Access to healthcare is a fundamental determinant of public health sustainability. Current literature on healthcare access tends to focus largely on vulnerable groups and objective indicators where access is defined through service utilization. When the literature on "perceived access to healthcare" is examined, it is observed that perceived access is generally treated as a determining factor explaining health outcomes or behaviors. However, the investigation of the socioeconomic, self-rated health, health literacy and spatial features that shape this perception itself within a holistic framework remains a less focused area in the literature. Methodologically, perceived access to healthcare is often defined with a limited number of variables or specifically within particular disease groups. Especially in regions such as Trabzon, where rugged topography and geographical barriers are intertwined with socio-cultural dynamics, analyzing the factors shaping the individual's perception of access within a comprehensive framework will offer a significant contribution to the literature. This study aims to integrate multidimensional factors -including socioeconomic status (SES), self-rated health, health literacy, health-seeking behavior, and travel time-into a comprehensive structural framework for the first time in the literature; to validate their effects through Structural Equation Modeling (SEM), and to uncover the spatial dependence patterns in access. This reearch was conducted with 1,491 adults. Data were analyzed using Structural Equation Modeling (SEM) to evaluate multidimensional pathways, and geospatial analysis was performed to determine spatial dependence patterns. The results of the research demonstrate that health literacy and professional health-seeking behavior are the primary elements strengthening the perception of access, whereas online health-seeking and increased travel time weaken this perception. One of the most original findings of the study is that the direct negative effect of SES on access is balanced through health literacy; this indicates that cognitive capacity can mitigate socioeconomic disadvantages. Spatial models confirm that while the general perceived access to healthcare is shaped by personal factors, the "accessibility" dimension exhibits a spatial dependence tied to local topography within a 1-km radius. Consequently, these findings scientifically support that health planning should shift from macro-scale strategies toward micro-spatial interventions aimed at minimizing physical barriers at the neighborhood and street levels. Integrating approaches that improve health literacy with interventions that minimize travel barriers will play a fundamental role in reducing health inequalities.
Diagnostic delay in axial spondyloarthritis (axSpA) worsens outcomes and increases costs, yet evidence from low-resource settings is scarce. We aimed to quantify diagnostic delay in Palestine and test the hypothesis that referral pathway and socioeconomic factors are independently associated with prolonged delay. We conducted a cross-sectional study (July-November 2024) across rheumatology clinics in the West Bank. Adults fulfilling ASAS criteria for axSpA were enrolled via structured interviews. Diagnostic delay was defined as years from symptom onset to confirmed diagnosis. Non-parametric tests and Spearman correlations explored univariable associations. Prolonged delay was prespecified as ≥ 6 years and evaluated using multivariable logistic regression. Exploratory patient phenotypes were derived with Partitioning Around Medoids clustering. Seventy-nine patients were included (73% male; mean age 43.0 ± 12.2 years). Mean diagnostic delay was 6.37 ± 5.8 years (median 5). On univariable analyses, longer delay was associated with older age, lower education, low income, first contact with a general practitioner (GP), HLA-B27 negativity/unknown status, and absence of reduced spinal mobility. In multivariable models, GP first contact independently increased the odds of prolonged delay (OR 3.69, 95% CI 1.04-13.11; p = 0.044), while reduced spinal mobility was associated with shorter diagnostic delay (OR 0.16, 95% CI 0.03-0.70; p = 0.016). Clustering identified three diagnostic phenotypes; the longest delays occurred among patients with low education/income and GP-first referral. Palestinian patients with axSpA experience an average diagnostic delay exceeding six years, comparable to global estimates. Referral pathway is the principal modifiable barrier, whereas overt clinical signs (reduced spinal mobility) may trigger earlier recognition. Targeted GP education, streamlined referral protocols, and improved access to HLA-B27 testing are priorities for reducing delay in low-resource settings. Key Points • General practitioner referral was the strongest independent barrier to timely diagnosis, increasing the odds of prolonged delay more than threefold. • Reduced spinal mobility was associated with shorter delay, suggesting that overt physical findings facilitate earlier recognition and referral. • Socioeconomic disadvantage and HLA-B27 negativity were linked to longer delays in univariable analyses but lost significance after adjustment, indicating that healthcare system factors outweigh individual characteristics. • This first national study from Palestine underscores the need for GP education, accessible rheumatology pathways, and early use of HLA-B27 testing to shorten diagnostic delay in low-resource settings.
Highly pathogenic avian influenza (HPAI) viruses, particularly subtypes such as H5N1 and H7N9, have caused widespread outbreaks in wild birds, poultry, livestock and occasionally humans, raising concerns about cross-species transmission and pandemic potential. Effective control and surveillance strategies require a thorough understanding of HPAI transmission dynamics, which can be supported by mathematical modelling. This scoping review aimed to identify mechanistic models used to study HPAI transmission. Specifically, we sought to categorize model types, describe their application contexts (e.g., wild birds, poultry, livestock, and humans), and highlight modelling gaps relevant to understanding and mitigating the risks of HPAI spread. Following PRISMA guidelines and the PRISMA extension for scoping reviews (PRISMA-ScR), we conducted systematic searches of PubMed and Web of Science to identify peer-reviewed studies employing deterministic and stochastic models to analyze HPAI transmission. Eligible articles published between January 2023 and June 2025 were screened and grouped by model structure, host populations, transmission pathways, and modelling objectives. After screening, 30 studies published after 2023 were included in this scoping review. Compartmental models were the most common (26 studies), with 16 deterministic and 10 stochastic approaches. These models were primarily used to describe transmission among wild birds, poultry, livestock, and humans and to evaluate interventions such as culling, vaccination, and movement restrictions. Agent-based models (2 studies) captured individual-level interactions and spatial heterogeneity, while network models (2 studies) represented contact structures and transmission pathways between farms or species. Currently, mechanistic modelling of HPAI is dominated by compartmental approaches, including both deterministic and stochastic formulations, whereas agent-based and network models remain relatively underused. Although most studies focus on transmission in wild birds and poultry, and in some cases spillover infections to humans, few explicitly examine infection dynamics in livestock or in transmission between livestock and humans, despite the importance of livestock (e.g., cattle) as potential intermediaries in human infection. Key gaps persist in the integration of empirical data, representation of multi-host interactions, and evaluation of realistic intervention strategies. Addressing these limitations is essential to improve predictive accuracy and to strengthen the role of modelling in informing HPAI surveillance and control.
Among the Hemiptera insects, a widespread way of feeding is sucking sap from host plants. Due to their nutrient-poor diet, these insects enter into obligate symbiosis with their microorganisms involved in the synthesis of components essential for host survival. However, within the Cicadellidae family, there is a relatively large group of mesophyll feeders-Typhlocybinae-that is considered to be devoid of obligate symbiotic companions. In this work, we examine the composition of microorganisms in this subfamily and compare the results with their close relatives-the Eurymelinae subfamily. To study the microbiome, we used high-throughput next-generation sequencing (NGS, Illumina) and advanced microscopic techniques, such as transmission electron microscopy (TEM) and fluorescence in situ hybridization (FISH), in a confocal microscope. In the bodies of Typhlocybinae insects, we did not detect the presence of microorganisms deemed to be obligate symbionts. Their microbial communities consist of facultative symbionts, mainly alphaproteobacteria such as Wolbachia or Rickettsia as well as others that can be considered as facultative, including Spiroplasma, Acidocella, Arsenophonus, Sodalis, Lariskella, Serratia, Cardinium, and Asaia. On the other hand, the Eurymelinae group is characterized by a high diversity of microbial communities, both obligate and facultative, similar to other Cicadomorpha. We find co-symbionts involved in the synthesis of essential amino acids such as Karelsulcia, betaproteobacteria Nasuia, or gammaproteobacteria Sodalis. In other representatives, we observed symbiotic yeast-like fungi from the family Ophiocordycipitaceae or Arsenophonus bacteria inhabiting the interior of Karelsulcia bacteria. Additionally, we investigated some aspects of symbiont transmission and the phylogeny of symbiotic organisms and their hosts. The Typhlocybinae and Eurymelinae leafhoppers differ significantly in their symbiotic communities. They have different diets, as Typhlocybinae insects feed on parenchyma, which is richer in nutrients, while Eurymelinae, like most representatives of Auchenorrhyncha, consume sap from the phloem fibers of plants. Our work presents comprehensive studies of 42 species belonging to the two above-mentioned, and so far poorly known, Cicadomorpha subfamilies. Phylogenetic studies indicate that the insects from the studied groups have a common ancestor. The diet shift in the Typhlocybinae leafhoppers contributed to major changes in the composition of microorganisms inhabiting the body of these insects. Research on the impact of diet on the microbiome and the subsequent consequences on the evolution and adaptation of organisms plays an important role in the era of climate change.
The H5N1 avian influenza A virus represents a serious threat to both animal and human health, with the potential to escalate into a global pandemic. Effective monitoring of social media during H5N1 avian influenza outbreaks could potentially offer critical insights to guide public health strategies. Social media platforms like Reddit, with their diverse and region-specific communities, provide a rich source of data that can reveal collective attitudes, concerns, and behavioral trends in real time. This study aims to analyze Reddit comments from state-specific subreddits in the United States from the most recent outbreak period of 2022 to 2024 to (1) assess the sentiments expressed as the H5N1 outbreak progresses; (2) identify predominant topics discussed, particularly those corresponding to negative sentiments; and (3) explore correlations between these sentiments or topics and the severity and spread of the outbreak in respective regions. We collected 2152 Reddit comments from 160 subreddits across 11 highly impacted states from February 2022 to July 2024. Outbreak data comprising almost 600 entries were obtained from the US Department of Agriculture database. Sentiment classification was performed using a fine-tuned Bidirectional Encoder Representations From Transformers (BERT) base model, and comments were categorized into 6 emotions: anger, fear, joy, love, sadness, and surprise, with a seventh "neutral" category added for low-confidence classifications. Topic modeling was conducted using BERTopic and latent Dirichlet allocation models. Statistical analyses included calculating correlations between sentiment intensity and outbreak severity levels and applying the Mann-Whitney U test to assess differences between sentiment categories. The findings illustrate that H5N1 unfolded in mostly discrete national waves and that only a subset of states-Minnesota and Iowa-experienced chronic, multiwave exposure, a pattern obscured in national aggregates. Sentiment intensity scoring revealed that although 90% (n=1931) of discourse was negative, emotions differed in how they tracked the epidemic: fear aligned weekly with real-time case counts (r=0.11), whereas anger, sadness, and even joy surged 3 weeks after the outbreak (r=0.20-0.24 after the lag was considered). When both the 3-week lag and an outlier month in terms of outbreak cases were adjusted for simultaneously, those associations strengthened further (overall r=0.223), showing how delayed reactions and anomalous surges can mask true sentiment-epidemiology links if left uncorrected. This defines the window in which risk communicators can pre-empt misinformation and economic anxiety. Topic modeling uncovered recurring themes of concern: avian flu culling, sharp egg-price hikes, and frustration over prolonged biosecurity measures. BERTopic provided more coherent and locally specific topics than latent Dirichlet allocation. Overall, these results underscore the critical role of social media analysis in understanding public reactions, including prevalent themes and sentiments, and guiding timely, targeted public health interventions during the H5N1 outbreak.
The effectiveness of hydroxyapatite (HAP) toothpastes in remineralizing initial caries and preventing caries development has been well-established. Calcium hypophosphite (CaP) is a calcium compound that readily dissolves in water providing calcium ions, and as such can promote remineralization. The present study investigated the potential of CaP to enhance the caries remineralizing capacity of HAP-containing toothpaste. 120 bovine tooth blocks were randomly assigned to four toothpaste groups (30/group) containing either 20% HAP, 20% HAP + 1% CaP, 1% CaP, or 1450 ppm fluoride (NaF). Blocks were subjected to 4-day demineralization by plaque growth in a mixed-species microbial caries model for development of initial caries lesions. The lesion-bearing blocks were subjected to remineralization by daily pH cycling consisting of three 2-minute toothpaste treatments, a 2-hour acidic challenge, and then storage in artificial saliva for the rest of the time for 14 days. Toothpastes were homogenized with water (1 toothpaste:3 water) and applied as slurry. Remineralization was measured as a change in mineral density (MD) of the lesions before and after treatment, measured using microcomputed tomography (µCT). Percentage change in MD (percentage remineralization [%Rem]) in each group was calculated. Intra-group (paired t-test) and inter-group (ANOVA/Tukey's test) comparisons were conducted (α = 0.05). Paired t-test indicated significant difference (p<.001) between pre-treatment and post-treatment MD in all groups demonstrating remineralization. Intergroup comparison based on their %Rem using ANOVA/Tukey's test showed that 20% HAP + 1% CaP (95.7 ± 3.26) had significantly (p<.001) higher %Rem than 1450 ppm fluoride (67.3 ± 7.81), 20% HAP (69.4 ± 4.79), and 1% CaP (80.4 ± 5.49). All other compared groups, except 1450 ppm fluoride vs. 20% HAP, differed significantly (p<.001). The present study shows that the addition of CaP to a HAP-containing toothpaste significantly enhanced the effectiveness of the HAP to remineralize initial caries. It further demonstrates that CaP alone effectively remineralizes caries lesions.
The COVID-19 pandemic exacerbated mental health issues, particularly in vulnerable communities. Non-psychiatric interventions, including psychological emotional regulation, contemplative practices, and physical activity, can be powerful tools for improving mental health, especially in vulnerable populations. The present study evaluates the effect of a novel low-cost Socioemotional and Physical Activity Intervention in a Brazilian large vulnerable community during the pandemic's final period. Participants were adults (18 to 60 years of age) that resided in the Paraisópolis, the third largest favela in Brazil. Recruitment was done through advertising via mobile messaging. Participants were divided into two groups, Intervention (Group I) or Waiting List Control (Group C). Group I participants underwent an in-person Multidimensional Intervention of 1 h per week, for 12 weeks, which was composed of socioemotional skills learning and moderate physical activities, while Group C maintained their usual daily routines. All participants were evaluated before (T0) and after (T1) the Intervention. The evaluation included four validated questionnaires to assess mental health (DASS-21, PANAS, WHO-5 and BRS), IPAQ for evaluating physical activity levels and a physical fitness assessment, which provided quantitative data. A semi-structured interview was also done, which provided qualitative data and was analyzed using a reflexive thematic analysis. Quantitative data was collected from 88 participants, 43 from Group I and 45 from Group C. We observed a reduction in the scores for depression (DASS-21; Mean difference between evaluations [MD] = -3.2 [± 1.13, SEM], p = 0.006) and negative affects (PANAS, MD = -2.7 [± 0.97], p = 0.012) observed only in the participants of the I group in T1 compared to T0, but not for the C group. We also found a reduction in systolic arterial blood pressure in hypertensive or pre-hypertensive participants after exercise (Group I n = 28; -7.0 [± 2.8] mmHg, p = 0.014), an increase in physical endurance (walk test, MD = +56.0 [±8.7] m, p < 0.001) and flexibility (sit and reach test, MD = +5.12 [±0.85] cm, p < 0.001) only in the I group on T1, compared to T0. The reflexive thematic analysis results suggest that the Intervention not only alleviated negative emotional states, such as anxiety and sadness, but also provided a notable enhancement in participant's physical vitality, corroborating and complementing the quantitative analysis results. The results presented here indicate that the Intervention presented here has the potential to reduce symptoms correlated with mental disorders and improve physical fitness in residents of a large vulnerable community.
To evaluate the smear layer removal ability, dentin mineral alteration, and dentinal tubules penetration of an ethyl acetate fraction (FEA) of Salvadora persica (Miswak) at 5 mg/mL, used alone and in combination with 1.25% sodium hypochlorite (NaOCl), compared with saline, 2.5% NaOCl, and EDTA. Forty human single-rooted premolars extracted for orthodontic purposes were prepared using rotary instrumentation. Specimens were randomly allocated into four groups (n = 10): saline (negative control), FEA miswak (5 mg/mL), FEA miswak + 1.25% NaOCl, and EDTA (positive control). Smear layer removal was evaluated using scanning electron microscopy (SEM) with a four-grade ordinal scoring system, and dentinal mineral content was analyzed using energy-dispersive X-ray spectroscopy (EDX). Dentinal tubule penetration was assessed by crystal violet bleaching depth. Statistical analysis was performed using the Kruskal-Wallis test with post-hoc comparisons for smear layer scores and one-way ANOVA with Bonferroni correction for penetration depth. Significant differences were observed among irrigation groups in smear layer removal (p < 0.05). The FEA miswak + NaOCl group showed smear layer scores comparable to EDTA (p > 0.05), while FEA miswak alone performed significantly better than saline. Dentinal tubules penetration differed significantly between groups (p < 0.05), with mean penetration depths (µm) as follows: Saline at 84.55 ± 33.71 μm, 2.5% NaOCl at 163.82 ± 32.92 μm, FEA miswak + NaOCl at 201.39 ± 24.61 μm, and FEA miswak alone at 212.71 ± 37.76 μm. No significant differences were found between NaOCl, FEA miswak, and FEA miswak + NaOCl (p > 0.05). The FEA miswak, particularly when combined with low-concentration NaOCl, demonstrated smear layer removal comparable to EDTA and enhanced dentinal tubules penetration, with minimal mineral alteration. Conventional root canal irrigation requires multiple solutions, is time-consuming, and risks dentin over demineralization. This study addresses the clinical need for simplified, multifunctional irrigants that maintain efficacy while preserving dentin integrity. The FEA miswak + low-concentration NaOCl combination offers translational potential as a single-dose root canal irrigant, potentially reducing chair time and adverse tissue effects in endodontic practice.
Nigeria has a population of 233 million people and high rates of adolescent motherhood. Reduction of adolescent motherhood is a priority and primarily aligns with the sexual and reproductive health target (indicator 3.7.2) in the specific United Nations Sustainable Development Goals (SDGs). This study examined the trends and social disparities of health impacting adolescent motherhood at the state level. The study analysed 24 668 adolescent females aged 15-19 years, drawn from 36 states and the Federal Capital Territory (FCT) using four Nigerian Demographic and Health Surveys (2003-2018). This study estimated the population-weighted prevalence of adolescent motherhood and employed the average annual rate of change (AARC) to compute the state-level trends in the prevalence. The normalised concentration index was also used to understand the sociodemographic inequalities. The national prevalence of adolescent motherhood is 18.73%, with substantial variation in AARC and a normalised concentration index across states in different geopolitical zones. The highest prevalence of adolescent motherhood was observed in Bauchi State in the North-East at 40.65%, while the lowest was in Lagos in the South-West at 1.1%. The AARC in Bauchi was +1.7%, while in Lagos it was reported at -9.96%. Out of the 36 states and FCT, 15 (40.5%) either experienced an increasing prevalence of adolescent motherhood (29.7%) or a slow decline (10.8%) while 22 (59.5%) showed progress. With respect to the distribution of adolescent motherhood, most of the high-burden states had a negative normalised concentration index for wealth (92%), education (92%) and area of residence (72%). Moreover, highly statistically significant variations were observed between high-burden states in the North and low-burden states in the South for wealth, education, rurality, child marriage, age at first child and polygyny. Adolescent motherhood remains persistently high in Nigeria, particularly in the northern part of the country, due to early marriage, intergenerational poverty and a lack of education. This necessitates scaling up state-specific health education programmes targeting adolescent girls in schools and government policy, enforcing the legal age of marriage to achieve the SDG 3.7.2 target.
Less is known about recovery from hip fracture in men. We found differences in 25-hydroxyvitamin D and bone biomarkers between men and women during the year after hip fracture, underscoring the importance of vitamin D assessment in older men and pharmaceutical treatment to reduce bone resorption after hip fracture. Less is known about recovery from hip fracture in men compared to women. We examined differences between men and women in 25-hydroxyvitamin D (25OHD) and bone turnover markers, and associations with bone mineral density (BMD) and physical function, during the year after a hip fracture. Community-dwelling, ambulatory adults aged 65 years and over (157 men and 154 women) enrolled in the Baltimore Hip Studies 7th cohort were included. We analyzed 25OHD, C-terminal telopeptide (β-CTX-I), procollagen type I N-terminal propeptide (PINP), PTH, and femoral neck BMD at baseline, 2, 6, and 12 months after hip fracture, and short physical performance battery (SPPB) at 2, 6, and 12 months. During admission for hip fracture, median 25OHD levels were 15.2 ng/mL (IQR 10.0) in men compared with 23.9 ng/mL (IQR 13.4) in women and remained lower in men at 2, 6, and 12 months (all p < 0.001). β-CTX-I was higher in men on admission, and at 2 and 6 months (all p < 0.05), and PINP was higher in men at 6 months (p = 0.04), with no significant differences between men and women in PTH. Higher 25OHD and PINP concentrations in women only and lower β-CTX-I and PTH concentrations in both sexes were associated with greater BMD. Higher 25OHD concentrations were associated with higher SPPB scores in both sexes. These findings underscore the importance of vitamin D assessment in older men and missed opportunities in both sexes for vitamin D supplementation and pharmaceutical treatment to reduce bone resorption after hip fracture.
The impact of socio-economic factors on abdominal aortic aneurysm (AAA) rupture are poorly understood at a geospatial level, but they are important considerations in the targeted distribution of preventive resources such as screening and treatment. This study aimed to map the nationwide geospatial distribution of AAA ruptures in Aotearoa New Zealand and to analyse associations with socio-economic factors. A nationwide, retrospective, geospatial analysis of all AAA ruptures between January 2000 and December 2019 in Aotearoa New Zealand was performed using national registry mortality and hospitalisation data within a Bayesian framework. Standardised incidence ratios (SIRs) of AAA rupture were calculated for populations grouped by socio-economic factors (deprivation, ethnicity, and urban accessibility). Geospatial analysis was performed using Bayesian Poisson regression modelling to provide smoothed estimates of AAA rupture incidence at the small community level. The association between rupture incidence and small area level smoking rates, Māori population proportion, urban accessibility, and socio-economic deprivation (SED) was examined through geospatially linked data. Over the 20 year study period, 5 942 fatal and non-fatal AAA ruptures were identified. High AAA rupture incidence was geospatially clustered into persistent hotspots. SED (coefficient 3.39, 95% credible interval [CrI] 2.38 - 4.49) and smoking prevalence (coefficient 1.14, 95% CrI -0.03 - 2.27) were associated with increased AAA rupture incidence and this was persistent over the study, despite the AAA rupture incidence falling from 1.05/1 000 person years (95% CrI 0.60 - 1.85) in 2000 - 2006, to 0.65/1 000 person years (95% Crl 0.38 - 1.13) in 2013 - 2019. SIRs were elevated in socio-economically deprived, Māori, and rural communities. AAA rupture is clustered into geographically defined and persistent high risk communities in Aotearoa New Zealand. High deprivation communities bear an excess burden of AAA rupture, as do the indigenous Māori population, consistent with entrenched health inequities following colonisation. This should inform the management and implementation of AAA screening and treatment.
with the increasing prevalence of refractive surgery, its impact on intraocular pressure (IOP) measurement has gained significant attention. This study aimed to elucidate the mechanism by which femtosecond laser-assistedin situkeratomileusis (FS-LASIK)-induced geometric alterations of the cornea affect IOP measurements obtained with the Goldmann applanation tonometer (GAT). IOP was measured with the GAT in patients undergoing FS-LASIK preoperatively and at 3 and 6 months postoperatively. A corneal finite element (FE) model, including aqueous humor for both pre- and post-operative states, was created to simulate the surgical volume required for correcting myopia of -2, -4, and -6 diopters (D). IOP values were calculated based on the principle of the GAT, and FE simulation results were compared with clinical IOP data measured using the GAT to validate the model. Clinical data from GAT measurements demonstrated a consistent decrease in IOP following surgery. FE results indicated that the postoperative IOP, ranging from 8.26 mmHg to 13.04 mmHg, decreased by 23%-51% compared to the preoperative IOP of 17.04 mmHg. Deeper ablation depths and larger optical zone diameters were associated with lower postoperative IOP. The FE analysis demonstrated a decreasing trend in postoperative IOP with increasing ablation depth and optical zone diameter. These findings provide valuable insights for guiding postoperative IOP monitoring, optimizing surgical parameters, and understanding postoperative corneal biomechanical behavior.
Avian influenza viruses (AIVs) of the H5, H7, and H10 subtypes pose substantial threats to global public health owing to their high pathogenicity, cross-species transmissibility, and potential to spark epidemics. Rapid and accurate detection is essential for outbreak control and zoonotic risk mitigation. Here, we report the development of a multiplex lateral flow immunoassay (LFA) based on core-shell upconversion nanoparticles (UCNPs) conjugated with subtype-specific monoclonal antibodies targeting the haemagglutinin proteins of H5, H7, and H10 AIVs. The assay achieved limits of detection of 0.0313, 0.0156, and 0.0625 ng/mL for recombinant HA proteins and 2-4, 2-4, and 2-3 haemagglutination units for viral titres of H5, H7, and H10, respectively. No cross-reactivity was observed with other AIV subtypes or respiratory pathogens, and intra- and inter-assay variation remained below 6%, demonstrating high specificity and reproducibility. Validation with 135 avian and 125 human clinical samples showed complete concordance with real-time RT-PCR results. Integration with a smartphone-based analytical platform enabled rapid readout, automated quantification, and cloud-based data sharing, providing results within 10 min. This intelligent UCNPs-LFA system combines ultra sensitivity, multiplexing, and field-deployable usability, representing a significant advance over conventional methods. By enabling timely and reliable detection of H5, H7, and H10 AIVs in both animal and human samples, this platform offers a practical tool for early warning, surveillance, and control of emerging zoonotic influenza, thereby contributing to global preparedness against avian influenza outbreaks.
Tumors exhibit impaired blood flow and hypoxic areas, which can reduce the effectiveness of treatments. Characterizing these tumor features can inform treatment decisions, including the use of vasculature modulation therapies. Imaging provides insight into these characteristics, with techniques varying between clinical and preclinical settings. To investigate changes in different tumor regions over time, R2* values from blood oxygen-level dependent MRI (BOLD-MRI), blood flow from power Doppler ultrasound, and oxygen saturation from photoacoustic ultrasound were analyzed and compared to CD31+ and pimonidazole tissue staining. To aid in preclinical translation, the fluorescence of a hypoxia probe was also compared to ultrasound techniques. The imaging techniques detected tumor heterogeneity and an overall decrease in blood flow and oxygen levels over time. The analysis found varying correlations between regions, indicating an indirect relationship between imaging outcomes, which is influenced by external factors. Regional analysis allowed for more accurate results, as areas less affected by various factors were examined separately from highly impacted regions, aiding in their identification. Examining tumor regions with multiple imaging techniques allowed for better understanding and identification of modality-specific limitations, as certain techniques may incorrectly suggest that tumors are more vascularized and less hypoxic than they are.
Acute kidney injury (AKI) is a common and severe complication of COVID-19, which significantly increases the risk of mortality. There has been a wide range of AKI prevalence reported throughout the pandemic, reflecting differences in geographic location, patient characteristics, and health care resources. We aimed to provide a global overview of the COVID-19 AKI prevalence reported in published studies to uncover geographic and socioeconomic disparities. We undertook a systematic review and meta-analysis, searching PubMed, Embase, Scopus, Web of Science, and Cochrane Library for full-text articles published in English reporting the prevalence of AKI from January 2020 to November 2023. All studies defined AKI according to the Kidney Disease Improving Global Outcomes criteria. Clinical characteristics were extracted and examined from 334 studies that met the inclusion criteria. With significant study heterogeneity, random-effect models were estimated. We reported pooled AKI prevalence by country, region, and income level. Meta-regression further examined the relationship between COVID-associated AKI and geographic location. After removing studies that utilised the same data, 345 796 patients from 246 studies were included, covering 49 countries. Of 246 studies, 137 came from high-income countries, whereas only three were conducted in low-income countries. Among non-intensive care unit (ICU) patients, low-income countries had the lowest COVID-19 AKI prevalence (14.1%; 95% confidence interval (CI) = 11.4-17.2). Among ICU patients, lower-middle-income countries had the lowest COVID-19 AKI prevalence (27.9%;95% CI = 19.4-38.4). Our study shows significant geographic and socioeconomic disparities in the prevalence of COVID-associated AKI, with a higher prevalence in high-income countries and a lower prevalence in low- and lower-middle-income countries. This study is the most comprehensive systematic review and meta-analysis highlighting global disparities in COVID-associated AKI prevalence. Further studies are needed to explain the reasons behind these differences.
To examine how cancer mortality in Chile varied across a continuous rurality gradient and to identify territorial differences in mortality risk and temporal trends. We analyzed cancer deaths in 343 continental municipalities between 2002 and 2022. A continuous Index of Relative Rurality was constructed using indicators of population concentration and spatial accessibility. Municipal mortality was modeled using Bayesian spatiotemporal models adjusted for age and sex. Exploratory analyses of the rurality gradient identified a threshold with a change in mortality-risk patterns, which was used to compare trajectories. A clear inflection in the mortality-rurality relationship emerged around an index value of 0.30, separating two territorial mortality profiles. Mortality declined nationally but reductions were slower in more rural municipalities. Cancers historically linked to structural disadvantage-such as stomach, gallbladder, and cervical cancer-showed higher mortality risks in more rural areas. In contrast, breast, lung, and colorectal cancers showed higher risks in less rural municipalities. Several cancers, including colorectal, lung, kidney, and bladder, also displayed less favorable temporal trends in more rural territories. Distinct trajectories along the rural-urban continuum reveal territorial inequalities that may remain hidden in national averages. These findings support targeting prevention efforts to higher-risk territories.
To investigate the prevalence of Relative Energy Deficiency in Sport (REDs) in elite adult team ball sport athletes and critically evaluate the methods used to assess prevalence. Systematic review. Six databases were searched in October 2024 for original articles published in English from 2005 onwards. Eligible studies measured prevalence of REDs, low energy availability (LEA), or the Triad in elite team ball sport athletes aged ≥18 years. Fourteen studies met the eligibility criteria (n = 2 case; n = 2 longitudinal; n = 10 cross-sectional), including 265 athletes representing 12 team ball sports. The 12 included cross-sectional and longitudinal studies used six different methods to identify REDs/LEA prevalence as 0-80 %. Seven studies used energy availability calculations, identifying clinical LEA (<30 kcal·kg FFM-1·day-1) in 26.3-63.6 % of athletes. The LEA in Females Questionnaire identified LEA in 29.6-80.0 % of participants across 4 studies. Two studies evaluated REDs via blood/salivary markers, with low total-testosterone in 0-36.4 % of participants. One study found 50 % with low free-testosterone, 9.1 % with low free-T3, and 13.6 % with elevated LDL cholesterol. The REDs Specific Screening Tool identified 33.3 % of athletes in one study at medium risk of REDs. The Exercise Dependence Scale and Eating Disorder Examination Questionnaire were distributed in combination in one study, finding prevalence of REDs in 4.3 % and 25.5 % of participants, respectively. REDs appears ubiquitous in elite team ball sports, but research remains limited. A criterion approach for evaluating REDs/LEA prevalence is needed for accurate, reliable, and consistent reporting and cross-study comparisons.
Following confirmation of the first case of the ongoing U.S. HPAI H5N1 epizootic in commercial poultry on February 8, 2022, the virus has continued to devastate the U.S. poultry sector and the pathogen has since managed to cross over to livestock and a few human cases have also been reported. Efficient outbreak management benefits greatly from timely detection and proper identification of the pathways of virus introduction and spread. In this study, we used changes in mortality rates as a proxy for HPAI incidence in a layer, broiler and turkey flock together with diagnostic test results to infer within-flock HPAI transmission dynamics. Mathematical modeling techniques, specifically the Approximate Bayesian Computation algorithm in conjunction with a stochastic within-flock HPAI transmission model were used in the analysis. The time window of HPAI virus introduction into the flock (TOI) and the adequate contact rate (ACR) were estimated. Then, using the estimated TOI together with the day when the first HPAI positive sample was collected from the flock, we calculated the most likely time to first positive sample (MTFPS) which reflects the time to HPAI detection. The estimated joint (i.e., all species combined) median of the MTFPS for different flocks was six days, the joint median most likely ACR was 6.8 newly infected birds per infectious bird per day, the joint median R0 was 13 and the joint median number of test days per flock was two. These results were also grouped by species and by epidemic phase and discussed accordingly. We conclude that this findings from this and other related studies are beneficial for the different stakeholders in outbreak management. We recommend that combining TOI analysis with complementary approaches such as phylogenetic analyses is critically important for improved understanding of disease transmission pathways. The estimated parameters can also be used to parametrize mathematical models that can guide the design of surveillance protocols, risk analyses of HPAI spread, and emergency preparedness for HPAI outbreaks.
BACKGROUND: Type 2 diabetes prevalence is increasing globally and is unequally distributed across socioeconomic groups. In Germany, little is known about how these socioeconomic inequalities have developed over time. Therefore, we aimed to estimate the age- and sex-specific prevalence of type 2 diabetes in Germany from 2011 to 2023 and assess related temporal trends in socioeconomic inequality. METHODS: We used nationwide claims data (N ~ 70 million persons per year) from the German statutory health insurance, aggregated at the county level and linked them to the German Index of Socioeconomic Deprivation (GISD), an area-based measure of deprivation based on education, occupation, and income. We identified prevalent type 2 diabetes cases using ICD-10 codes E11, E12, E13, and E14. Log-binomial regression was used to estimate prevalence ratios for the association between GISD quintiles and type 2 diabetes prevalence, with temporal trends assessed through the four-way interaction between age, sex, GISD, and calendar year. RESULTS: Crude type 2 diabetes prevalence increased from 9.00% (95% confidence interval: 8.99–9.01) in 2011 to 9.60% (9.59–9.61) in 2023, while age-standardised prevalence showed a smaller increase, from 9.00 (8.99-9.00) in 2011 to 9.35% (9.34–9.35) in 2023. A clear socioeconomic gradient emerged, with the highest prevalence of 11.80% (11.78–11.82) in 2023 in the most deprived regions (quintile 5), compared to 8.00% (7.99–8.01) in the least deprived regions (quintile 1). Prevalence was consistently higher in men than women, but the socioeconomic gradient was more pronounced among women (prevalence ratio 2023 women 1.29 (1.23–1.35), men 1.22 (1.17–1.26)). CONCLUSIONS: Our findings highlight persistent socioeconomic disparities in type 2 diabetes prevalence, especially among women. Further research is needed to explore the mechanisms underlying these disparities and to evaluate targeted interventions for high-risk populations.
Telemedicine usage surged during the COVID-19 pandemic, shaping how patients access healthcare services. Its sustained role in post-pandemic healthcare may uncover long-term trends and variations in utilization. To characterize telemedicine utilization from 2019 to 2024 and identify patient characteristics associated with telemedicine use. This retrospective cohort study analyzed outpatient visits across five hospitals within the University of Pennsylvania Health System (Penn Medicine) from January 1, 2019, to September 30, 2024. The primary outcome was whether each outpatient encounter was conducted via telemedicine (vs in-person). We used multivariable logistic regression clustering on patients to assess associations between telemedicine use and patient- and encounter-level characteristics, including demographics, insurance, patient portal use, income, clinical comorbidity, distance from care, provider specialty, encounter type, hospital index, and visit year. The study included 46,149,734 visits among 2,248,341 patients. Telemedicine surged from 1% of visits pre-pandemic to 17% in April 2020, stabilized at 8-13% through late 2020, and remained 4-6% from 2022 to 2024. Telemedicine use was lower among older adults (aOR 0.67 for ages 40-64; 0.47 for ≥ 65 vs. < 40 years), males (aOR 0.90), and new visits (aOR 0.46). Higher use was observed among unmarried (aOR 1.10), patient portal users (aOR 1.44), patients with fewer comorbidities, those living ≥ 15 miles from care (aOR 1.42 vs. < 5 miles), lower-income (< $50,000 aOR 1.06 vs. $50,000-$100,000), and primary care (aOR 1.23 vs. specialty care). Telemedicine use was lower among Non-Hispanic Black (aOR 0.88), Hispanic (aOR 0.94), and Asian (aOR 0.82) patients compared to Non-Hispanic White patients. Patterns differed by clinical condition, with disproportionately higher use among White patients with mental health disorders. Telemedicine use persists post-pandemic but reflects differences in access by age, race/ethnicity, socioeconomic status, and prior engagement with the patient portal. Targeted policies are needed to ensure equitable telemedicine adoption and accessibility for all patients.