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Background: Primaquine, the only widely available treatment to prevent relapsing Plasmodium vivax malaria, is produced as 15 mg tablets, and new paediatric formulations are being developed. To inform the optimal primaquine dosing regimen for children, we aimed to determine the efficacy and safety of different primaquine dose strategies in children younger than 15 years., Methods: We undertook a systematic review (Jan 1, 2000-July 26, 2024) for P vivax efficacy studies with at least one treatment group that was administered primaquine over multiple days, that enrolled children younger than 15 years, that followed up patients for at least 28 days, and that had data available for inclusion by June 30, 2022. Patients were excluded if they were aged 15 years or older, presented with severe malaria, received adjunctive antimalarials within 14 days of diagnosis, commenced primaquine more than 7 days after starting schizontocidal treatment, had a protocol violation in the original study, or were missing data on age, sex, or primaquine dose. Available individual patient data were collated and standardised. To evaluate efficacy, the risk of recurrent P vivax parasitaemia between days 7 and 180 was assessed by time-to-event analysis for different total mg/kg primaquine doses (low total dose of ∼3·5 mg/kg and high total dose of ∼7 mg/kg). To evaluate tolerability and safety, the following were assessed by daily mg/kg primaquine dose (low daily dose of ∼0·25 mg/kg, intermediate daily dose of ∼0·5 mg/kg, and high daily dose of ∼1 mg/kg): gastrointestinal symptoms (vomiting, anorexia, or diarrhoea) on days 5-7, haemoglobin decrease of at least 25% to less than 7g/dL (severe haemolysis), absolute change in haemoglobin from day 0 to days 2-3 or days 5-7, and any serious adverse events within 28 days. This study is registered with PROSPERO, CRD42021278085., Findings: In total, 3514 children from 27 studies and 15 countries were included. The cumulative incidence of recurrence by day 180 was 51·4% (95% CI 47·0-55·9) following treatment without primaquine, 16·0% (12·4-20·3) following a low total dose of primaquine, and 10·2% (8·4-12·3) following a high total dose of primaquine. The hazard of recurrent P vivax parasitaemia in children younger than 15 years was reduced following primaquine at low total doses (adjusted hazard ratio [HR] 0·17, 95% CI 0·11-0·25) and high total doses (0·09, 0·07-0·12), compared with no primaquine. In 525 children younger than 5 years, the relative rates of recurrence were also reduced, with an adjusted HR of 0·33 (95% CI 0·18-0·59) for a low total dose and 0·13 (0·08-0·21) for a high total dose of primaquine compared with no primaquine. The rate of recurrence following a high total dose was reduced compared with a low dose in children younger than 15 years (adjusted HR 0·54, 95% CI 0·35-0·85) and children younger than 5 years (0·41, 0·21-0·78). Compared with no primaquine, children treated with any dose of primaquine had a greater risk of gastrointestinal symptoms on days 5-7 after adjustment for confounders, with adjusted risks of 3·9% (95% CI 0-8·6) in children not treated with primaquine, 9·2% (0-18·7) with a low daily dose of primaquine, 6·8% (1·7-12·0) with an intermediate daily dose of primaquine, and 9·6% (4·8-14·3) with a high daily dose of primaquine. In children with 30% or higher glucose-6-phosphate dehydrogenase (G6PD) activity, there were few episodes of severe haemolysis following no primaquine (0·4%, 95% CI 0·1-1·5), a low daily dose (0·0%, 0·0-1·6), an intermediate daily dose (0·5%, 0·1-1·4), or a high daily dose (0·7%, 0·2-1·9). Of 15 possibly drug-related serious adverse events in children, two occurred following a low, four following an intermediate, and nine following a high daily dose of primaquine., Interpretation: A high total dose of primaquine was highly efficacious in reducing recurrent P vivax parasitaemia in children compared with a low dose, particularly in children younger than 5 years. In children treated with high and intermediate daily primaquine doses compared with low daily doses, there was no increase in gastrointestinal symptoms or haemolysis (in children with 30% or higher G6PD activity), but there were more serious adverse events., Funding: Medicines for Malaria Venture, Bill & Melinda Gates Foundation, and Australian National Health and Medical Research Council., Competing Interests: Declaration of interests JKB reports institutional research funding from MMV, GSK, Wellcome Trust, and Sanaria; participation on the US National Institutes of Health data safety monitoring board; and membership of the editorial board of Travel Medicine and Infectious Disease and the guidelines development group for malaria control and elimination, Global Malaria Programme, WHO. RJC, JKB, and RNP report contributions to Up-to-Date. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To investigate associations of the 'weekend warrior' physical activity pattern with mild dementia., Methods: Participants in the Mexico City Prospective Study were surveyed from 1998 to 2004 and re-surveyed from 2015 to 2019. Participants were asked about leisure time physical activity at baseline. Those who exercised up to once or twice per week were termed 'weekend warriors' and those who exercised more often were termed 'regularly active'. A Mini Mental State Examination (MMSE) was used to assess mild dementia at re-survey. Cox models were adjusted for age, sex, education, income, blood pressure, smoking, body mass index, civil status, sleep, diet and alcohol at baseline. The attributable fraction was defined as the proportion of cases that would not exist if all adults were to exercise once or twice per week or more often., Results: The analysis included 10 033 adults of mean (SD) age 51 (10) years followed for 16 (2) years. There were 2400 cases when mild dementia was defined as a score of ≤22 on the MMSE. Compared with the group that reported no sport or exercise, the hazard ratio was 0.75 (95% CI 0.61 to 0.91) in the weekend warrior group, 0.89 (95% CI 0.78 to 1.02) in the regularly active group and 0.84 (95% CI 0.75 to 0.95) in the combined group. The attributable fraction was 13% (95% CI 5% to 21%). Similar results were observed when mild dementia was defined as a score of ≤23 on the MMSE., Conclusions: This longitudinal analysis suggests that the weekend warrior physical activity pattern is associated with a reduced risk of mild dementia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Latin American (LatAm) cities are grappling with elevated levels of gaseous and particulate pollutants, which are having detrimental effects on both the local ecosystem and human health. Of particular concern are aerosols with smaller diameters (lower or equal to 2.5 μm, PM2.5), known for their ability to penetrate deep into the respiratory system. While measurements in the region are increasing, they remain limited. This study addresses this gap by presenting the results of a comprehensive, year-long PM2.5 monitoring campaign conducted in six LatAm cities: Buenos Aires, São Paulo, Medellín, San José, Quito and Ciudad de México. Despite all six monitoring sites being urban, they exhibited significant variations in PM2.5 levels, as well as in the content and seasonal behavior of elemental carbon (EC) and organic carbon (OC). Estimations of secondary organic carbon (SOC) using the EC-tracer method revealed a notable SOC relevance across all cities: secondary organic aerosols (SOA) accounted in average for between 19 % to 48 % of the total carbonaceous matter. Source attribution, conducted through the Positive Matrix Factorization (PMF) model, highlights substantial contributions from gasoline and diesel traffic emissions (29 % to 49 % of total carbon, TC), regional biomass burning (21 % to 27 %), and SOA (20 % to 38 %) in all cities, with similar chemical signatures. Additionally, industrial emissions were significant in two cities (Medellín and San José), while two others experienced minor impacts from construction machinery at nearby sites (Buenos Aires and Quito). This comparative analysis underscores the importance of considering not only the thermal optical EC/OC fractions as tracers of sources but also the OC/EC ratio of the PMF factors. This dual approach not only adds depth to the research but also suggests varied methodologies for addressing this crucial environmental concern. This study lays the groundwork for future investigations into the factors influencing the content and seasonality of SOA in the region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population., Design: Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model., Findings: In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures., Conclusions: Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The current study aimed to investigate the association between predicted vitamin D status and depression in a prospective Spanish cohort of university graduates. The SUN Project is a dynamic cohort study designed to investigate multiple aspects of health and lifestyle. Participants were asked to complete a comprehensive questionnaire consisting of 556 items, that included a validated food-frequency questionnaire. Participants initially free of depression were classified as incident cases if they reported a medical diagnosis of depression during follow-up. Serum vitamin D levels were predicted by a previously validated equation. Vitamin D deficiency was defined as vitamin D levels below 20 ng/mL. Cox models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). We included 15,175 Spanish university graduates [mean (SD) age: 36.9 year (11.5)] followed-up for a median of 12.7 years. Among 192,976 person-years of follow-up, we identified 753 incident cases of depression. Participants with vitamin D deficiency had a 27% higher risk of depression as compared to those with vitamin D sufficiency (HR: 1.27, 95% CI: 1.09-1.48; p = 0.002) after adjusting for potential confounders. Furthermore, a significant effect modification by female sex was observed with higher depression risks associated with vitamin D deficiency in women than in men (p for interaction = 0.034). In educated middle-aged Spanish adults, we observed a direct association between vitamin D deficiency and the risk of depression, that was stronger among women., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Sacoor C et al.)

Oral methadone maintenance is a widely adopted and effective treatment for heroin and other opioid dependencies. However, injectable methadone usage may pose greater risks than heroin itself. Despite decades of oral methadone treatment in Spain, there is limited understanding of the motivations for parenteral consumption. This study aimed to examine the reasons for methadone injection, delineate its specific advantages and disadvantages compared with those of heroin use, and assess the benefits and drawbacks of supervised methadone injection within a harm reduction service from the perspective of people who inject drugs. A qualitative phenomenological study was conducted in 11 patients at a safe injection facility in Barcelona. Semistructured interviews revealed that the reasons for injecting methadone were its provision of a euphoric rush, the pleasurable sensation of needle insertion, and the avoidance of gastrointestinal discomfort associated with oral methadone use. The main attraction of methadone injection was its accessibility as a legal and fully state-funded treatment option in Spain, coupled with its effectiveness in relieving withdrawal symptoms. However, notable disadvantages included the risks inherent in injection. The benefits of supervised consumption rooms were its provision of immediate medical assistance in overdose situations, ease of access, and physical safety. Drawbacks included waiting times, limited opening hours, neighborhood stigmatization, and the distance people who inject methadone had to travel when obtaining methadone from the illicit market. Based on these findings, we make several recommendations aimed at reducing the harm associated with methadone injection and emphasize the need for comprehensive harm reduction strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Urinary tract infections (UTIs) constitute one of the main complications in kidney recipients, increasing both morbidity and mortality. Due to the resurgence of antimicrobial resistance, new prophylactic approaches are being investigated. Nitrofurantoin is an antibiotic from the nitrofuran group that is effective against several Gram-negative and Gram-positive organisms; hence, there has been a resurgence in its prescription for treating MDR pathogens. Objectives : This study aims to assess the effectiveness of nitrofurantoin as an add-on to conventional therapy (amikacin + ceftriaxone or cefotaxime) for the treatment of urinary tract infections in kidney recipients. Methods : In a prospective cohort study, we included patients who received a kidney in a tertiary-care hospital. According to the intensive care specialist, group 1 patients were treated with the conventional prophylactic treatment plus nitrofurantoin as an add-on. Group 2 patients were treated only with the conventional prophylactic treatment. They were followed-up for 3 months, and the incidence of urinary tract infections was reported. Results : The UTI incidence for group 1 at 3 months was 20.6%, and for group 2, it was 20.0%; no statistical difference between treatments was observed ( p = 0.9). The most commonly isolated pathogens were E. coli (28.5) and K. pneumonie (28.5%). The factor most associated with developing a UTI was female gender (aHR: 7.0; 95% IC 2.3-20.9, p < 0.001). Conclusions : In our cohort study, nitrofurantoin as an add-on in conventional therapy did not prove to be effective in preventing UTI development; therefore, other treatment options should be considered as a part of prophylactic treatment.

Objectives: To understand in-facility follow-up care-seeking behavior among both people who self-managed medication abortions and those who obtained facility-managed care in low-and-middle-income countries. We explore factors that contribute to meeting individual self-reported follow-up care needs, core to person-centered care., Study Design: We conducted a qualitative, codebook thematic analysis of 67 in-depth interviews conducted with people who self-managed medication abortions or obtained facility-managed medication abortion care. We first classified individuals as having their follow-up care needs met (not seeking care when the participant felt confident that additional care was not warranted or desired or receiving care if it was desired) or not. Our a priori analytic domains came from the Anderson model of health services utilization - predisposing, enabling, or need factors (perceived and evaluated need for health services) that contributed to having follow-up care needs met or not. We also describe emergent themes within each domain., Results: Most participants (n=59, 88%) had their follow-up care needs met; half (n=33, 49%) sought follow-up care in a facility. Prior birth or abortion experiences emerged as predisposing factors for having follow-up care needs met. Having accompaniment support (from activists or hotlines who provide abortion guidance outside of clinical settings), knowing what to expect, and information sources were key enabling factors for having follow-up care needs met. Need factors included flexible follow-up care guidelines. Those who did not have their follow-up care needs met described predisposing negative health system experiences; enabling factors including health system challenges, stigma from providers, and legal risk; and need factors of required follow-up care guidelines., Conclusions: Medication abortion follow-up care experiences are diverse, and individual needs can be met both in and outside of health facilities. Understanding prior experiences, enabling accompaniment support, and considering flexible follow-up care guidelines can support meeting individual follow-up care needs, which is essential to person-centered abortion care., Implications: Follow-up care needs, essential to ensuring access to high-quality abortion services, can be met in both self-managed and in-facility medication abortion models. Policies that require follow-up care when it is not needed or desired by the person can reinforce ideas that self-managed abortion is not safe or effective, despite existing evidence., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Carbon dots (CDs) are fluorescent carbon-based nanomaterials with remarkable properties, making them more attractive than traditional fluorophores. Consequently, researchers focused on their development and application in fields such as sensing and bioimaging. One potential advantage of employing CDs is using organic waste as carbon precursors in their synthesis, providing a pathway for waste upcycling for a circular economy. However, waste-based CDs often have low fluorescence quantum yields (QYFL), limiting their practical applications. So, there is a need for a well-defined strategy to consistently produce waste-based CDs with appreciable QYFL, irrespective of the starting waste material. Herein, we developed a fabrication strategy based on the hydrothermal treatment of waste materials, using citric acid as a co-carbon precursor and ethylenediamine as N-dopant. This strategy was tested with various materials, including corn stover, spent coffee grounds, cork powder, and sawdust. The results showed consistently appreciable QYFL, reaching up to ~40%. A Life Cycle Assessment (LCA) study demonstrated that producing these waste-based CDs has lower environmental impacts compared to CDs made solely from commercial reagents. Thus, we have established a framework for the environmentally friendly production of CDs by upcycling different waste materials without significant sacrifices in performance (QYFL)., (© 2024 Wiley‐VCH GmbH.)

Background In Latin American countries and Suriname, sexual transmission is one of the most common modes of HIV transmission, and men who have sex with men (MSM) who engage in sex work constitute a key population. Methods In a sample of MSM (N =53,166) from the Latin American Internet Survey (2018) across 18 countries, we examined how sex work engagement is associated with syndemic conditions (multidrug use, homophobic abuse, depression/anxiety, alcohol dependency (CAGE alcohol questionnaire) and internalised homonegativity) and condomless anal intercourse with non-steady male partners using separate logistic regressions. We then used a structural equation model to determine if and how syndemic conditions mediate the relationship between sex work engagement and non-steady male partners. Results We found that getting paid for sex was associated with less condom use for anal intercourse with non-steady male partners and particular syndemic conditions, such as multidrug use, homophobic abuse and alcohol dependency. In our structural equation model, the results showed that the direct relationship between sex work engagement and non-steady male partners was positive and significant, and syndemic conditions partially mediated this relationship. Conclusion Our results highlight the continuing need for including MSM who engage in sex work and those who experience syndemic conditions in the prevention strategies targeted to MSM in Latin America and Suriname, to prevent the transmission of HIV.

This study aimed to identify the sociodemographic and health-related factors associated with the consumption of voluntarily fortified foods with micronutrients (Mn-FF) by the Portuguese population, using data from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016). Food consumption, sociodemographic and other health-related factors, and physical activity data were computerised using the You Eat & Move e-platform. Foods consumed by participants and labelled foods reported as consumed were included in the database. Mn-FF were considered all foods containing added micronutrients legally authorised, and MN-FF users were those who consumed at least one Mn-FF on at least one of the dietary recall days. Approximately 57% of the population consumed at least one Mn-FF. Children and adolescents consumed significantly more Mn-FF than older age groups. The primary contributors to Mn-FF consumption were breakfast cereals and fat spreads. Being a child (female OR 2.07 [95% CI: 1.52, 2.83]; male OR 4.80 [95% CI: 3.23, 7.14]) or adolescent (female OR 1.62 [95% CI: 1.78, 2.22]; male OR 4.59 [95% CI: 3.26, 6.47]), having a higher level of education (female OR 1.52 [95% CI: 1.17, 1.99]; male OR 1.85 [95% CI: 1.42, 2.42]) and engaging in regular physical activity (female OR 1.31 [95% CI: 1.09, 1.58]; male OR 1.36 [95% CI: 1.11, 1.68]) were factors positively associated with Mn-FF consumption. Conversely, obesity (female OR 0.76 [95% CI: 0.60, 0.96]), living in predominantly rural areas (male OR 0.70 [95% CI: 0.49, 0.91]) and eating fewer mid-meals per day (female OR 0.60 [95% CI: 0.48, 0.76]; male OR 0.64 [95% CI: 0.49, 0.84]) were associated with lower Mn-FF consumption. Younger age, higher education and physical activity practice were positively associated with Mn-FF consumption. These findings provide important insights on priority factors to be considered when deciding on nutrient fortification policies from both public health and food industry perspectives., (© 2024 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation.)

The United States Pharmacopeial Convention (USP) is a nonprofit, scientific, standard-setting organization, and world leader in establishing quality, purity, and testing standards for medicines, foods, and dietary supplements. USP quality standards are used in more than 140 countries and are legally recognized by more than 40 countries. Currently, there is renewed interest in herbal medicines globally, and health policies are being implemented worldwide for the use of complementary and traditional medicine. In response, USP has developed a robust body of monographs that can be used to guide industry and regulators in ensuring the quality and safety of botanical ingredients used in dietary supplements and herbal medicines. Throughout the Pan American regions, there is a strong tradition of using botanicals as herbal medicines and, as in other regions, a growing desire for botanical dietary supplements. This underscores the need for public quality standards to ensure quality, reduce the flow of substandard and adulterated products, and ensure public health and safety. In April 2022, USP launched the Pan America Botanical Dietary Supplements and Herbal Medicines Expert Panel, with experts representing 12 different countries. The Expert Panel's work focuses on developing quality control standards for the most important botanical ingredients used in the respective countries, ingredients that are also of global importance. This article provides an overview of the state of botanical dietary supplements and herbal medicines in different Pan American regions with a focus on the regulatory status of herbal products, the development of national quality and research initiatives, and policies related to agriculture conservation and sustainability, among other topics., Competing Interests: Author MF was employed by Pharmavite LLC. Author EF was employed by Native Botanicals Inc. Author WP was employed by CAMAG Scientific Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Upton, Agudelo, Cabrera, Caceres, Calderón, Calzada, Camacho, da Costa, Dobrecky, Enciso, Escobar, Fakhary, Fletcher, Gao, Lock, Mata, Parada, Perera, Pombo, Reich, Sanchez, Simirgiotis, Sood, Amiguet, Villar, Ghelman, Schveitzer, Portella, Wolffenbüttel, Ruppelt, Frickmann, Gavillan-Suarez, Allen, Alvarado, Sarma, Marles, Monagas and Navarro-Hoyos.)

This study aimed to assess the prevalence of anemia in children of two Guarani communities in Misiones, Argentina, and to analyze its association with socioenvironmental and parasitic factors. This cross-sectional study took place in two villages, Koen Ju and Kaa Poty, and included Mbya Guarani children aged 6 months to 14 years. A multivariable analysis was performed to evaluate the association of anemia with the presence of intestinal parasites. Altogether, 162 children were included in the study: 53.1% were boys, 32.7% had low weight-for-age, and 22.2% low height-for-age. Nearly half (46.9%, n=76) had anemia, which was mainly mild (92.1%), with a few moderate cases (7.9%). Of the 109 children who underwent testing for intestinal parasites, 89 (81.7%) had at least one, and 53 (59.5%) had more than one. The main parasite was Blastocystis hominis (49.5%), followed by Entamoeba coli (47.7%), hookworms (36.7%), and Ascaris lumbricoides (31.5%). In the multivariable analysis, anemia was associated with intestinal parasitosis (adjusted odds ratio [OR] 4.24, 95% confidence interval [CI] 1.08-16.5; p=0.038) and male sex (adjusted OR 2.66; 95% CI 1.08-6.47; p= 0.01). Overall, we found that both anemia and intestinal parasites are common in the pediatric population of the Guarani ethnic group. Intestinal parasites and male sex were associated with the presence of anemia.

Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Dengue, caused by the dengue virus (DENV), is a global health threat transmitted by Aedes mosquitoes, resulting in 400 million cases annually. The disease ranges from mild to severe, with potential progression to hemorrhagic dengue. Current research is focused on natural antivirals due to challenges in vector control. This study evaluates the antiviral potential of peptides derived from the microalgae Phaeodactylum tricornutum , known for its bioactive compounds. Microalgae were cultivated under controlled conditions, followed by protein extraction and hydrolysis to produce four peptide fractions. These fractions were assessed for cytotoxicity via the MTT assay and antiviral activity against DENV serotype 2 using flow cytometry and plaque formation assays. The 10-30 kDa peptide fraction, at 150 and 300 μg/mL concentrations, demonstrated no cytotoxicity and significantly reduced the percentage of infected cells and viral titers. These findings suggest that peptides derived from Phaeodactylum tricornutum exhibit promising antiviral activity against dengue virus serotype 2, potentially contributing to developing new therapeutic approaches for dengue.

Violence against women or gender-based violence (GBV) is a significant public health issue facing women and girls in different settings. It is reported to have worsened globally during the COVID-19 pandemic. Despite the impact of the COVID-19 pandemic on increased violence against women in general, which has been reported in many settings globally, there is a paucity of evidence of its impact on violence against highly vulnerable women living with HIV or tuberculosis (TB). Using a qualitative design, this study aimed to explore the views and experiences of women living with HIV (n = 19) or TB (n = 23) in Timor Leste regarding the GBV they faced during the COVID-19 pandemic. They were recruited using the snowballing sampling technique. Data were collected using one-on-one, in-depth interviews and focus group discussions. The five steps of qualitative data analysis suggested in Ritchie and Spencer's analysis framework were employed to guide the analysis of the findings. Findings indicated that women in this study experienced intensified physical, verbal, sexual and psychological violence by their partners, spouses, in-laws, and parents or other family members during the COVID-19 pandemic. Several prominent risk factors that worsened violence against women during the pandemic were (i) HIV or TB-positive status, (ii) traditional gender roles or responsibilities and expectations, (iii) economic and financial difficulties reflected in the loss of jobs and incomes due to the pandemic, and (iv) individual factors such as jealousy and increased alcohol drinking developed during the lockdowns. The women's experience of GBV during the pandemic also led to various negative psychological impacts. The findings underscore the urgent need for multifaceted interventions to address GBV, which should encompass challenging traditional gender norms, addressing economic inequalities, and targeting individual-level risk factors. The findings also indicate the need for the development of robust monitoring and evaluation systems to assess the effectiveness of policies and interventions addressing GBV where the results can inform future improvement. The findings also indicate the need to include GBV in the protocol or guidelines for HIV and TB management. Future large-scale quantitative studies to capture the magnitude and specific drivers of GBV against women living with HIV and TB during the pandemic are recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Martins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: In view of the importance of managers' wellbeing for their leadership behaviour, employee health, and business effectiveness and survival, a better understanding of managers' wellbeing and working conditions is important for creating healthy and sustainable businesses. Previous research has mostly provided a static picture of managers' wellbeing and work in the context of small businesses, missing the variability and dynamism that is characteristic of this context. Therefore, the purpose of this study is to explore how managers in small companies perceive their working conditions and wellbeing in the context of business growth., Methods: The study is based on qualitative semi-structured interviews with 20 managers from twelve small companies. Content and thematic analysis were applied., Results: The findings indicate that a manager's working environment evolves from its initial stages and through the company's growth, leading to variations over time in the manager's experiences of wellbeing and work-life balance as well as changes in job demands and resources. Managers' working situation becomes less demanding and more manageable when workloads and working hours are reduced and a better work-life balance is achieved. The perceived improvement is related to changes in organizational factors (e.g. company resources), but also to individual factors (e.g. managers' increased awareness of the importance of a sustainable work situation). However, there were differences in how the working conditions and wellbeing changed over time and how organizational and individual resources affected the studied managers' wellbeing., Conclusions: This study shows that, in the context of small business, managers' working conditions and wellbeing are dynamic and are linked to growth-related changes that occur from the start of organizational activities and during periods of growth. In addition, the findings suggest that changes in managers' working conditions and wellbeing follow different trajectories over time because of the interaction between organizational and personal factors., (© 2024. The Author(s).)

Objective: Drunk driving is a major cause of road traffic injuries and deaths in Latin America. We evaluated the impact of a drunk driving intervention in Leon, Mexico on road traffic safety., Methods: The intervention included increased drunk driving penalties, enhanced sobriety checkpoints and a young adult-focused mass media campaign, beginning 19 December 2018. We created a synthetic control Leon from 12 Mexican municipalities from a pool of 87 based on similarity to Leon using key predictors from 2015 to 2019. We assessed the effect of the intervention on road traffic collisions overall and collisions with injuries, deaths and involving alcohol, using data from police, insurance claims and vital registration., Results: As compared with the synthetic control, Leon experienced significant postintervention lower police-reported total collision rate (17%) and injury collisions (33%). Alcohol-involved collisions were 38% lower than the synthetic control. Fatal collisions reported by police were 28% lower while vital registration road traffic deaths were 12% lower, though these declines were not statistically significant. We found no impact on insurance collision claims. There was heterogeneity in these changes over the evaluation year, with stronger initial effects and weaker effects by the end of the year., Conclusions: Drunk driving policies in Leon led to fewer traffic collisions and injuries during the first year of implementation, with a weakening of this effect over time, similar to interventions in high-income settings and other Latin American countries. Supporting the expansion of similar policies to other cities in the region could improve road safety., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Methods and validated tools for evaluating the performance of competency-based implementation research (IR) training programmes in low-middle-income countries (LMICs) are lacking. In this study, we developed tools for assessing the performance of IR training programmes based on a framework of IR core competencies in LMICs., Methods: We developed self-assessment and objective-assessment tools drawing on the IR competency framework. We used exploratory factor analyses and a one-parameter logistic model to establish construct validity and internal consistency of the tools drawing on a survey conducted in 2020 with 166 trainees before and after an index IR course across five universities and LMICs under the Special Program for Research and Training in Tropical Diseases postgraduate IR training scheme. We conducted key informant interviews (KII) with 20 trainees and five trainers to reflect on the usefulness of the tools and framework for guiding IR training in LMICs., Results: Two 16-item tools for self-assessment of IR knowledge and self-efficacy and a 40-item objective assessment tool were developed. The factor loadings of items in the self-assessment tools were 0.65-0.87 with Cronbach's alpha (α) of 0.97, and 0.77-0.91 with α of 0.98 for the IR knowledge and self-efficacy tools, respectively. The distribution of item difficulty in the objective-assessment tool was consistent before and after the index IR course. Pearson correlation coefficient (r) between the self-assessed and objectively assessed IR knowledge before the index IR course was low, r=0.27 (p value: <0.01), with slight improvements after the index IR course, r=0.43 (p value: <0.01). All KII respondents reported the assessment tools and framework were valid for assessing IR competencies., Conclusion: The IR competency framework and tools developed for assessing IR competencies and performance of IR training programmes in LMICs are reliable and valid. Self-assessment methods alone may not suffice to yield a valid assessment of performance in these settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The relationship between serum glycoprotein syndecan-1 and disease activity in rheumatoid arthritis (RA) is still unknown. This study aimed to evaluate whether serum syndecan-1 concentrations are associated with moderate/severe disease activity. Methods: Study Design: This was a cross-sectional study. Seventy-five adult women with RA were classified into (a) moderate/severe RA based on the disease activity score, using the erythrocyte sedimentation rate (DAS28-ESR ≥ 3.2, n = 50), and (b) RA in remission (DAS28-ESR < 2.6, n = 25). Twenty-five healthy women were taken as the reference group. Syndecan-1 levels were determined using enzyme-linked immunosorbent assay (ELISA). High values of serum syndecan-1 levels (≥24 ng/mL) were used to identify the utility values of this biomarker. Results: The patients with RA had higher levels of syndecan-1 than the controls ( p < 0.001). RA patients with active disease had higher syndecan-1 levels than RA patients in remission (57.6 vs. 23.5 ng/mL, respectively; p = 0.002). High syndecan-1 concentrations demonstrated the following utility values for identifying disease activity: sensitivity, 84% (95%CI: 71-93); specificity, 52% (95%CI: 31-72); positive predictive value, 78% (95%CI: 70-84); and negative predictive value, 62% (95%CI: 44-77). Conclusions: High syndecan-1 levels have good sensitivity and positive predictive value for identifying disease activity; however, their specificity is limited. Future prospective studies are needed to assess whether syndecan-1 levels can predict treatment failure in RA.

Chronic musculoskeletal conditions cause pain and disability and have significant impact on morbidity worldwide. Tele-rehabilitation is proposed as an alternative or complement to improve patient's muscle function, pain, and quality of life. However, the satisfaction of both patients and professionals must be assessed, together with the patient's daily life activity independence. A search of the literature was made to locate assessment reports, systematic reviews and reports from regulatory bodies with support from a documentarian from the Andalusian Health Technologies Assessment Area (AETSA). For this purpose, the following sources were used: Medline, EMBASE, INAHTA (international network of health technologies assessment) and PEDro (Physiotherapy Evidence Database) from 2014 onwards. Subsequently a secondary search was carried out on the articles selected in the initial search. A search of open clinical trials was also carried out in the database: www.ClinicalTrials.gov Initially 345 articles were identified. Duplicated articles (57) were excluded. By first analysing the title and abstract 238 articles were excluded. The full texts of the remaining 30 articles were analysed. Finally 18 articles were included., (Copyright © 2024 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: More than 550 million people speak Spanish and, yet, psychometric data on psychological instruments in Spanish lags. Given evidence of significant traumatic exposure and distress among Spanish speakers, the aim of the current study was to examine the factor structure of the Impact of Events Scale-Revised (IES-R), in a large sample of Spanish-speaking adults., Method: Participants ( n = 725) were university students living in Latin America ( M = 21.02; SD = 3.12). Most were born in Mexico (77.6%) and the next largest subgroup was from Ecuador (18.9%). Respondents completed the 22-item IES-R., Results: The IES-R mean score was 20.08 ( SD = 21.34) and 26.6% of the sample met the cutoff score for clinically significant symptoms. Regarding factor structure, eight different factor structures that have demonstrated a good fit in the extant literature were examined. The one-factor model demonstrated an acceptable fit, χ²(209) = 839.13, p < .0001; root-mean-square error (RMSEA) = 0.06, 95% confidence interval (CI) [0.06, 0.07]; comparative fit index (CFI) = 0.91, Tucker-Lewis index (TLI) = 0.90. The two-factor model demonstrated good fit, χ²(208) = 746.70, p < .0001; RMSEA = 0.06, 95% CI [0.05, 0.06]; CFI = 0.92, TLI = 0.91, and nested model comparisons of the two-factor and one-factor models using the chi-square difference test supported the two-factor model., Conclusions: The most parsimonious of the multifactor models, a two-factor model with Avoidance symptoms as one factor and Intrusions and Hyperarousal combined into a second may be of greatest use for this particular version of the IES-R. The current research demonstrates strong psychometric support for Intrusion/Hyperarousal and Avoidance subscales when measuring traumatic stress in Spanish speakers and underscores the need for culturally and contextually sensitive assessment in this population, in which posttraumatic stress is prevalent. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Children are vulnerable to secondhand smoke (SHS) exposure, especially those with lower socioeconomic status. This study assesses the changes in prevalence and socioeconomic inequalities in SHS exposure in children younger than 12 years old in Spain between 2016 and 2019., Methods: We conducted two cross-sectional studies among representative samples of households with children aged <12 years in Spain, in 2016 (n=2411) and 2019 (n=2412). Families were interviewed to assess children's SHS exposure in private settings and outdoor public venues and their adoption of home and car smoke-free rules. We used the education level of the home main earner as a proxy for socioeconomic position. Changes over time in the prevalence and socioeconomic inequalities of SHS exposure and smoke-free rules were estimated through adjusted Poisson regression models with robust variance according to sociodemographic covariates (adjusted prevalence ratios, APRs)., Results: In 2019, 70.5% of children were exposed to SHS in Spain. No changes between 2016 and 2019 were found for overall SHS exposure, exposure at home, and at school entrances. SHS exposure increased at public transport stations (APR=1.24; 95% CI: 1.03-1.49) and outdoor hospitality venues (APR=1.17; 95% CI: 1.07-1.29) while it decreased in cars (APR=0.74; 95% CI: 0.56-0.98) and parks (APR=0.87; 95% CI: 0.77-0.98). Households with lower education level had higher prevalence of SHS exposure at home in 2019 compared with those with university studies (primary: APR=1.30; 95% CI: 1.11-1.51; secondary: APR=1.12; 95% CI: 1.00-1.25) and were less likely to adopt home indoor smoke-free rules (primary: APR=0.88; 95% CI: 0.79-0.99; secondary: APR=0.95; 95% CI: 0.89-1.02). Socioeconomic inequalities in SHS exposure at home persisted between 2016 and 2019 (p>0.05), while decreased in smoke-free rules in cars (p=0.039)., Conclusions: Reported SHS exposure among children in Spain remained high between 2016 and 2019. Inequalities persisted at home, highlighting the need for measures to reduce such exposure with an equity perspective., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2024 Sanz-Mas M. et al.)

Sarcopenia is defined by the presence of decreased skeletal muscle mass, strength, and functionality in older people. Multicomponent interventions represent an alternative to non-pharmacological treatment for preventing disease progression. This study aimed to evaluate the effects of a multicomponent intervention approach in women at risk of sarcopenia., Methods: A quasi-experimental pilot study of 12 weeks was conducted, with 24 sessions of dancing and resistance exercises and 12 sessions of nutritional education. The outcomes were changes in muscle mass, grip strength, gait speed, and body composition. The project was registered on Clinical Trials: NCT06038500 (14 September 2023)., Results: Twelve women aged 55-75 years participated in this study; after the intervention, changes were found in the following variables: grip strength, from 18.70 (17.98-19.23) at baseline to 21.57 (20.67-23.16) kg ( p = 0.002); gait speed, from 0.95 (0.81-1.18) at baseline to 1.34 (1.20-1.47) m/s ( p = 0.003); and hip circumference, from 99.75 (94.75-110.37) at baseline to 97.65 (93.92-109.50) cm ( p = 0.023). Other measurements that appeared without changes were appendicular skeletal muscle mass, from 21.17 (18.58-22.33) at baseline to 20.77 (18.31-22.39) kg ( p = 0.875), and the appendicular skeletal muscle mass index, from 8.64 (8.08-9.35) at baseline to 8.81 (7.91-9.38) kg/m 2 ( p = 0.875) after the intervention., Conclusions: The three-month multicomponent intervention in women at risk of sarcopenia improved their grip strength and gait speed.

Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate public policies and protocols to prevent stillbirth, improve maternal care and support bereaved families. METHODS AND ANALYSIS: In this case-control study with stillbirths and live births in 14 public hospitals in São Paulo, mothers are interviewed at hospitals after delivery, and hospital records and prenatal care registries are reviewed. Maternal and umbilical cord blood samples and placentas are collected to analyse angiogenesis and infection biomarkers, and the placenta's anatomopathological exam. Air pollutant exposure is estimated through the participant's residence and work addresses. Traditional and non-invasive autopsies by image-guided histopathology are conducted in a subset of stillbirths. Subsample mothers of cases are interviewed at home 2 months after delivery on how they were dealing with grief. Information contained in the official prenatal care registries of cases and controls is being compiled. Hospital managers are interviewed about the care offered to stillbirth mothers. Data analysis will identify the main risk factors for stillbirth, investigate their interrelations, and evaluate health services care and support for bereaved families. We hope this project will contribute to the understanding of stillbirth's risk factors and related health services in Brazil, providing new knowledge about this central public health problem, contributing to the improvement of public policies and prenatal and puerperal care, helping to prevent stillbirths and improve the healthcare and support for bereaved families. ETHICS AND DISSEMINATION: This study protocol was approved by the Ethics Committee of the Municipal Health Secretary (process no 16509319.0.3012.5551) and of the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (process no 16509319.0.0000.0068). Results will be communicated to the study participants, policy-makers and the scientific community., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In this work, optical fiber Bragg grating sensors were used to measure water velocity and examine how it was distributed in open channels. Several types of coatings were incorporated into the design of the sensors to examine their effects on the strain that the fibers experienced as a result of the water flow. Due to their low elastic coefficient, which reduced the hysteresis, the results indicated that the aluminum- and acrylate-coated fibers had the best performance. ANSYS-CFX V2020 R2 software was used to model the strain encountered by the fibers under various flow rates to assess the performance of the FBG sensors. The calculations and actual data exhibited good convergence, demonstrating the accuracy of the FBG sensors in determining water velocity. The study illustrated the usability of the proposal in both scenarios by contrasting its application in rivers and channels., (© 2024. The Author(s).)

This study aims to determinate the correlation between tobacco control policies (TCP) and the prevalence of tobacco use in the 32 Mexican states during the 2016-2017 period. This is an ecological study that measured TCP by the Tobacco Control Scale (TCS) which assigns a score (0-100) based on the level of these component's implementation: price, prohibition in public spaces, expenditures of public information campaigns, publicity prohibitions, health warnings, and treatments. We analyzed the associations between the TCS scores and prevalence of tobacco use extracted from the National Survey of Drug, Alcohol and Tobacco Consumption using Spearman correlations. Prevalence of daily smokers is negatively correlated with global TCS scores for adolescents (p = 0.026). Price showed similar negative correlations with daily prevalence in adolescents (p = 0.003), adults (p = 0.040), men (p < 0.006), and women (p = 0.040). Many Mexican states need to improve on tobacco control policies, especially targeting a key population: adolescents., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Diabetes education is an integral part of the treatment for the metabolic control of patients with diabetes. The use of the Internet as a tool for diabetes education, as well as its acceptance, is still under study., Aim: To assess the usability of the educational website "I understand my diabetes" designed for patients with type 2 diabetes attending primary care clinics., Material and Method: A cross-sectional study was done in 110 patients with type 2 diabetes from two family medicine clinics, each of whom was assigned a user account on the educational website "Entiendo mi diabetes." The web site assigned a user name and password to each patient. They were able to access the educational website at home. After a 15-day review period, participants were asked to evaluate usability using the Computer System Usability Questionnaire. Additionally, we developed an eight-item questionnaire usability focusing on diabetes care. Sociodemographic data, blood pressure, and anthropometric measurements were recorded. Glucose levels and lipid profiles were also measured., Results: The patients with diabetes had a mean age of 52.7 years and a median of 5 years since they were diagnosed with diabetes. The website received a good usability rating from 89.1% of participants, with favorable assessments in all three dimensions: 87.3% for information, 85.5% for quality, and 88.2% for interface. Regarding usability specifically for diabetes care, 98.2% rated it as having good usability., Conclusion: The website for education about the disease in patients "I understand my diabetes" had an adequate usability evaluation by patients, so they also considered it very useful for diabetes care. The diabetes care instrument had adequate usability and reliability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ortíz, Vega García, Islas Salinas, Muñoz Torres and Velázquez López.)

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences ( p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ocaña-Ortiz, Gea-Caballero, Juárez-Vela, Peiró, Pérez-Sanz, Santolalla-Arnedo, Sufrate-Sorzano, Garrote-Cámara and Paredes-Carbonell.)

Background: After childbirth, mothers are particularly vulnerable to mental health problems including anxiety and depression, which often remain undetected and untreated. In the United Arab Emirates (UAE), recent figures revealed a substantial prevalence of postpartum depression. However, postpartum mental health remains largely understudied in the country's clinical and research settings. Therefore, given the paucity of literature in the UAE and building upon previous epidemiological findings, this study aimed to explore the perceived mental health experiences and needs of mothers during the postpartum period to guide the development of targeted interventions that address mothers' unique mental health challenges., Methodology: Four focus groups were conducted, involving a total of 27 Emirati and multicultural expatriate mothers aged 32.47 ± 4.56 years old, living in the UAE and within their first year postpartum. Descriptive interpretive thematic analysis was employed to analyze the data., Analysis: Six themes were generated that capture the mothers postpartum experiences and mental health needs: (1) distinct postpartum experiences of primiparous and multiparous mothers, (2) experiences of emotional distress in the initial postpartum stage, (3) multifaceted challenges in breastfeeding, (4) multifactorial influences on postpartum mental health, (5) postpartum social support resources and providers, and (6) the need for formal and informal resources., Conclusions: The findings highlight the importance of considering the unique cultural and societal factors that impact maternal mental health in the UAE, given its diverse population. A collaborative multidisciplinary approach, integrating culture sensitivity, is vital to address the mental health needs of postpartum mothers and to guide the development of tailored evidence-based interventions., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Breast cancer mortality rates in Latin America (LA) are higher than those in the United States, possibly because of advanced disease presentation, health care disparities, or unfavorable molecular subtypes. The Latin American Cancer Research Network was established to address these challenges and to promote collaborative clinical research. The Molecular Profiling of Breast Cancer Study (MPBCS) aimed to evaluate the clinical characteristics and treatment outcomes of LA participants with locally advanced breast cancer (LABC)., Patients and Methods: The MPBCS enrolled 1,449 participants from Argentina, Brazil, Chile, Mexico, and Uruguay. Through harmonized procedures and quality assurance measures, this study evaluated clinicopathologic characteristics, neoadjuvant chemotherapy response, and survival outcomes according to residual cancer burden (RCB) and the type of surgery., Results: Overall, 711 and 480 participants in the primary surgery and neoadjuvant arms, respectively, completed the 5-year follow-up period. Overall survival was independently associated with RCB (worse survival for RCBIII-adjusted hazard ratio, 8.19, P < .001, and RCBII [adjusted hazard ratio, 3.69, P < .008] compared with RCB0 [pathologic complete response or pCR]) and type of surgery (worse survival in mastectomy than in breast-conserving surgery [BCS], adjusted hazard ratio, 2.97, P = .001). The hormone receptor-negative-human epidermal growth factor receptor 2-positive group had the highest proportion of pCR (48.9%). The analysis of the ASCO Quality Oncology Practice Initiative breast module revealed high compliance with pathologic standards but lower adherence to treatment administration standards. Notably, compliance with trastuzumab administration varied widely among countries (33.3%-88.7%)., Conclusion: In LABC, we demonstrated the survival benefit of BCS and the prognostic effect of the response to available neoadjuvant treatments despite an important variability in access to key treatments. The MPBCS represents a significant step forward in understanding the real-world implementation of oncologic procedures in LA.

This experiment compared narasin and monensin as anticoccidials for calves naturally infected with Eimeria spp. Twenty-four weaned, non-castrated male calves ( Bos indicus  ×  B. taurus cross) were assigned to this experiment (days -8 to 42). All calves were infected by Eimeria spp. according to oocyst count per gram ( OPG ) from fecal samples collected on days -8 and -7 (average 1,059 ± 101 oocysts/g). Calves were housed in individual pens, received corn silage, mineral mix, and water for ad libitum consumption, in addition to a grain-based supplement at 200 g/head daily. Fecal samples were collected on days -2 and -1 for OPG, and results averaged as initial OPG value. Calves were blocked according to initial OPG into eight blocks of three calves each, ranked within each block according to body weight ( BW ) recorded on day -1, and assigned to receive narasin ( NAR; 0.8 mg/kg of BW), monensin ( MON; 1 mg/kg of BW), or no ionophore ( CON ; negative control). Ionophores were added to the grain-based supplement, and offered from days 0 to 42 of the experiment. Calf BW was recorded on days 7, 14, 21, 28, 35, and 42. Fecal samples were collected on days 6 and 7, 13 and 14, 20 and 21, 26 and 27, 34 and 35, and 41 and 42 for OPG analysis, and results from samples collected on consecutive days were averaged. Aliquoted fecal samples were also pooled across calves from the same treatment and collection days, and used to determine the prevalence of individual species of Eimeria . No treatment effects were detected ( P  ≥ 0.51) for calf BW or growth rate. A treatment × day interaction was detected ( P  < 0.01) for OPG, as NAR and MON calves had less ( P  < 0.01) OPG compared with CON calves beginning on day 7. The OPG was also less ( P  ≤ 0.03) in MON compared with NAR calves on days 7, 14, and 28, but did not differ ( P  ≥ 0.48) on days 21, 35, and 42. The anticoccidial efficacy of NAR and MON did not differ ( P  ≥ 0.16) when calculated across all Eimeria spp., or according to prevalence of E. bovis and E. alabamensins . A treatment × day interaction was detected ( P  = 0.04) for anticoccidial efficacy to E. alabamensis , which was greater ( P  < 0.01) in MON calves on days 7 and 14 and did not differ ( P  ≥ 0.40) afterward. Collectively, both ionophores were similarly effective in controlling coccidiosis upon completion of the 42-d study, although the anticoccidial effects of monensin were noted earlier in the experiment. Nonetheless, these results corroborate narasin as an efficient anticoccidial ionophore for naturally infected calves., Competing Interests: Tiago Leiva, José Manuel Correia de Simas, Pedro V. F. Lasmar, and Rodrigo L. Valarelli are employed by the funder of this project (Elanco Saúde Animal; São Paulo, Brazil) and contributed to research design and interpretation of results. All other authors of this manuscript have no additional conflict of interest to report., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society of Animal Science.)

Dengue is the most prevalent mosquito-borne viral disease in humans, and cases are continuing to rise globally. In particular, islands in the Caribbean have experienced more frequent outbreaks, and all four dengue virus (DENV) serotypes have been reported in the region, leading to hyperendemicity and increased rates of severe disease. However, there is significant variability regarding virus surveillance and reporting between islands, making it difficult to obtain an accurate understanding of the epidemiological patterns in the Caribbean. To investigate this, we used travel surveillance and genomic epidemiology to reconstruct outbreak dynamics, DENV serotype turnover, and patterns of spread within the region from 2009-2022. We uncovered two recent DENV-3 introductions from Asia, one of which resulted in a large outbreak in Cuba, which was previously under-reported. We also show that while outbreaks can be synchronized between islands, they are often caused by different serotypes. Our study highlights the importance of surveillance of infected travelers to provide a snapshot of local introductions and transmission in areas with limited local surveillance and suggests that the recent DENV-3 introductions may pose a major public health threat in the region., (© 2024. The Author(s).)

Background: The periparturient period in dairy cows is marked by immunosuppression which increases the likelihood of infectious disorders, particularly also mastitis. An in-depth understanding of peripartum leukocyte biology is vital for the implementation of highly successful post-partum disease prevention measures. Immune checkpoint molecules, such as programmed death 1 (PD-1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4), are critical inhibitory receptors expressed on immune cells, particularly T cells, that drive immunosuppressive signaling pathways. However, the potential role of immune checkpoint molecules expression in T-cells on udder health has never been explored. Thus, the association between the occurrence of new postpartum intramammary infections (IMIs) and the expression of programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) on blood T-cells during the peripartum period was investigated., Results: In this study, the incidence of IMIs by any pathogen in early lactation was not associated with a higher expression of PD-1 and CTLA-4 in the periparturient period. However, the incidence of IMIs by major pathogens throughout the first month of lactation was significantly associated with higher expression of PD-1 at 14 days before calving (P = 0.03) and CTLA-4 at parturition (P = 0.03) by blood T-cells. Also, the expression of CTLA-4 at D0 (P = 0.012) by T-cells was associated with the occurrence of persistent IMIs during the first month of lactation., Conclusions: To our knowledge, this is the first report to investigate the expression of PD-1 and CTLA-4 by blood T-lymphocytes during the periparturient period in dairy cows and to explore their relationship with the incidence of new IMIs in the postpartum period. Thus, a comprehensive understanding of leukocyte biology during peripartum would appear to be a prerequisite for the identification of resilient dairy cows or targets innovative (immunological) non-antibiotic approaches in the transition period., (© 2024. The Author(s).)

The 2023 monkeypox (mpox) epidemic was caused by a subclade IIb descendant of a monkeypox virus (MPXV) lineage traced back to Nigeria in 1971. Person-to-person transmission appears higher than for clade I or subclade IIa MPXV, possibly caused by genomic changes in subclade IIb MPXV. Key genomic changes could occur in the genome's low-complexity regions (LCRs), which are challenging to sequence and are often dismissed as uninformative. Here, using a combination of highly sensitive techniques, we determine a high-quality MPXV genome sequence of a representative of the current epidemic with LCRs resolved at unprecedented accuracy. This reveals significant variation in short tandem repeats within LCRs. We demonstrate that LCR entropy in the MPXV genome is significantly higher than that of single-nucleotide polymorphisms (SNPs) and that LCRs are not randomly distributed. In silico analyses indicate that expression, translation, stability, or function of MPXV orthologous poxvirus genes (OPGs), including OPG153, OPG204, and OPG208, could be affected in a manner consistent with the established "genomic accordion" evolutionary strategies of orthopoxviruses. We posit that genomic studies focusing on phenotypic MPXV differences should consider LCR variability., (© 2024. The Author(s).)

Introduction: Diffuse interstitial lung disease (ILD) describes a broad group of pulmonary inflammatory and fibrosis disorders. Asbestosis and silicosis are the main causes linked to occupational exposure. The aim of this study was to estimate the proportion of cases with possible occupational origin and describe their exposure, clinical, and occupational status., Method: We conducted a retrospective longitudinal study of ILD cases between 2017 - 2022 at the University Hospital of Navarra was conducted. Information was supplemented with interviews of cases with possible occupational origin. The occupational proportion was calculated, labor and clinical characteristics analyzed, by statistical comparison of percentages and means., Results: Out of 1067 ILD cases, 56 had a possible occupational origin 5,2% (95% CI 3,9-6,6%). 36 (64,3%) corresponded to asbestosis, 15 (26,8%) to silicosis, and 5 (8,9%) to unspecified pneumoconiosis. The most frequent activities in silicosis were "stone cutting-carving" and in asbestosis "manufacture of iron products". The average age of asbestosis cases was higher than that of silicosis cases (78,2 vs. 67,3 years), as well as their clinical manifestation. Five cases (8,9%) had been recognized as occupational diseases., Conclusions: The implementation of a computer tool in medical records has made it possible to estimate the magnitude and assess the evolution of occupational ILD treated in the Public Health Service. Economic activities reflect the economic risk structure of the region. However, there is a lack of recognition of these diseases as occupational illnesses and they represent a preventable burden of respiratory disease.

Objective: To understand the association of food insecurity with sociodemographic factors in a sample population in Latin America during the COVID-19 pandemic., Methods: This was a multicenter cross-sectional study conducted in 10 countries in Latin America using an online survey through various digital platforms from October 14, 2020 to February 15, 2021. Statistical analysis of data was performed by applying descriptive statistics, chi-square test, and logistic regression analysis., Results: Of a total of 6 357 surveys, 58.2% of respondents experienced food security, 29.3% were slightly food insecure, 9.2% were moderately food insecure, and 3.3% were severely food insecure. Concerning the association food insecurity and sociodemographic variables, there is a significant association in the variables studied, including area of residence, education level, occupation, number of persons in the household, household with children younger than 10 years of age, and socioeconomic level., Conclusions: These findings indicate that sociodemographic factors associated with food insecurity during the COVID-19 pandemic in Latin America were rural residence; complete and incomplete basic and secondary schooling; occupation (homemaker, unemployed, and self-employed); low, medium-low, and medium socioeconomic level; household with more than four persons; and household with children younger than 10 years of age.

Background: Fast and complete reperfusion in endovascular therapy (EVT) for ischemic stroke leads to superior clinical outcomes. The effect of changing the technical approach following initially unsuccessful passes remains undetermined., Objective: To evaluate the association between early changes to the EVT approach and reperfusion., Methods: Multicenter retrospective analysis of prospectively collected data for patients who underwent EVT for intracranial internal carotid artery, middle cerebral artery (M1/M2), or basilar artery occlusions. Changes in EVT technique after one or two failed passes with stent retriever (SR), contact aspiration (CA), or a combined technique (CT) were compared with repeating the previous strategy. The primary outcome was complete/near-complete reperfusion, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) of 2c-3, following the second and third passes., Results: Among 2968 included patients, median age was 66 years and 52% were men. Changing from SR to CA on the second or third pass was not observed to influence the rates of eTICI 2c-3, whereas changing from SR to CT after two failed passes was associated with higher chances of eTICI 2c-3 (OR=5.3, 95% CI 1.9 to 14.6). Changing from CA to CT was associated with higher eTICI 2c-3 chances after one (OR=2.9, 95% CI 1.6 to 5.5) or two (OR=2.7, 95% CI 1.0 to 7.4) failed CA passes, while switching to SR was not significantly associated with reperfusion. Following one or two failed CT passes, switching to SR was not associated with different reperfusion rates, but changing to CA after two failed CT passes was associated with lower chances of eTICI 2c-3 (OR=0.3, 95% CI 0.1 to 0.9). Rates of functional independence were similar., Conclusions: Early changes in EVT strategies were associated with higher reperfusion and should be contemplated following failed attempts with stand-alone CA or SR., Competing Interests: Competing interests: RN: consultant: Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron; stock options: Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse, Perfuze; principal investigator: ENDOLOW and DUSK trials; stock options: Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, Tulavi Therapeutics, Vastrax, Piraeus Medical, Brain4Care, Quantanosis AI, Viseon. SAS: NIH grant (R01NS121154); consultant: Penumbra and Imperative Care; ownership: Motif Neurosciences. SO-G: grants: Medtronic, Stryker, NINDS, Methinks. personal fees: Medtronic and Stryker outside the submitted work. DCH: consultant: Stryker Neurovascular, Cerenovus, Chiesi USA, Brainomix, Poseydon Medical. Consulting/DSMB: Jacobs Institute/Medtronic, Vesalio, Rapid Pulse. Stock options: VizAI, Motif Neurotech. Other authors: none., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: At the end of 2022, the football world championship will be held in Qatar. These types of meetings require a risk analysis. It proposes an approach to determine which health risks should be prioritized., Method: We use a mixed methodology (Hierarchical Process Analysis, World Health Organization STAR and European Commission INFORM) to determine the risk level of a total of 12 health entities., Results: Our analysis identifies 6 health entities with a moderate risk. There are 4 whose valuation is as low risk and 2 as very low., Conclusions: In our work we focus the analysis from a point of view of the route of transmission or presentation of health events, which facilitates a visualization of the preventive measures to be implemented, both organizationally and individually by the attendees., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate the association between dairy intake patterns and the risk of prostate cancer (PC), and its histological differentiation, among men from Mexico City., Methods: We analyzed the information from 394 incident PC cases paired by age (± 5 years) with 794 population controls. According to the Gleason score at diagnosis, cases were classified as well- (≤ 6), moderately- (= 7), and poorly differentiated PC (≥ 8). Based on a semiquantitative-food frequency questionnaire and using energy-density approach, we estimated the energy-adjusted daily intake of whole milk, cheese (fresh, Oaxaca, and Manchego), cream, and yogurt. Through a principal component analysis, we identified three dairy intake patterns: whole milk, cheese, and yogurt. The association between each dairy intake pattern and PC was evaluated from independent nonconditional logistic regression models. We also evaluated the mediator role of calcium and saturated fat intake., Results: After adjustment, a high intake of whole milk pattern was associated with a 63% increased risk of PC (OR high vs low : 1.63; 95% CI 1.17-2.25, p trend = 0.002); at expenses of moderately (OR high vs low : 1.77; 95% CI 1.09-2.85, p trend = 0.015) and poorly differentiated PC (OR high vs low : 1.75; 95% CI 1.05- 2.92, p trend = 0.031). The association was mainly mediated by calcium intake (proportion mediated = 1.17; p < 0.01). No associations were found between cream and yogurt intake patterns with risk of PC, and its histological grade., Conclusions: A differential association of dairy intake patterns with risk of PC, and the poorly differentiated PC, was identified. This association seems to be determined by different dairy matrices and it is mediated by calcium content. Longitudinal studies are needed to confirm these findings and be able to identify other potential mediators in the etiology of PC., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: The COVID-19 pandemic prompted the use of face masks as a social distancing measure. Although evidence supports their effectiveness in preventing infection, it remains unclear why some adolescents choose to continue wearing them postpandemic, even when it is no longer mandatory. This study aims to explore adolescents' experiences of wearing face masks during the COVID-19 pandemic when their use was no longer mandatory., Method: In this exploratory qualitative study, data were collected from 16 adolescents through face-to-face semistructured interviews. The participants were asked about the reasons and feelings associated with continuing to wear masks, as well as the contexts in which they felt safe without a mask. The collected data were analysed using Braun and Clarke's thematic analysis., Results: Three main themes were identified: (1) Navigating complex decision-making: balancing safety and self-image, (2) peer influence dynamics and (3) managing the future: weather dynamics and pandemic evolution., Discussion: The potential implications of withdrawing COVID-19 preventive measures, such as mask-wearing, beyond the pandemic remain understudied. It is crucial to further investigate the perceptions related to wearing masks and its cessation, especially amongst vulnerable individuals., Patient or Public Contribution: Due to methodological constraints associated with participants' age, they were not engaged in the design, data analysis, data interpretation or manuscript preparation phases of the study., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Objective: To evaluate the effect of replacing 1 h/week of watching television with 1 h/week of light to moderate (LMPA) or vigorous physical activity (VPA) before and during pregnancy on the risk of gestational diabetes mellitus (GDM)., Methods: A case-control study was conducted in pregnant women. Physical activity and television watching before and during pregnancy were assessed using the Paffenbarger Physical Activity Questionnaire. Each type of activity was classified according to intensity (metabolic equivalent of task; MET): less than 6 METs is LMPA, 6 METs or more is VPA. The duration of physical activity and watching television was calculated, and logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals for their association with GDM risk. The isotemporal substitution model was used to calculate the effect of replacing 1 h/week of watching television with the same duration of physical activity., Results: The GDM cases (n = 290) spent less time performing VPA than controls without GDM (n = 1175) and more time watching television during pregnancy (P < 0.05). During pregnancy, the risk of GDM increased for each hour of watching television (aOR = 1.02; 95% confidence interval 1.00-1.03). Women who spent more time watching television during pregnancy were likely to develop GDM (aOR >14 h/week vs. 0-6 h/week  = 2.03; 95% confidence interval 1.35-3.08). Replacing 1 h/week of watching television with 1 h/week of VPA during pregnancy could decrease the chance of developing GDM (aOR = 0.66; 95% confidence interval 0.43-1.00)., Conclusions: A simple change of 1 h/week of watching television for 1 h/week of VPA in pregnant women may reduce the risk of GDM considerably., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)