scale and prioritized future actions based on importance, achievability, and effectiveness. Of the 56 indicators assessed, 27% were rated as "very little or no implementation" and 37% as "low implementation." Only 13% were rated as "high." Infrastructure support indicators generally scored higher than policy components. Thirteen indicators were not addressed in any existing policy documents. Experts identified 13 priority actions, seven of which aligned with WHO "double-duty actions." Inter-rater reliability was moderate (Gwet AC2 = 0.46). Significant policy gaps remain in Burundi's approach to improving food environments. There is an urgent need for comprehensive, multisectoral strategies to strengthen public health nutrition and reduce the impact of diet-related NCDs.
In the original publication [...].