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Aim: Real-world evidence on the management of hemorrhoidal disease (HD) is limited. This international study collected clinical practice data on the effectiveness of conservative treatments for acute HD on symptoms and quality of life (QoL), providing perspectives of treatment modalities from different continents. Patients & methods: The 4-week observational prospective CHORALIS study involved adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification) and prescribed conservative treatments according to usual clinical practice. Assessments were: anal pain/discomfort (visual analog scale [VAS]), other signs/symptoms (patient questionnaire), Patient Global Impression of Change (PGI-C) questionnaire and disease-specific QoL (HEMO-FISS-QoL questionnaire). Results: Of 3592 participants, 3505 were analyzed (58.4% male; age 40.5 ± 13.7 years; history of HD in 48.4%; 72.1% Goligher grade I and II). Pain and discomfort were the most common symptoms. Most treatments were venoactive drugs (VADs; 90.9%), particularly micronized purified flavonoid fraction (MPFF; 73.7%) and diosmin (14.6%). All VAD-based therapies improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL. MPFF was associated with a significantly greater proportion of patients with no symptoms (48.8 vs diosmin 34.4%, p < 0.001), pain disappearance (69.7 vs diosmin 52.8%, p < 0.001), treatment impact at 1 week rated on PGI-C as 'very much better' (30.5 vs diosmin 17.9%, p < 0.001) and shorter times to improvement (mean ± SD 3.9 ± 1.5 days vs diosmin 4.2 ± 1.7 days). Conclusion: In this prospective real-world study of patients with acute HD, conservative therapies consisting mainly of VADs, including MPFF, improved the clinical signs and symptoms of disease, as well as QoL. This study evidence supports clinical advantages associated with VADs, mostly MPFF, for effectively managing acute HD.

Compared to normal cells, tumour cells exhibit an upregulation of glucose transporters and an increased rate of glycolytic activity. In previous research, we successfully identified a promising hit compound BH10 through a rigorous screening process, which demonstrates a potent capacity for inhibiting cancer cell proliferation by targeting glucose metabolism. In the current study, we identify Kelch-like ECH-associated protein 1 (Keap1) as a potential protein target of BH10via avidin pull-down assays with biotinylated-BH10. Subsequently, we present a comprehensive analysis of a series of BH10 analogues characterized by the incorporation of a naphthoimidazole scaffold and the introduction of a triazole ring with diverse terminal functional groups. Notably, compound 4d has emerged as the most potent candidate, exhibiting better anti-cancer activities against HEC1A cancer cells with an IC 50 of 2.60 μM, an extended biological half-life, and an improved pharmacokinetic profile (compared to BH10) in mice., 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 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Cardiovascular disease (CVD) risk factors tend to cluster and interact multiplicatively and have been incorporated into risk equations such as the Framingham risk score, which can reasonably predict CVD over short- and long-term periods. Beyond risk factor levels at a single time point, recent evidence demonstrated that risk trajectories are differentially related to CVD risk. However, factors associated with suboptimal control or unstable CVD risk trajectories are not yet established., Objective: This study aims to examine factors associated with CVD risk trajectories in a semirural, multiethnic community-dwelling population., Methods: Data on demographic, socioeconomic, lifestyle, mental health, and cardiovascular factors were measured at baseline (2013) and during follow-up (2018) of the South East Asia Community Observatory cohort. The 10-year CVD risk change transition was computed. The trajectory patterns identified were improved; remained unchanged in low, moderate, or high CVD risk clusters; and worsened CVD risk trajectories. Multivariable regression analyses were used to examine the association between risk factors and changes in Framingham risk score and predicted CVD risk trajectory patterns with adjustments for concurrent risk factors., Results: Of the 6599 multiethnic community-dwelling individuals (n=3954, 59.92% female participants and n=2645, 40.08% male participants; mean age 55.3, SD 10.6 years), CVD risk increased over time in 33.37% (n=2202) of the sample population, while 24.38% (n=1609 remained in the high-risk trajectory pattern, which was reflected by the increased prevalence of all major CVD risk factors over the 5-year follow-up. Meanwhile, sex-specific prevalence data indicate that 21.44% (n=567) of male and 41.35% (n=1635) of female participants experienced an increase in CVD risk. However, a stark sex difference was observed in those remaining in the high CVD risk cluster, with 45.1% (n=1193) male participants and 10.52% (n=416) female participants. Regarding specific CVD risk factors, male participants exhibited a higher percentage increase in the prevalence of hypertension, antihypertensive medication use, smoking, and obesity, while female participants showed a higher prevalence of diabetes. Further regression analyses identified that Malay compared to Chinese (P<.001) and Indian (P=.04) ethnicity, nonmarried status (P<.001), full-time employment (P<.001), and depressive symptoms (P=.04) were all significantly associated with increased CVD risk scores. In addition, lower educational levels and frequently having meals from outside were significantly associated to higher odds of both worsening and remaining in high CVD risk trajectories., Conclusions: Sociodemographics and mental health were found to be differently associated with CVD risk trajectories, warranting future research to disentangle the role of psychosocial disparities in CVD. Our findings carry public health implications, suggesting that the rise in major risk factors along with psychosocial disparities could potentially elevate CVD risk among individuals in underserved settings. More prevention efforts that continuously monitor CVD risk and consider changes in risk factors among vulnerable populations should be emphasized., (©Hamimatunnisa Johar, Chiew Way Ang, Roshidi Ismail, Zaid Kassim, Tin Tin Su. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 26.09.2024.)

There is growing global concern regarding the detrimental health impacts of PM 2.5 emissions from traditional stoves that utilize polluting fuels. Conventional methods for estimating daily personal PM 2.5 exposure involve personal air samplers and measuring devices placed in a waist pouch, but these instruments are cumbersome and inconvenient. To address this issue, we developed a novel neck-mounted PM 2.5 monitoring device (Pocket PM 2.5 Logger) that is compact, lightweight, and can operate continuously for 1 week without recharging. Twelve participants who utilized charcoal, firewood, or propane gas for cooking in rural regions of Rwanda wore the Pocket PM 2.5 Logger continuously for 1 week, and time-series variations in personal PM 2.5 exposure were recorded at 5-min intervals. Individual daily exposure concentrations during cooking differed significantly among users of the different fuel types, and PM 2.5 exposure was at least 2.6 and 3.4 times higher for charcoal and firewood users, respectively, than for propane gas users. Therefore, switching from biomass fuels to propane gas would reduce daily individual exposure by at least one-third. An analysis of cooking times showed that the median cooking time per meal was 30 min; however, half the participants cooked for 1.5 h per meal, and one-third cooked for over 4.5 h per meal. Reducing these extremely long cooking times would reduce exposure with all fuel types. The Pocket PM 2.5 Logger facilitates the comprehensive assessment of personal PM 2.5 exposure dynamics and is beneficial for the development of intervention strategies targeting household air pollution., (© 2024. The Author(s).)

Background and Objectives: The diagnostic challenge of myasthenia gravis (MG) is exacerbated by the variable efficacy of current testing methodologies, necessitating innovative approaches to accurately identify the condition. This study aimed to assess ocular muscle fatigue in patients with MG using video-oculography (VOG) by examining repetitive saccadic eye movements and comparing these metrics to those of healthy control participants., Methods: This prospective, cross-sectional study was conducted at a tertiary care center and involved 62 patients diagnosed with MG (48 with ocular MG and 14 with generalized MG) and a control group of 31 healthy individuals, matched for age and sex. The assessment involved recording saccadic eye movements within a ± 15° range, both horizontally and vertically, at a rate of 15 saccades per minute over a 5-min period, resulting in 75 cycles. Participants were afforded a 3-min rest interval between each set to mitigate cumulative fatigue. The primary outcome was the detection of oculomotor fatigue, assessed through changes in saccadic waveforms, range, peak velocity, latency, and the duration from onset to target, with a focus on comparing the second saccade against the average of the last five saccades., Results: In the evaluation of repetitive saccadic movements, patients with MG exhibited a reduced saccadic range and a prolonged duration to reach the target, compared to healthy subjects. Furthermore, a significant elevation in the frequency of multistep saccades was observed among MG patients, with a marked rise observed over consecutive trials. Receiver operating characteristic (ROC) analysis revealed the discriminative performance of multistep saccade frequency, in conjunction with variations in saccadic range and duration from onset to target achievement between the second saccade and the mean of the final five saccades, as effective in distinguishing MG patients from healthy subjects. Although alterations in peak saccadic velocity and latency were less pronounced, they were nevertheless detectable., Discussion: The utilization of VOG for repetitive saccadic testing in the diagnosis of MG has demonstrated considerable diagnostic precision. This methodology affords significant accuracy in evaluating ocular muscle fatigue in MG patients, providing class III evidence supportive of its clinical application., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

There is evidence that reducing modifiable risk factors and strengthening medical and health interventions can reduce early mortality and economic losses from non-communicable diseases (NCDs). Machine learning (ML) algorithms have been successfully applied to preventing and controlling NCDs. Reinforcement learning (RL) is the most promising of these approaches because of its ability to dynamically adapt interventions to NCD disease progression and its commitment to achieving long-term intervention goals. This paper reviews the preferred algorithms, data sources, design details, and obstacles to clinical application in existing studies to facilitate the early application of RL algorithms in clinical practice research for NCD interventions. We screened 40 relevant papers for quantitative and qualitative analysis using the PRISMA review flow diagram. The results show that researchers tend to use Deep Q-Network (DQN) and Actor-Critic as well as their improved or hybrid algorithms to train and validate RL models on retrospective datasets. Often, the patient's physical condition is the main defining parameter of the state space, while interventions are the main defining parameter of the action space. Mostly, changes in the patient's physical condition are used as a basis for immediate rewards to the agent. Various attempts have been made to address the challenges to clinical application, and several approaches have been proposed from existing research. However, as there is currently no universally accepted solution, the use of RL algorithms in clinical practice for NCD interventions necessitates more comprehensive responses to the issues addressed in this paper, which are safety, interpretability, training efficiency, and the technical aspect of exploitation and exploration in RL algorithms., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Nano zero-valent metals (nZVMs) have been extensively utilized for decades in the reductive remediation of groundwater contaminated with chlorinated organic compounds, owing to their robust reducing capabilities, simple application, and cost-effectiveness. Nevertheless, there remains a dearth of information regarding the efficient reductive defluorination of linear or branched per- and polyfluoroalkyl substances (PFASs) using nZVMs as reductants, largely due to the absence of appropriate catalysts. In this work, various soluble porphyrin ligands [[meso‑tetra(4-carboxyphenyl)porphyrinato]cobalt(III)]Cl·7H 2 O (CoTCPP), [[meso‑tetra(4-sulfonatophenyl) porphyrinato]cobalt(III)]·9H 2 O (CoTPPS), and [[meso‑tetra(4-N-methylpyridyl) porphyrinato]cobalt(II)](I) 4 ·4H 2 O (CoTMpyP) have been explored for defluorination of PFASs in the presence of the nZn 0 as reductant. Among these, the cationic CoTMpyP showed best defluorination efficiencies for br-perfluorooctane sulfonate (PFOS) (94%), br-perfluorooctanoic acid (PFOA) (89%), and 3,7-Perfluorodecanoic acid (PFDA) (60%) after 1 day at 70 °C. The defluorination rate constant of this system (CoTMpyP-nZn 0 ) is 88-164 times higher than the VB 12 -nZn 0 system for the investigated br-PFASs. The CoTMpyP-nZn 0 also performed effectively at room temperature (55% for br-PFOS, 55% for br-PFOA and 25% for 3,7-PFDA after 1day), demonstrating the great potential of in-situ application. The effect of various solubilizing substituents, electron transfer flow and corresponding PFASs defluorination pathways in the CoTMpyP-nZn 0 system were investigated by both experiments and density functional theory (DFT) calculations. SYNOPSIS: Due to the unavailability of active catalysts, available information on reductive remediation of PFAS by zero-valent metals (ZVMs) is still inadequate. This study explores the effective defluorination of various branched PFASs using soluble porphyrin-ZVM systems and offers a systematic approach for designing the next generation of catalysts for PFAS remediation., 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 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The Bárány Society recently established diagnostic criteria for presbyvestibulopathy, an age-related bilateral vestibular impairments in older individuals. Drawing upon a cross-sectional database, this study delves into the demographic and clinical features of presbyvestibulopathy patients and investigates the implications of otolith dysfunction., Methods: The study retrospectively analyzed 1218 patients aged 60 years or older who visited the tertiary dizziness clinic in 2020, due to symptoms of dizziness or instability. By reviewing medical records, we gathered clinical information and laboratory vestibular test results, such as cervical and ocular vestibular evoked myogenic potentials, and subjective visual vertical., Results: Out of 1218 patients aged 60 and above who reported dizziness or unsteadiness, 33 patients (2.7 %, with an average age of 74.2 ± 9.2 years) were diagnosed with presbyvestibulopathy. Deficiencies in horizontal angular vestibulo-ocular reflex were found in caloric tests (75 %), video head impulse tests (51.7 %), and rotatory chair tests (47.8 %), respectively. Otolith dysfunction was also observed, as shown by abnormal ocular and cervical vestibular evoked myogenic potentials in 62.96 % and 51.85 % of patients, and abnormal subjective visual vertical in 45.8 % of the cases., Conclusions: Among elderly patients experiencing consistent dizziness or instability, the incidence of presbyvestibulopathy was approximately 2.7 % over one year. Alongside the abnormalities detected in the horizontal angular vestibulo-ocular reflex, significant changes were also noted in the ocular and cervical vestibular evoked myogenic potentials, as well as in the subjective visual vertical tests. As a result, it's vital to underscore the significance of both otolithic function and vestibulo-ocular reflex in the fundamental mechanisms of presbyvestibulopathy., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sun-Young Oh reports financial support was provided by Korea Ministry of Science and ICT. Sun-Young Oh reports a relationship with Korea Ministry of Science and ICT that includes: funding grants., (© 2024 Published by Elsevier Ltd.)

This research paper delves into the intricate interplay between decarbonisation and sustainability, focusing on adopting chemical looping technologies. Deep decarbonisation scenarios necessitate a profound transformation in various sectors to mitigate climate change, and oil refineries, as pivotal players, must adapt to these changes. Employing the BLUES integrated assessment model, we evaluate the evolution of the refining sector in decarbonisation pathways, emphasising its potential for sustainability through repurposing and emissions mitigation. Additionally, we delve into chemical looping technologies, including Solar Thermal Chemical Looping (STCL), Reverse Water Gas Shift Chemical Looping (RWGS-CL), Chemical Looping Reforming (CLR), and Super Dry Reforming (SDR), elucidating their principles and contributions to carbon dioxide (CO 2 ) conversion. These technologies offer promising routes for CO 2 capture and present opportunities for sustainable carbon loop cycles, potentially revolutionising industries' emissions reduction efforts. In a world of climate change, this research illuminates a sustainable path forward by integrating decarbonisation and innovative CO 2 management strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing for financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In avian embryos, xenoestrogens induce abnormalities in reproductive organs, particularly the testes and Müllerian ducts (MDs). However, the molecular mechanisms remain poorly understood. We investigated the effects of ethynylestradiol (EE2) exposure on gene expression associated with reproductive organ development in Japanese quail embryos. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) analysis revealed that the left testis containing ovary-like tissues following EE2 exposure highly expressed the genes for steroidogenic enzymes (P450scc, P45017α, lyase, and 3β-HSD) and estrogen receptor-β, compared to the right testis. No asymmetry was found in these gene expression without EE2. EE2 induced hypertrophy in female MDs and suppressed atrophy in male MDs on both sides. RNA sequencing analysis of female MDs showed 1,366 differentially expressed genes between developing left MD and atrophied right MD in the absence of EE2, and these genes were enriched in Gene Ontology terms related to organogenesis, including cell proliferation, migration and differentiation, and angiogenesis. However, EE2 reduced asymmetrically expressed genes to 21. RT-qPCR analysis indicated that genes promoting cell cycle progression and oncogenesis were more highly expressed in the left MD than in the right MD, but EE2 eliminated such asymmetric gene expression by increasing levels on the right side. EE2-exposed males showed overexpression of these genes in both MDs. This study reveals part of the molecular basis of xenoestrogen-induced abnormalities in avian reproductive organs, where EE2 may partly feminize gene expression in the left testis, developing as the ovotestis, and induce bilateral MD malformation by canceling asymmetric gene expression underlying MD development., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: To target public health obesity prevention, we need to predict who might become obese i.e. predictors of increasing Body Mass Index (BMI) or obesity incidence. Predictors of incidence may be distinct from more well-studied predictors of prevalence, therefore we explored parent, child and sociodemographic predictors of child/adolescent BMI z-score and obesity incidence over 5 years in Malaysia., Methods: The South East Asia Community Observatory in Segamat, Malaysia, provided longitudinal data on children and their parents (n = 1767). Children were aged 6-14 years at baseline (2013-14) and followed up 5 years later. Linear multilevel models estimated associations with child BMI z-score at follow-up, adjusting for baseline BMI z-score and potential confounders. Predictors included parent cardiometabolic health (overweight/obesity, central obesity, hypertension, hyperglycaemia), and socio-demographics (ethnicity, employment, education). Logistic multilevel models explored predictors of obesity incidence., Results: Higher baseline BMI z-score predicted higher follow-up BMI z-score both in childhood to late adolescence (0.60; 95% CI: 0.55, 0.65) and early to late adolescence (0.76; 95% CI: 0.70, 0.82). There was inconsistent evidence of association between child BMI z-score at follow-up with parent cardiometabolic risk factors independent of baseline child BMI z-score. For example, maternal obesity, but not overweight, predicted a higher BMI z-score in childhood to early adolescence (overweight: 0.16; 95% CI: -0.03, 0.36, obesity: 0.41; 95% CI: 0.20, 0.61), and paternal overweight, but not obesity, predicted a higher BMI z-score in early to late adolescence (overweight: 0.22; 95% CI: 0.01, 0.43, obesity: 0.16; 95% CI: -0.10, 0.41). Parental obesity consistently predicted five-year obesity incidence in early to late adolescence, but not childhood to early adolescence. An adolescent without obesity at baseline with parents with obesity, had 3-4 times greater odds of developing obesity during follow-up (incidence OR = 3.38 (95% CI: 1.14-9.98, mother) and OR = 4.37 (95% CI 1.34-14.27, father) respectively)., Conclusions: Having a higher BMI z-score at baseline was a stronger predictor of a higher BMI z-score at follow-up than any parental or sociodemographic factor. Targeting prevention efforts based on parent or sociodemographic factors is unwarranted but early childhood remains a key period for universal obesity prevention., (© 2024. The Author(s).)

Diabetic retinopathy's signs, such as exudates (EXs) and aneurysms (ANs), initially develop from under the retinal surface detectable from optical coherence tomography (OCT) images. Detecting these signs helps ophthalmologists diagnose DR sooner. Detecting and segmenting exudates (EXs) and aneurysms (ANs) in medical images is challenging due to their small size, similarity to other hyperreflective regions, noise presence, and low background contrast. Furthermore, the scarcity of public OCT images featuring these abnormalities has limited the number of studies related to the automatic segmentation of EXs and ANs, and the reported performance of such studies has not been satisfactory. This work proposes an efficient algorithm that can automatically segment these anomalies by improving key steps in the process. The potential area where these hyper-reflective EXs and ANs occur was scoped by our method using a deep-learning U-Net++ program. From this area, the candidates for EX-AN were segmented using the adaptive thresholding method. Nine features based on appearances, locations, and shadow markers were extracted from these candidates. They were trained and tested using bagged tree ensemble classifiers to obtain only EX-AN blobs. The proposed method was tested on a collection of a public dataset comprising 80 images with hand-drawn ground truths. The experimental results showed that our method could segment EX-AN blobs with average recall, precision, and F1-measure as 87.9%, 86.1%, and 87.0%, respectively. Its F1-measure drastically outperformed two comparative methods, binary thresholding and watershed (BT-WS) and adaptive thresholding with shadow tracking (AT-ST), by 78.0% and 82.1%, respectively., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tanthanathewin 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.)

We investigated the association between dietary intake and metabolic risk factors in children and adolescents within a semi-rural Malaysian community. Using an interviewer-led questionnaire, we surveyed 623 participants aged 7-18 from the South East Asia Community Observatory (SEACO). Anthropometric and blood pressure data were collected from all participants, while a subset (n = 162) provided blood samples for biomarker analysis, including fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Metabolic syndrome was determined using the International Diabetes Federation's Definition of Metabolic Syndrome in Children and Adolescents. Most participants were Malay (66.8%), with a median household income of MYR1,500 and a balanced sex distribution. Cereals, processed foods, beverages, fruits, and vegetables were commonly consumed. Obesity and abdominal obesity were prevalent, affecting more than a third of participants. Adherence to dietary recommendations was generally poor (ranging from 19.9 to 58.1%) and varied across age, sex, and ethnicity. Notably, some food groups displayed unexpected associations with health markers; for instance, fruit consumption was linked to abdominal obesity in children (abdominal obesity vs. normal: 2.4 servings/day vs. 1.6 servings/day). These findings emphasise the necessity of longitudinal studies to explore the complex relationship between diet and long-term health outcomes, including cardiometabolic diseases, while acknowledging the unique challenges posed by the COVID-19 pandemic on data collection and analysis., (© 2024. The Author(s).)

This cross-sectional study evaluated the validity of three alternative methods compared to the gold standard 24-h urine collection for estimating dietary sodium intake, a modifiable risk factor for hypertension, among middle-aged and older adults with elevated blood pressure. These included spot urine collection (using Kawasaki, Tanaka, and INTERSALT equations), 24-h dietary recall, and food frequency questionnaire responses, compared to 24-h urine collection in a subset of 65 participants (aged 50-75 years, 58.5% women, 61.6% hypertensive) from the DePEC-Nutrition trial. The validity of the methods was assessed using bias, the Spearman correlation coefficient (SCC), the intraclass correlation coefficient (ICC), and Bland-Altman analysis. Among the alternative methods, spot urine collection using the Kawasaki equation showed the strongest correlation (SCC 0.238; ICC 0.119, 95% CI -0.079 to 0.323), but it exhibited a significant bias (1414 mg/day, p -value < 0.001) relative to 24-h urine collection. Conversely, dietary surveys had a smaller bias but wider limits of agreement. These findings underscore the complexities of accurately estimating dietary sodium intake using spot urine collection or dietary surveys in this specific population, suggesting that a combination or the refinement of existing methodologies might improve accuracy. Further research with larger samples is necessary to develop more reliable methods for assessing sodium intake in this high-risk group.

In ovo exposure to o,p'-dichloro-diphenyl-trichloroethane (o,p'-DDT) impairs reproduction by inducing malformation of the reproductive organs in birds, although the mechanism remains unclear. Here, we examined the effects of o,p'-DDT on the development of the reproductive organs, the expression of genes controlling sexual differentiation, and the plasma concentrations of testosterone and estradiol in Japanese quail embryos. o,p'-DDT-containing sesame oil was injected into the yolk sac on Embryonic Day (E) 3 at a dose of 500, 2,000, or 8,000 μg per egg. On E15, the reproductive organs were observed; the gonads and Müllerian ducts (MDs) were sampled to measure the mRNA of steroidogenic enzymes, sex steroid receptors, anti-Müllerian hormone (AMH), and AMH receptor 2 (AMHR2); blood samples were collected to assay plasma testosterone and estradiol levels; and the gonads were used for histological analysis. o,p'-DDT dose-dependently increased the prevalence of hypertrophic MDs in females and residual MDs in males. In female MDs, o,p'-DDT dose-dependently decreased estrogen receptor (ER) α, ERβ, and AMHR2 mRNA expression. o,p'-DDT dose-dependently induced left-biased asymmetry of testis size, and ovary-like tissue was found in the left testis after exposure to 8,000 μg per egg o,p'-DDT, although asymmetric gene expression did not occur. o,p'-DDT did not affect ovarian tissue but did decrease 17α-hydroxylase/C17-20 lyase mRNA expression and dose-dependently increased ERβ mRNA expression. o,p'-DDT decreased plasma testosterone concentrations in females. These findings suggest that o,p'-DDT induces hypertrophy of the MDs and ovarian tissue formation in the left testis. Abnormal MD development may be linked to altered gene expression for sensing estrogens and AMH signals., (© 2023 John Wiley & Sons Ltd.)

Background: Heatwaves present health risks globally but there is limited evidence on how temperature perceptions affect activities. This study aimed to examine community perceptions of heat as a potential health hazard and ascertain the current heat protection measures of the residents of the South East Asia Community Observatory (SEACO) in Malaysia., Methods: In this longitudinal study, we randomly selected community members aged between 18 and 70 years who resided in Segamat district of Johor state, Malaysia. Over 21 days, we conducted three home visits to each participant. During each visit, participants completed a questionnaire consisting of Likert scale, multiple choice, and free text questions and we collected quantitative and qualitative data. These inquiries assessed the participants' perception of heat as health threat, whether or not they took heat preventive measures, and the specific protective measures they routinely employed. Descriptive data analyses were conducted and patterns of protective measures were investigated., Findings: Between March 29 and July 31, 2023, 120 participants (72 women and 48 men) completed 360 questionnaires over three home visits. Initially, 58% participants recognised heat hazards to daily activities, decreasing to 42% and 35% by visits 2 and 3. Participants took preventive measures throughout the day, which was consistently high between 1200 h and 1400 h, with 77% of participants taking preventive measures on visit 1, 82% on visit 2, and 82% on visit 3. Use of preventive measures was also high between 1400 h and 1730 h, with 77% using preventive measure on visit 1, 81% on visit 2, and 79% on visit 3. The most common protective measures were fans (used by 68-88% of participants), drinking more water (70-78% of participants), and resting (44-72% of participants). The least common were relocating to cooler places, removing clothes, and using wet towels (0-2·5%). Despite high temperatures, perceptions of heat risks decreased over time. Participants took basic protections, especially at midday, but improved literacy and affordable cooling options are needed to protect vulnerable rural populations., Interpretation: Our findings underline the need to improve heat literacy and adaptation as only half of the population assessed perceived heat as a potential health hazard and practised limited heat protective measures. Addressing climate change and health necessitates fundamental behavioural changes on the part of individuals and communities, to protect them against the adverse effects of heat., Funding: Monash University Malaysia and Heidelberg Institute of Global Health, Heidelberg University., Competing Interests: Declaration of interests We declare 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.)

Background and Objectives: Self-perception of aging is an important psychosocial factor that can influence quality of life in older age. This review aimed to synthesize findings on the association between self-perception of aging and quality of life among older adults aged 60 and above., Research Design and Methods: A systematic search was conducted in 4 electronic databases (Ovid Medline, PsycInfo, CINAHL, and Web of Science). Studies conducted in English and including measures on the perception of aging and quality of life were included in this review. A total of 32 observational studies (21 cross-sectional, 8 longitudinal, 2 mixed-method, and 1 qualitative) met the inclusion criteria. Outcomes reported in the included studies were quality of life, physical health and functioning, psychological health, mental health, and general well-being., Results: Overall, 20 quantitative studies indicated a strong association between positive perception of aging and increased quality of life. Similarly, 9 quantitative studies demonstrated that negative perception of aging is associated with lower quality of life. Results of the mixed-method and qualitative studies indicated that older adults with higher morale and good physical capability had more positive perceptions of health., Discussion and Implications: These results suggest that promoting a positive perception of aging and a self-care attitude would help to enhance older adults' quality of life and should be incorporated into future health promotions and interventions., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Background: Ocular infections caused by antibiotic-resistant pathogens can result in partial or complete vision loss. The development of pan-resistant microbial strains poses a significant challenge for clinicians as there are limited antimicrobial options available. Synthetic peptoids, which are sequence-specific oligo-N-substituted glycines, offer potential as alternative antimicrobial agents to target multidrug-resistant bacteria., Methods: The antimicrobial activity of synthesised peptoids against multidrug-resistant (MDR) ocular pathogens was evaluated using the microbroth dilution method. Hemolytic propensity was assessed using mammalian erythrocytes. Peptoids were also incubated with proteolytic enzymes, after which their minimum inhibitory activity against bacteria was re-evaluated., Results: Several alkylated and brominated peptoids showed good inhibitory activity against multidrug-resistant Pseudomonas aeruginosa strains at concentrations of ≤15 μg mL -1 (≤12 µM). Similarly, most brominated compounds inhibited the growth of methicillin-resistant Staphylococcus aureus at 1.9 to 15 μg mL -1 (12 µM). The N-terminally alkylated peptoids caused less toxicity to erythrocytes. The peptoid denoted as TM5 had a high therapeutic index, being non-toxic to either erythrocytes or corneal epithelial cells, even at 15 to 22 times its MIC. Additionally, the peptoids were resistant to protease activity., Conclusions: Peptoids studied here demonstrated potent activity against various multidrug-resistant ocular pathogens. Their properties make them promising candidates for controlling vision-related morbidity associated with eye infections by antibiotic-resistant strains., 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 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Among pharmacy workers, low workplace wellbeing can lead to reduced effectiveness. However, to date, studies on this issue are limited within the community pharmacy setting in Vietnam., Objectives: This study was conducted to identify the component aspects of workplace wellbeing and their associations with demographic characteristics., Methods: The cross-sectional descriptive study was conducted in Can Tho, Vietnam. Self-administered questionnaires were hand-delivered to all pharmacy workers working at selected community pharmacies. The workplace wellbeing scale comprised 18 items., Results: In total, 382 pharmacy workers participated in this study. Factor analysis revealed three fundamental aspects to workplace wellbeing: Factor 1 - perceived self-worth and job satisfaction, Factor 2 - positive emotions with work, and Factor 3 - negative emotions with work. Factor 1 showed a positive correlation with Factor 2, with a correlation coefficient (ρ) of 0.509, while both Factor 1 (ρ = -0.399) and Factor 2 (ρ = -0.416) demonstrated negative correlations with Factor 3. Higher income was associated with higher positive emotions with work ( P = 0.008), higher perceived self-worth and job satisfaction ( P = 0.013), and lower negative emotions with work ( P < 0.001)., Conclusion: Workplace wellbeing of pharmacy workers in their professional environments was associated with financial aspects. These findings suggest that policies aimed at improving income for pharmacy workers could bring benefits to enhancing job satisfaction and workplace wellbeing., Competing Interests: Conflicts of interest: The authors have no conflicts of interest to declare., (© 2024 the Author(s), licensee AIMS Press.)

Introduction: Education improves the economy and quality of life. The availability of skilled education in Malaysia is not restricted to the younger generation but is available to people of all ages, including those with low incomes., Methods: This study used the EuroQol 5-Dimension 5-Level (EQ- 5D-5L) tool during the COVID-19 pandemic to examine relationships between socio-demographics, knowledge, and attitudes towards education and outcomes of health-related quality of life (HRQOL). Between September and October 2020 and January and February 2021, a cross-sectional study using a multi-stage sampling technique was carried out., Results: A total of 1,997 adults participated, with a mean age of 45.17 (SD 14.113). In total, 74.9% had good knowledge, while 59.8% had a positive attitude towards skill education. In univariate analyses, the EQ-5D-5L score was related to age, income, education level, marital status, employment status, financial strain level, and knowledge and attitude towards skilled education. Generalised linear model analyses demonstrated that lower EQ-5D-5L scores were associated with older age, financial constraints, and a negative attitude towards skills education. However, additional adjustments for knowledge and attitude towards skills education show only an increase in age and financial strain was significant., Conclusion: The findings suggest that appropriate strategies be implemented to increase low-income populations' knowledge and attitude towards skill education. Improving education may improve the quality of life for this vulnerable group. Additionally, a qualitative study can be conducted to determine the barriers to low-income households participating in skilled education to fill in the knowledge gap., 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 Yasin, Tan, Said, Rasul, Thangiah, Rizal, Magli, Ithnin, Majid, Ismail and Su.)

Introduction: Breast cancer is the commonest cancer among Malaysian women. Current clinical practice guidelines (CPG) by the Ministry of Health, Malaysia comprise recommendations based on a risk stratification approach., Aim: This paper reviewed and reflected on the challenges and uncertainties that needed to be considered regarding the implementation and delivery of risk-stratified breast cancer screening in Malaysia., Methods: Our iterative writing, discussions and reflections revolved around the results of key relevant literature search from the Ministry of Health Malaysia website, PubMed, and Google Scholar, and on feedback from local clinical experts in the field of breast cancer screening practice. The articles related to risk-stratified breast cancer screening, genetic testing, screening guidelines for the Malaysia population, and articles published in English were included in this narrative review., Result: Further infrastructure and workforce capacity building is needed in order to achieve successful wider implementation e.g.; genetic counselling and testing services are limited in Malaysia. Furthermore, there is a need to elicit Malaysian women's views and evaluate their acceptance of risk-stratified breast cancer screening. The primary healthcare setting is an obvious potential avenue to introduce and deliver initial risk assessment and stratification. However, the workload and willingness of Malaysian primary healthcare doctors to practice risk-stratified screening is yet to be explored to have a better understanding on their perspective., Conclusion and Recommendation: Identifying a valid and appropriate risk model tailored to the population profile and needs of Malaysian women and conducting a pilot project of risk-stratified screening, guided by implementation science would provide lessons and insights for policymakers, health service managers, and public and primary health care professionals. The results of these activities would increase the likelihood that decisions and plans would lead to the successful implementation in Malaysia of a sustainable and effective breast cancer screening strategy that incorporates a patient-sensitive, risk-stratified approach.

Background: Although health insurance (HI) has effectively mitigated healthcare financial burdens, its contribution to healthy lifestyle choices and the presence of non-communicable diseases (NCDs) is not well established. We aimed to systematically review the existing evidence on the effect of HI on healthy lifestyle choices and NCDs., Methods: A systematic review was conducted across PubMed, Medline, Embase, Cochrane Library and CINAHLComplet@EBSCOhost from inception until 30 September 2022, capturing studies that reported the effect of HI on healthy lifestyle and NCDs. A narrative synthesis of the studies was done. The review concluded both longitudinal and cross-sectional studies. A critical appraisal checklist for survey-based studies and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies were used for the quality assessment., Result: Twenty-four studies met the inclusion criteria. HI was associated with the propensity to engage in physical activities (6/11 studies), consume healthy diets (4/7 studies), not to smoke (5/11 studies) or take alcohol (5/10 studies). Six (of nine) studies showed that HI coverage was associated with a lowered prevalence of NCDs., Conclusion: This evidence suggests that HI is beneficial. More reports showed that it propitiated a healthy lifestyle and was associated with a reduced prevalence of NCDs., (© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health.)

Background: Quantifying movement behaviours over 24-hours enables the combined effects of and inter-relations between sleep, sedentary time and physical activity (PA) to be understood. This is the first study describing 24-hour movement behaviours in school-aged children and adolescents in South-East Asia. Further aims were to investigate between-participant differences in movement behaviours by demographic characteristics and timing of data collection during Ramadan and COVID-19 restrictions., Methods: Data came from the South-East Asia Community Observatory health surveillance cohort, 2021-2022. Children aged 7-18 years within selected households in Segamat, Malaysia wore an Axivity AX6 accelerometer on their wrist for 24 hours/day over 7 days, completed the PAQ-C questionnaire, and demographic information was obtained. Accelerometer data was processed using GGIR to determine time spent asleep, inactive, in light-intensity PA (LPA) and moderate-to-vigorous PA (MVPA). Differences in accelerometer-measured PA by demographic characteristics (sex, age, ethnicity, socioeconomic group) were explored using univariate linear regression. Differences between data collected during vs outside Ramadan or during vs after COVID-19 restrictions, were investigated through univariate and multiple linear regressions, adjusted for age, sex and ethnicity., Results: The 491 participants providing accelerometer data spent 8.2 (95% confidence interval (CI) = 7.9-8.4) hours/day asleep, 12.4 (95% CI = 12.2-12.7) hours/day inactive, 2.8 (95% CI = 2.7-2.9) hours/day in LPA, and 33.0 (95% CI = 31.0-35.1) minutes/day in MVPA. Greater PA and less time inactive were observed in boys vs girls, children vs adolescents, Indian and Chinese vs Malay children and higher income vs lower income households. Data collection during Ramadan or during COVID-19 restrictions were not associated with MVPA engagement after adjustment for demographic characteristics., Conclusions: Demographic characteristics remained the strongest correlates of accelerometer-measured 24-hour movement behaviours in Malaysian children and adolescents. Future studies should seek to understand why predominantly girls, adolescents and children from Malay ethnicities have particularly low movement behaviours within Malaysia., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Brady 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.)

Background and Aims: Inequality in health care access is a socioeconomic driver for non-communicable disease related risk factors. This study examined the inequality trend in healthcare cost coverage (HCC) compared to private health insurance (PHI) coverage, a subtype of HCC, over 5 years. The study will also determine the association between HCC (and PHI) and the status of hypertension and diabetes diagnosis., Method: The rich-poor ratio, concentration curve and concentration index were derived to determine the level of inequality. Furthermore, logistic regression was done to determine the association between HCC and the status of hypertension and diabetes., Results: The PHI group (rich-poor ratio: 1.4 [rich: 454, poor: 314] and 2.6 [rich: 375, poor: 142]; concentration index: 0.123 [95% confidence interval, CI: 0.093-0.153] and 0.144 [95% CI: 0.109-0.178] in 2013 and 2018, respectively) has relatively higher inequality compared with the HCC group (rich-poor ratio: 0.9 [rich: 307, poor: 337] and 1.1 [rich: 511, poor: 475]; concentration index: -0.027 [95% CI: -0.053 to -0.000] and -0.014 [95% CI: -0.033 to 0.006] in 2013 and 2018, receptively). Contrasting to the observation with the HCC group, PHI was associated with higher odds for hypertension (adjusted odds ratio [aOR] = 1.252, p  = 0.01, 95% CI: 1.051-1.493) and diabetes (aOR = 1.287, p  = 0.02, 95% CI: 1.041-1.590) in 2018., Conclusion: Over 5 years, the inequality in PHI coverage remained higher compared with HCC, which suggests that the rich enjoyed private healthcare more. Furthermore, those with PHI were more likely to report known hypertension and diabetes in 2018. It is reasonable to assume that those with PHI are more likely to have earlier diagnoses compared to others and are more likely to be aware of their condition. Policymakers need to identify strategies that can narrow the existing gap in quality and type of service between the private and public health sectors., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Multimorbidity-the coexistence of at least two chronic health conditions within the same individual-is an important global health challenge. In high-income countries (HICs), multimorbidity is dominated by non-communicable diseases (NCDs); whereas, the situation may be different in low- and middle-income countries (LMICs), where chronic communicable diseases remain prominent. The aim of this systematic review was to identify determinants (including risk and protective factors) and potential mechanisms underlying multimorbidity from published longitudinal studies across diverse population-based or community-dwelling populations in LMICs. We systematically searched three electronic databases (Medline, Embase, and Global Health) using pre-defined search terms and selection criteria, complemented by hand-searching. All titles, abstracts, and full texts were independently screened by two reviewers from a pool of four researchers. Data extraction and reporting were according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality and risk of bias assessment was performed using the Newcastle-Ottawa Scale for cohort studies. Data were summarized using narrative synthesis. The search yielded 1782 records. Of the 52 full-text articles included for review, 8 longitudinal population-based studies were included for final data synthesis. Almost all studies were conducted in Asia, with only one from South America and none from Africa. All studies were published in the last decade, with half published in the year 2021. The definitions used for multimorbidity were heterogeneous, including 3-16 chronic conditions per study. The leading chronic conditions were heart disease, stroke, and diabetes, and there was a lack of consideration of mental health conditions (MHCs), infectious diseases, and undernutrition. Prospectively evaluated determinants included socio-economic status, markers of social inequities, childhood adversity, lifestyle behaviors, obesity, dyslipidemia, and disability. This review revealed a paucity of evidence from LMICs and a geographical bias in the distribution of multimorbidity research. Longitudinal research into epidemiological aspects of multimorbidity is warranted to build up scientific evidence in regions beyond Asia. Such evidence can provide a detailed picture of disease development, with important implications for community, clinical, and interventions in LMICs. The heterogeneity in study designs, exposures, outcomes, and statistical methods observed in the present review calls for greater methodological standardisation while conducting epidemiological studies on multimorbidity. The limited evidence for MHCs, infectious diseases, and undernutrition as components of multimorbidity calls for a more comprehensive definition of multimorbidity globally., (© 2023 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Floods occur frequently in Romania and throughout the world and are one of the most devastating natural disasters that impact people's lives. Therefore, in order to reduce the potential damages, an accurate identification of surfaces susceptible to flood phenomena is mandatory. In this regard, the quantitative calculation of flood susceptibility has become a very popular practice in the scientific research. With the development of modern computerized methods such as geographic information system and machine learning models, and as a result of the possibility of combining them, the determination of areas susceptible to floods has become increasingly accurate, and the algorithms used are increasingly varied. Some of the most used and highly accurate machine learning algorithms are the decision tree models. Therefore, in the present study focusing on flood susceptibility zonation mapping in the Trotus River basin, the following algorithms were applied: forest by penalizing attribute-weights of evidence (forest-PA-WOE), best first decision tree-WOE, alternating decision tree-WOE, and logistic regression-WOE. The best performant, characterized by a maximum accuracy of 0.981, proved to be forest-PA-WOE, whereas in terms of flood exposure, an area of over 16.22% of the Trotus basin is exposed to high and very high floods susceptibility. The performances applied models in the present work are higher than the models applied in the previous studies in the same study area. Moreover, it should be noted that the accuracy of the models is similar with the accuracies of the decision tree models achieved in the studies focused on other areas across the world. Therefore, we can state that the models applied in the present research can be successfully used in by the researchers in other case studies. The findings of this research may substantially map the flood risk areas and further aid watershed managers in limiting and remediating flood damage in the data-scarce regions. Moreover, the results of this study can be a very useful for the hazard management and planning authorities., (© 2023 Society for Risk Analysis.)

Objectives: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder for which the Bárány Society has established diagnostic criteria. This nationwide multicenter study aims to investigate the clinical features of individuals with definite PPPD and clinical variant PPPD who do not fully meet the diagnostic criteria, with a particular focus on visual exaggeration., Methods: Between September 2020 and September 2021, a total of 76 individuals with definite PPPD and 109 individuals with clinical variant PPPD who did not meet all three exacerbating factors outlined in Criterion B were recruited from 18 medical centers in South Korea. The study gathered information on demographic factors, clinical manifestations, balance scales, and personality assessments., Results: Comparative analysis between groups with definite PPPD and clinical variant with visual exacerbation revealed no significant differences in sociodemographic characteristics, clinical course, dizziness impact, and specific precipitants. Only disease duration was significantly longer in definite PPPD compared with variant with visual exacerbation. However, the variant without visual exacerbation displayed significantly reduced rates of panic disorder, diminished space-motion discomfort, lesser impact of dizziness, and decreased prevalence of depression when compared with the definitive PPPD., Conclusion: This is the first comprehensive nationwide study examining clinical features of both definite PPPD patients and its clinical variants, considering visual exacerbating factors. Differences in dizziness and personality traits emerged between definite PPPD and its potential variant without visual issues. Our results highlight the possibility of a distinct clinical variant of PPPD influenced by visual dependency., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Extant cicada (Hemiptera: Cicadoidea) includes widely distributed Cicadidae and relictual Tettigarctidae, with fossils ascribed to these two groups based on several distinct, minimally varying morphological differences that define their extant counterparts. However, directly assigning Mesozoic fossils to modern taxa may overlook the role of unique and transitional features provided by fossils in tracking their early evolutionary paths. Here, based on adult and nymphal fossils from mid-Cretaceous Kachin amber of Myanmar, we explore the phylogenetic relationships and morphological disparities of fossil and extant cicadoids. Our results suggest that Cicadidae and Tettigarctidae might have diverged at or by the Middle Jurassic, with morphological evolution possibly shaped by host plant changes. The discovery of tymbal structures and anatomical analysis of adult fossils indicate that mid-Cretaceous cicadas were silent as modern Tettigarctidae or could have produced faint tymbal-related sounds. The discovery of final-instar nymphal and exuviae cicadoid fossils with fossorial forelegs and piercing-sucking mouthparts indicates that they had most likely adopted a subterranean lifestyle by the mid-Cretaceous, occupying the ecological niche of underground feeding on root. Our study traces the morphological, behavioral, and ecological evolution of Cicadoidea from the Mesozoic, emphasizing their adaptive traits and interactions with their living environments., (© 2024. The Author(s).)

There is increasing recognition that cells may activate apoptotic caspases but not die, instead displaying various physiologically relevant consequences. Mechanisms that underlie the life-or-death decision in a cell that has activated apoptotic caspases, however, are incompletely understood. By optimizing a published reporter for past caspase activity, we were able to visualize cells that survived caspase activation specifically after exposure to ionizing radiation in Drosophila larval wing discs. We found that cells with X-ray-induced past active caspases (XPAC) did not arise at random but were born at specific locations within the developing wing imaginal discs of Drosophila larvae. Inhibiting key components of the apoptotic pathway decreased XPAC number, suggesting that apoptotic signaling is needed to induce XPAC cells. Yet, XPAC cells appeared in stereotypical patterns that did not follow the pattern of IR-induced apoptosis, suggesting additional controls at play. Functional testing identified the contribution of wingless (Drosophila Wnt1) and Ras signaling to the prevalence of XPAC cells. Furthermore, by following irradiated larvae into adulthood, we found that XPAC cells contribute to the adult wing. To address the relationship between XPAC and genome stability, we combined a reporter for past caspase activity with mwh, an adult marker for Loss of Heterozygosity (LOH). We found a lower incidence of LOH among XPAC compared to cells that did not activate the reporter for past caspase activity. In addition, at time points when wing disc cells are finishing DNA repair, XPAC cells show an anti-correlation with cells with unrepaired IR-induced double-stranded breaks. Our data suggest that non-lethal caspase activity safeguards the genome by facilitating DNA repair and reducing LOH after transient exposure to X-rays. These results identify a physiological role for non-lethal caspase activity during recovery from radiation damage., (© 2024. The Author(s).)

Loss of heterozygosity (LOH) can occur when a heterozygous mutant cell loses the remaining wild-type allele to become a homozygous mutant. LOH can have physiological consequences if, for example, the affected gene encodes a tumor suppressor. We used fluorescent reporters to study the mechanisms of LOH induction by X-rays, a type of ionizing radiation (IR), in Drosophila melanogaster larval wing discs. IR is used to treat more than half of patients with cancer, so understanding its effects is of biomedical relevance. Quantitative analysis of IR-induced LOH at different positions between the telomere and the centromere on the X chromosome showed a strong sex dependence and the need for a recombination-proficient homologous chromosome, whereas, paradoxically, position along the chromosome made little difference in LOH incidence. We propose that published data documenting high recombination frequency within centromeric heterochromatin on the X chromosome can explain these data. Using a focused screen, we identified E2F1 as a key promotor of LOH and further testing suggests a mechanism involving its role in cell-cycle regulation. We leveraged the loss of a transcriptional repressor through LOH to express transgenes specifically in cells that have already acquired LOH. This approach identified JNK signaling and apoptosis as key determinants of LOH maintenance. These studies reveal previously unknown mechanisms for the generation and elimination of cells with chromosome aberrations after exposure to IR., Competing Interests: Conflicts of interest The author(s) declare no conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Genetics Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Familial hypercholesterolemia (FH) is an inherited metabolic disorder characterized by high levels of low-density lipoprotein cholesterol (LDL-c) from birth. About 85% of all FH cases are caused by pathogenic variants in the LDLR gene. Individuals with FH have increased cardiovascular risk, including a high risk of premature myocardial infarction (PMI)., Methods: We conducted an opportunistic exome screening to identify variants in the LDLR gene among Vietnamese patients with PMI treated at a general hospital in southern Vietnam. A cascade testing for LDLR variants was conducted in their relatives within three generations, and the effects of the LDLR variant on the response to rosuvastatin treatment were also studied using a comparative before-and-after study design on those who were eligible., Results: A total of 99 participants from the three generations of four PMI patients were recruited, mean age 37.3 ± 18.5 years, 56.6% males. Sanger sequencing revealed two variants in the LDLR gene: variant rs577934998 (c.664T>C), detected in 17 individuals within one family, and variant rs12710260 (c.1060+10G>C), found in 32 individuals (49.5%) in the other three families tested. Individuals harboring the variant c.664T>C had significantly higher baseline LDL-c and total cholesterol levels compared to those with variant c.1060+10G>C (classified as benign) or those without LDLR variants, and among the 47 patients subjected to a 3-month course of rosuvastatin therapy, those with variant c.664T>C had a significantly higher risk of not achieving the LDL-c target after the course of treatment compared to the c.1060+10G>C carriers., Conclusions: These findings provide evidence supporting the existence of pathogenic LDLR variants in Vietnamese patients with PMI and their relatives and may indicate the need for personalizing lipid-lowering therapies. Further studies are needed to delineate the extent and severity of the problem.

Escalating costs have made the accessibility of drugs one of the biggest challenges faced by the Malaysian government. The government agreed to regulate drug prices by means of external reference pricing, but its proposed policy had a setback owing to much opposition from the pharmaceutical industry. The policy did gain support from the public and from non-governmental organisations because it ensured easy access to affordable medicines. Comments from public consultations with key stakeholders were used to explore stakeholders' perceptions of the external reference pricing policy. A total of 140 comments were analysed for this study. Stakeholders' views were classified as being from the Socioeconomic, industrial, and government sectors. To summarise, the government must carefully manage and consider stakeholders' views to ensure a sound policy. Using Mendelow's stakeholder mapping, this study mapped out stakeholders' views in a systematic approach. The classification of different stakeholders' views and recommendations led to suggestions for reviewing current practices in pharmaceutical pricing regulations in the Malaysian healthcare system. The analyses can be extended to other countries that face similar concerns., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Loh 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.)

Background: Malaysia is projected to experience an increase in heat, rainfall, rainfall variability, dry spells, thunderstorms, and high winds due to climate change. This may lead to a rise in heat-related mortality, reduced nutritional security, and potential migration due to uninhabitable land. Currently, there is limited data regarding the health implications of climate change on the Malaysian populace, which hinders informed decision-making and interventions., Objective: This study aims to assess the feasibility and reliability of using sensor-based devices to enhance climate change and health research within the SEACO health and demographic surveillance site (HDSS) in Malaysia. We will particularly focus on the effects of climate-sensitive diseases, emphasizing lung conditions like chronic obstructive pulmonary disease (COPD) and asthma., Methods: In our mixed-methods approach, 120 participants (>18 years) from the SEACO HDSS in Segamat, Malaysia, will be engaged over three cycles, each lasting 3 weeks. Participants will use wearables to monitor heart rate, activity, and sleep. Indoor sensors will measure temperature in indoor living spaces, while 3D-printed weather stations will track indoor temperature and humidity. In each cycle, a minimum of 10 participants at high risk for COPD or asthma will be identified. Through interviews and questionnaires, we will evaluate the devices' reliability, the prevalence of climate-sensitive lung diseases, and their correlation with environmental factors, like heat and humidity., Results: We anticipate that the sensor-based measurements will offer a comprehensive understanding of the interplay between climate-sensitive diseases and weather variables. The data is expected to reveal correlations between health impacts and weather exposures like heat. Participant feedback will offer perspectives on the usability and feasibility of these digital tools., Conclusion: Our study within the SEACO HDSS in Malaysia will evaluate the potential of sensor-based digital technologies in monitoring the interplay between climate change and health, particularly for climate-sensitive diseases like COPD and asthma. The data generated will likely provide details on health profiles in relation to weather exposures. Feedback will indicate the acceptability of these tools for broader health surveillance. As climate change continues to impact global health, evaluating the potential of such digital technologies is crucial to understand its potential to inform policy and intervention strategies in vulnerable regions., 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 © 2023 Barteit, Colmar, Nellis, Thu, Watterson, Gouwanda, Bärnighausen and Su.)

Introduction: Although the combined use of chemical and electrochemical decontamination protocols can completely remove contaminants from the surfaces of one-time used healing abutments (HAs), their effectiveness in multiple-used HAs remains unknown. We aimed to investigate the effect of reused HAs frequency on the implant-HA contact surface area, micro-gap, microleakage, and surface topography following chemical and combined chemical and electrochemical decontamination protocols., Methods: Ninety bone level titanium implants were assembled with 90 bone level HAs, in which 80 contaminated HA samples were collected from human participants. The retrieved HAs were randomly divided into two groups according to the cleaning protocol: ultrasonication with 5.25% NaOCl solution for 15 min and steam autoclaving (group I); ultrasonication with 5.25% NaOCl solution for 15 min, followed by electrochemical cleaning and steam autoclaving (group II). The control group (group III) comprised 10 new unused HAs. The cleaning protocol was applied after each insertion as follows: (a) single-use and cleaning, (b) double-use and double cleaning cycles, (c) triple-use and triple cleaning cycles, and (d) more than triple-use and more than triple cleaning cycles. The contact surface area and micro-gap were assessed with micro-computed tomography scanning technique, microleakage test using 2% methylene blue staining, surface morphology with scanning electron microscopy, and surface elemental composition with energy-dispersive X-ray spectroscopy analysis., Results: Group Id exhibited the smallest contact surface area. The values of the micro-gap volumes and microleakage were significantly different (p < 0.001) in the descending order of Id > Ic > Ib > IId > Ia, IIa, and III. Morphological evaluation of Groups IIa, IIb, and IIc revealed that residual biological debris was optimally removed without altering their surface properties., Conclusions: Chemical and electrochemical decontamination protocols are more effective than NaOCl cleaning methods, particularly for multiple consecutive uses with better decontamination levels, which decreases micro-gap volume and microleakage without surface alterations. Although the use of combined decontamination protocols for the contact surface area at the implant-HA interface showed comparable results with the control, change in the contact surface area was observed following the NaOCl cleaning methods. Therefore, titanium HA reuse can be considered in multiple times, if they are cleaned and sterilized using combined chemical and electrochemical decontamination protocols., (© 2023 Wiley Periodicals LLC.)

Kidney diseases with kidney failure or damage, such as chronic kidney disease (CKD) and acute kidney injury (AKI), are common clinical problems worldwide and have rapidly increased in prevalence, affecting millions of people in recent decades. A series of novel diagnostic or predictive biomarkers have been discovered over the past decade, enhancing the investigation of renal dysfunction in preclinical studies and clinical risk assessment for humans. Since multiple causes lead to renal failure, animal studies have been extensively used to identify specific disease biomarkers for understanding the potential targets and nephropathy events in therapeutic insights into disease progression. Mice are the most commonly used model to investigate the mechanism of human nephropathy, and the current alternative methods, including in vitro and in silico models, can offer quicker, cheaper, and more effective methods to avoid or reduce the unethical procedures of animal usage. This review provides modern approaches, including animal and nonanimal assays, that can be applied to study chronic nonclinical safety. These specific situations could be utilized in nonclinical or clinical drug development to provide information on kidney disease.

Introduction: Breast cancer (BC) screening uptake in Malaysia is low and a high number of cases present at a late stage. Community navigation and mobile health (mHealth) may increase screening attendance, particularly by women from rural communities. This randomized controlled study evaluated an intervention that used mHealth and community health workers to educate women about BC screening and navigate them to clinical breast examination (CBE) services in the context of the COVID-19 pandemic., Methods: Women aged 40-74 years, from Segamat, Malaysia, with a mobile phone number, who participated in the South East Asian Community Observatory health survey, (2018) were randomized to an intervention (IG) or comparison group (CG). The IG received a multi-component mHealth intervention, i.e. information about BC was provided through a website, and telephone calls and text messages from community health workers (CHWs) were used to raise BC awareness and navigate women to CBE services. The CG received no intervention other than the usual option to access opportunistic screening. Regression analyses were conducted to investigate between-group differences over time in uptake of screening and variable influences on CBE screening participation., Results: We recruited 483 women in total; 122/225 from the IG and 144/258 from the CG completed the baseline and follow-up survey. Uptake of CBE by the IG was 45.8% (103/225) whilst 3.5% (5/144) of women from the CG who completed the follow-up survey reported that they attended a CBE during the study period (adjusted OR 37.21, 95% CI 14.13; 98.00, p<0.001). All IG women with a positive CBE attended a follow-up mammogram (11/11). Attendance by IG women was lower among women with a household income ≥RM 4,850 (adjusted OR 0.48, 95% CI 0.20; 0.95, p = 0.038) compared to participants with a household income

Objectives: This systematic review aimed to evaluate the current evidence on the effectiveness of autogenous dentin block graft prepared chairside for alveolar ridge augmentation and compare its clinical outcomes to the main available grafting materials and techniques., Materials and Methods: Three databases were screened, including prospective clinical studies, utilizing autogenous dentin blocks for ridge augmentation, with at least 3 months of postoperative follow-up., Results: Eight articles were included, and four of them were meta-analyzed. Dentin blocks demonstrated similar vertical bone gain and significantly higher width gain, compared to bone blocks (WMD = 0.03, 95% CI -0.51 to 0.57, p = .92 and WMD = 1.34, 95% CI 0.57 to 2.12, p = .0007, respectively). Vertical and horizontal resorption were similar between the two groups (WMD = -0.36, 95% CI -0.91 to 0.18, p = .19, and WMD = -0.47, 95% CI -1.05 to 0.11, p = .11, respectively). Dentin blocks showed more incidences of postoperative complications, however, with no statistical significance (RR = 4.30, 95% CI 0.97 to 18.96, p = .054). The need for additional augmentation upon implant placement was also similar between both grafts (RR = 0.95, 95% CI 0.39 to 2.28, p = .90). Recorded incidences of graft exposure were low (2.27%), and no study stated surgical site infection., Conclusion: Within its limitations, this study indicates that the autogenous dentin blocks prepared chairside could be a possible alternative to the other established bone augmentation techniques for staged ridge augmentation. Nevertheless, future studies are needed to confirm its efficacy and implant success/survival in sites grafted with this material., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Galvanic vestibular stimulation (GVS) has shown positive outcomes in various neurological and psychiatric disorders, such as enhancing postural balance and cognitive functions. In order to expedite the practical application of GVS in clinical settings, our objective was to determine the best GVS parameters for patients with vestibulopathy and cerebellar disorders using optimal design calculation., Methods: A total of 31 patients (26 males, mean age 57.03 ± 14.75 years, age range 22-82 years) with either unilateral or bilateral vestibulopathy (n = 18) or cerebellar ataxia (n = 13) were enrolled in the study. The GVS intervention included three parameters, waveform (sinusoidal, direct current [DC], and noisy), amplitude (0.4, 0.8, and 1.2 mA), and duration of stimulation (5 and 30 min), resulting in a total of 18 GVS intervention modes as input variables. To evaluate the effectiveness of GVS, clinical vertigo and gait assessments were conducted using the Dizziness Visual Analogue Scale (D-VAS), Activities-specific Balance Confidence Scale (ABC), and Scale for Assessment and Rating of Ataxia (SARA) as output variables. Optimal design and local sensitivity analysis were employed to determine the most optimal GVS modes., Results: Patients with unilateral vestibulopathy experienced the most favorable results with either noisy or sinusoidal GVS at 0.4 mA amplitude for 30 min, followed by DC GVS at 0.8 mA amplitude for 5 min. Noisy GVS at 0.8 or 0.4 mA amplitude for 30 min demonstrated the most beneficial effects in patients with bilateral vestibulopathy. For patients with cerebellar ataxia, the optimal choices were noisy GVS with 0.8 or 0.4 mA amplitude for 5 or 30 min., Conclusions: This study is the first to utilize design optimization methods to identify the GVS stimulation parameters that are tailored to individual-specific characteristics of dizziness and imbalance. A sensitivity analysis was carried out along with the optimal design to offset the constraints of a limited sample size, resulting in the identification of the most efficient GVS modes for patients suffering from vestibular and cerebellar disorders.

Background: This study aims to investigate the presence of spatial cognitive impairments in patients with acute unilateral peripheral vestibulopathy (vestibular neuritis, AUPV) during both the acute phase and the recovery phase., Methods: A total of 72 AUPV patients (37 with right-sided AUPV and 35 with left-sided AUPV; aged 34-80 years, median 60.5; 39 males, 54.2%) and 35 healthy controls (HCs; aged 43-75 years, median 59; 20 males, 57.1%) participated in the study. Patients underwent comprehensive neurotological assessments, including video-oculography, video head impulse and caloric tests, ocular and cervical vestibular-evoked myogenic potentials, and pure-tone audiometry. Additionally, the Visual Object and Space Perception (VOSP) battery was used to evaluate visuospatial perception, while the Block design test and Corsi block-tapping test assessed visuospatial memory within the first 2 days (acute phase) and 4 weeks after symptom onset (recovery phase)., Results: Although AUPV patients were able to successfully perform visuospatial perception tasks within normal parameters, they demonstrated statistically worse performance on the visuospatial memory tests compared to HCs during the acute phase. When comparing right versus left AUPV groups, significant decreased scores in visuospatial perception and memory were observed in the right AUPV group relative to the left AUPV group. In the recovery phase, patients showed substantial improvements even in these previously diminished visuospatial cognitive performances., Conclusion: AUPV patients showed different spatial cognition responses, like spatial memory, depending on the affected ear, improving with vestibular compensation over time. We advocate both objective and subjective visuospatial assessments and the development of tests to detect potential cognitive deficits after unilateral vestibular impairments., 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 © 2023 Oh, Nguyen, Kang, Kirsch, Boegle, Kim and Dieterich.)

Background: Job satisfaction is an important factor affecting job performance and turnover of healthcare workers, especially hospital pharmacists. Nevertheless, limited studies have reported this issue in the context of Vietnam., Objectives: To help maintain the quality and size of the limited hospital pharmacy workforce in Vietnam, especially in the Mekong Delta area, this study investigated the job satisfaction of hospital pharmacists, and the associated factors, in Vinh Long province, a representative province in the central Mekong Delta., Methods: A cross-sectional survey was conducted, recruiting hospital pharmacists working in all 17 province/district-affiliated healthcare facilities across Vinh Long province, Vietnam, between August and September 2022., Results: Among the 235 survey participants (representing a response rate of 97.1%), 189 pharmacists (80.4%) reported that they were satisfied with their job. Working conditions, leadership styles, and benefits were factors found to significantly influence job satisfaction. Pharmacists who had worked in the field for 3-5 years (OR = 3.752, 95% CI = 1.036-13.595), more than 5 years (OR = 6.361, 95% CI = 2.264-17.875), did not have additional duties besides their primary responsibilities (OR = 2.046, 95% CI = 1.005-4.163), and worked in a private healthcare facility (OR = 12.021, 95% CI = 1.470-98.316), were significantly more likely to be satisfied with their job., Conclusions: Most hospital pharmacists were satisfied with their current job. To further improve job satisfaction in this population, further improvements to working conditions are necessary., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Tran 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.)

The rapid advancements in technology have paved the way for innovative solutions in the healthcare domain, aiming to improve scalability and security while enhancing patient care. This abstract introduces a cutting-edge approach, leveraging blockchain technology and hybrid deep learning techniques to revolutionize healthcare systems. Blockchain technology provides a decentralized and transparent framework, enabling secure data storage, sharing, and access control. By integrating blockchain into healthcare systems, data integrity, privacy, and interoperability can be ensured while eliminating the reliance on centralized authorities. In conjunction with blockchain, hybrid deep learning techniques offer powerful capabilities for data analysis and decision making in healthcare. Combining the strengths of deep learning algorithms with traditional machine learning approaches, hybrid deep learning enables accurate and efficient processing of complex healthcare data, including medical records, images, and sensor data. This research proposes a permissions-based blockchain framework for scalable and secure healthcare systems, integrating hybrid deep learning models. The framework ensures that only authorized entities can access and modify sensitive health information, preserving patient privacy while facilitating seamless data sharing and collaboration among healthcare providers. Additionally, the hybrid deep learning models enable real-time analysis of large-scale healthcare data, facilitating timely diagnosis, treatment recommendations, and disease prediction. The integration of blockchain and hybrid deep learning presents numerous benefits, including enhanced scalability, improved security, interoperability, and informed decision making in healthcare systems. However, challenges such as computational complexity, regulatory compliance, and ethical considerations need to be addressed for successful implementation. By harnessing the potential of blockchain and hybrid deep learning, healthcare systems can overcome traditional limitations, promoting efficient and secure data management, personalized patient care, and advancements in medical research. The proposed framework lays the foundation for a future healthcare ecosystem that prioritizes scalability, security, and improved patient outcomes.

Respiratory health problems in poultry production are frequent and knotty and thus attract the attention of farmers and researchers. The breakthrough of gene sequencing technology has revealed that healthy lungs harbor rich microbiota, whose succession and homeostasis are closely related to lung health status, suggesting a new idea to explore the mechanism of lung injury in broilers with pulmonary microbiota as the entry point. This study aimed to investigate the succession of pulmonary microbiota in healthy broilers during the growth cycle. Fixed and molecular samples were collected from the lungs of healthy broilers at 1, 3, 14, 21, 28, and 42 d of age. Lung tissue morphology was observed by hematoxylin and eosin staining, and the changes in the composition and diversity of pulmonary microbiota were analyzed using 16S rRNA gene sequencing. The results showed that lung index peaked at 3 d, then decreased with age. No significant change was observed in the α diversity of pulmonary microbiota, while the β diversity changed regularly with age during the broilers' growth cycle. The relative abundance of dominant bacteria of Firmicutes and their subordinate Lactobacillus increased with age, while the abundance of Proteobacteria decreased with age. The correlation analysis between the abundance of differential bacteria and predicted function showed that dominant bacteria of Firmicutes, Proteobacteria and Lactobacillus were significantly correlated with most functional abundance, indicating that they may involve in lung functional development and physiological activities of broilers. Collectively, these findings suggest that the lung has been colonized with abundant microbiota in broilers when they were just hatched, and their composition changed regularly with day age. The dominant bacteria, Firmicutes, Proteobacteria, and Lactobacillus, play crucial roles in lung function development and physiological activities. It paves the way for further research on the mechanism of pulmonary microbiota-mediated lung injury in broilers., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To conduct a cultural adaptation and validation of the Champion Health Belief Model Scale (CHBMS) for colorectal cancer (CRC) screening (CHBMS-CRC-M) in order to assess and investigate perceptions and beliefs about CRC screening in Malaysia., Designs and Participants: The results from an evidence synthesis and the outcomes from an expert panel discussion were used to shape CHBMS scale content into an assessment of beliefs about CRC screening (CHBMS-CRC). This questionnaire assessment was translated into the official language of Malaysia. An initial study tested the face validity of the new scale or questionnaire with 30 men and women from various ethnic groups. Factorial or structural validity was investigated in a community sample of 954 multiethnic Malaysians., Setting: Selangor state, Malaysia., Results: The new scale was culturally acceptable to the three main ethnic groups in Malaysia and achieved good face validity. Cronbach's alpha coefficients ranged from 0.66 to 0.93, indicating moderate to good internal consistency. Items relating to perceived susceptibility to CRC 'loaded' on Factor 1 (with loadings scoring above 0.90); perceived benefits of CRC screening items loaded on factor 2 and were correlated strongly (loadings ranged between 0.63 and 0.83) and perceived barriers (PBA) to CRC screening (PBA) items loaded on factor 3 (range 0.30-0.72)., Conclusion: The newly developed CHBMS-CRC-M fills an important gap by providing a robust scale with which to investigate and assess CRC screening beliefs and contribute to efforts to enhance CRC screening uptake and early detection of CRC in Malaysia and in other Malay-speaking communities in the region., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Precision medicine has emerged as a transformative approach to healthcare, aiming to deliver personalized treatments and therapies tailored to individual patients. However, the realization of precision medicine relies heavily on the availability of comprehensive and diverse medical data. In this context, blockchain-enabled federated learning, coupled with electronic medical records (EMRs), presents a groundbreaking solution to unlock revolutionary insights in precision medicine. This abstract explores the potential of blockchain technology to empower precision medicine by enabling secure and decentralized data sharing and analysis. By leveraging blockchain's immutability, transparency, and cryptographic protocols, federated learning can be conducted on distributed EMR datasets without compromising patient privacy. The integration of blockchain technology ensures data integrity, traceability, and consent management, thereby addressing critical concerns associated with data privacy and security. Through the federated learning paradigm, healthcare institutions and research organizations can collaboratively train machine learning models on locally stored EMR data, without the need for data centralization. The blockchain acts as a decentralized ledger, securely recording the training process and aggregating model updates while preserving data privacy at its source. This approach allows the discovery of patterns, correlations, and novel insights across a wide range of medical conditions and patient populations. By unlocking revolutionary insights through blockchain-enabled federated learning and EMRs, precision medicine can revolutionize healthcare delivery. This paradigm shift has the potential to improve diagnosis accuracy, optimize treatment plans, identify subpopulations for clinical trials, and expedite the development of novel therapies. Furthermore, the transparent and auditable nature of blockchain technology enhances trust among stakeholders, enabling greater collaboration, data sharing, and collective intelligence in the pursuit of advancing precision medicine. In conclusion, this abstract highlights the transformative potential of blockchain-enabled federated learning in empowering precision medicine. By unlocking revolutionary insights from diverse and distributed EMR datasets, this approach paves the way for a future where healthcare is personalized, efficient, and tailored to the unique needs of each patient.

Introduction: Hypertension, a major health concern, is associated with significant mortality and disease burden worldwide, including Vietnam. Comprehensive interventions targeting medication, lifestyle modifications, dyslipidemia (DLP), and microalbuminuria (MAU) are vital for effective hypertension management and reducing the risk of cardiovascular disease complications (CDV). While medication interventions have proven efficacy, the evidence regarding the effectiveness of community-based health education interventions in managing DLP and MAU is limited. Therefore, this study aims to evaluate the effectiveness of community health education interventions in reducing hypertension risk factors and achieving hypertension management objectives, as well as managing DLP and MAU among hypertension patients., Methods: A quasi-experimental study was conducted on 330 hypertensive patients with dyslipidemia (DLP) and/or microalbuminuria (MAU) who were divided into a control group (n = 164) and an intervention group (n = 166). The control group received standard national hypertension management, while the intervention group received additional intensive health education provided by trained volunteers. The effectiveness of the intervention was assessed by comparing outcomes such as lifestyle factors, BMI control, treatment adherence, hypertension control, and DLP and MAU status between the two groups before and after a two-year intervention period., Results: The health education intervention resulted in significant reductions in dietary risk factors, specifically in fruit and vegetable consumption ( p < 0.001). There was a lower prevalence of high salt intake in the intervention group compared to the control group ( p = 0.002), while no significant differences were observed in other dietary factors. Smoking habits and low physical activity significantly decreased in the intervention group, with a notable disparity in physical activity proportions ( p < 0.001). Both groups showed significant improvements in achieving hypertension management targets, with the intervention group demonstrating superior outcomes. The intervention was effective in reducing the prevalence of risk factors, particularly treatment non-adherence, blood pressure control, and low physical activity. Additionally, the intervention group had a higher likelihood of achieving DLP and MAU control compared to the control group., Conclusions: This study underscored the additional positive impact of incorporating health education by non-professional educators in achieving favorable outcomes, including better control of BMI, blood pressure, medication adherence, and management of dyslipidemia (DLP) and microalbuminuria (MAU). Further research is warranted to fully explore the potential of health education in primary healthcare settings and maximize its effectiveness.