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The frequency of virus-associated cancers is growing worldwide, especially in resource-limited settings. One of the biggest challenges in cancer research among people living with HIV (PLWH) has been understanding how infection with both HIV and Kaposi sarcoma-associated herpesvirus (KSHV) promotes the pathogenesis of Kaposi sarcoma (KS), the most common cancer among PLWH worldwide and a significant public health problem in regions with high prevalence of HIV such as Sub-Saharan Africa (SSA). The AIDS and Cancer Specimen Resource (ACSR) provides samples for research, including dried blood spots (DBS) that were collected from large clinical epidemiology studies of KSHV and KS in PLWH conducted more than a decade ago in SSA. Here, we validated the quality of DNA derived from DBS samples from SSA studies and provided evidence of quantitative recovery of inflammatory cytokines using these DBS samples through comparison with paired frozen plasma. Significant differences in DNA, protein yields, and inflammatory biomarker levels were also observed between PLWH with/without KS. Establishing the fitness of DBS samples for studies of KS pathogenesis extends the number of projects that can be supported by these ACSR special collections and provides evidence that DBS collection for future KS research is a practical option in resource-limited settings.

Advancements in artificial intelligence (AI) for point-of-care ultrasound (POCUS) have ushered in new possibilities for medical diagnostics in low-resource settings. This review explores the current landscape of AI applications in POCUS across these environments, analyzing studies sourced from three databases-SCOPUS, PUBMED, and Google Scholars. Initially, 1196 records were identified, of which 1167 articles were excluded after a two-stage screening, leaving 29 unique studies for review. The majority of studies focused on deep learning algorithms to facilitate POCUS operations and interpretation in resource-constrained settings. Various types of low-resource settings were targeted, with a significant emphasis on low- and middle-income countries (LMICs), rural/remote areas, and emergency contexts. Notable limitations identified include challenges in generalizability, dataset availability, regional disparities in research, patient compliance, and ethical considerations. Additionally, the lack of standardization in POCUS devices, protocols, and algorithms emerged as a significant barrier to AI implementation. The diversity of POCUS AI applications in different domains (e.g., lung, hip, heart, etc.) illustrates the challenges of having to tailor to the specific needs of each application. By separating out the analysis by application area, researchers will better understand the distinct impacts and limitations of AI, aligning research and development efforts with the unique characteristics of each clinical condition. Despite these challenges, POCUS AI systems show promise in bridging gaps in healthcare delivery by aiding clinicians in low-resource settings. Future research endeavors should prioritize addressing the gaps identified in this review to enhance the feasibility and effectiveness of POCUS AI applications to improve healthcare outcomes in resource-constrained environments.

Background: Multimorbidity is associated with significant out-of-pocket expenditures (OOPE) and catastrophic health expenditure (CHE), especially in low- and middle-income countries like India. Despite this, there is limited research on the financial burden of multimorbidity in outpatient and inpatient care, and cross-state comparisons of CHE are underexplored. Methods: We conducted a cross-sectional analysis using nationally representative data from the National Sample Survey 75th Round 'Social Consumption in India: Health (2017–18)', focusing on patients aged 30 and above in outpatient and inpatient care in India. We assessed multimorbidity prevalence, OOPE, CHE incidence, and CHE intensity. Statistical models, including linear, log-linear, and logistic regressions, were used to examine the financial risk, with a focus on non-communicable diseases (NCDs), healthcare facility choice, and socioeconomic status and Epidemiological Transition Levels (ETLs). Results: Multimorbidity prevalence in outpatient care (6.1%) was six times higher than in inpatient care (1.1%). It was most prevalent among older adults, higher MPCE quintiles, urban patients, and those with NCDs. Multimorbidity was associated with higher OOPE, particularly in the rich quintile, patients seeking care from private providers, low ETL states, and rural areas. CHE incidence was highest in low ETL states, private healthcare users, poorest quintile, males, and patients aged 70 + years. CHE intensity, measured by mean positive overshoot, was greatest among the poorest quintile, low ETL states, rural, and male patients. Log-linear and logistic regressions indicated that multimorbidity patients with NCDs, those seeking private care, and those in low ETL states had higher OOPE and CHE risk. The poorest rural multimorbidity patients had the greatest likelihood of experiencing CHE. Furthermore, CHE intensity was significantly elevated among multimorbidity patients with NCDs (95% CI: 19.29–45.79), patients seeking care in private, poorest, and from low ETL states (95% CI: 7.36–35.79). Conclusions: The high financial burden of OOPE and CHE among multimorbidity patients, particularly those with NCDs, highlight the urgent need for comprehensive health policies that address financial risk at the primary care level. To alleviate the financial burden among multimorbidity patients, especially in low-resource settings, it is crucial to expand public healthcare coverage, incorporate outpatient care into financial protection schemes, advocate for integrated care models and preventive strategies, establish standardized treatment protocols for reducing unnecessary medications linked to polypharmacy, and leverage the support of digital health technologies. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes is escalating globally, underscoring the need for comprehensive evidence to inform health systems in effectively addressing this epidemic. The purpose of this study was to examine the patterns of countries' capacity to manage diabetes using latent class analysis (LCA) and to determine whether the patterns are associated with diabetes-related deaths and healthcare costs. Methods: Eight indicators of country-level capacity were drawn from the World Health Organization Global Health Observatory dataset: the widespread availability of hemoglobin A1C (HbA1c) testing, existence of diabetes registry, national diabetes management guidelines, national strategy for diabetes care, blood glucose testing, diabetic retinopathy screening, sulfonylureas, and metformin in the public health sector. We performed LCA of these indicators, testing 1–5 class solutions, and selecting the best model based on Bayesian Information Criteria (BIC), entropy, corrected Akaike Information Criteria (cAIC), as well as theoretical interpretability. Multivariable linear regression was used to assess the association between capacity to manage diabetes (based on the latent class a country belongs) and diabetes-related deaths and healthcare costs. Results: We included 194 countries in this secondary analysis. Countries were classified into "high capacity" (88.7%) and "limited capacity" (11.3%) countries based on the two-class solution of the LCA (entropy = 0.91, cAIC = 1895.93, BIC = 1862.93). Limited capacity countries were mostly in Africa. Limited capacity countries had significantly higher percentage of their deaths attributable to diabetes (adjusted beta = 1.34; 95% CI: 0.15, 2.53; p = 0.027) compared to high capacity countries even after adjusting for income status and diabetes prevalence. Conclusions: Our findings support the report by the Lancet commission on diabetes, which suggests that differences in diabetes outcomes among countries may be explained by variations in the capacity of and investments made in their health systems. Future studies should evaluate initiatives such as the WHO Global Diabetes Compact that are currently underway to improve the capacity of resource-limited countries. [ABSTRACT FROM AUTHOR]

Background: In Cameroon, like in many other resource-limited countries, data generated by health settings including morbidity and mortality parameters are not always uniform. In the absence of a national guideline necessary for the standardization and harmonization of data, precision of data required for effective decision-making is therefore not guaranteed. The objective of the present study was to assess the reporting style of morbidity and mortality data in healthcare settings. Methods: An institutional-based cross-sectional study was carried out from May to June 2022 at the Yaoundé Central Hospital. A questionnaire was used to assess the need to set up a standard tool to improve the reporting system. Medical records were used to collect mortality and morbidity data which were then compared to the International Statistical Classification of Diseases and Related Health Problems-11 (ICD-11) codification. Data were analyzed using IBM-SPSS version 26. Results: Out of 200 patients' morbidity causes recorded, nearly three-quarter (74.0%) were heterogeneous, and two over five (41.0%) of mortality causes reported were also heterogeneous. Most of respondents stated the need to set up a standard tool for collecting mortality and morbidity data (83.6%). Less than one-fifth (18.2%) of health care providers were able to understand data flow, correctly archived data (36.6%) and used electronic tools for data quality control (40.0%). Conclusion: There were high levels of heterogeneities of morbidity and mortality causes among patients admitted to the Yaoundé Central Hospital in 2021. It is therefore urgent that Cameroon national health authorities implement the ICD-11 to allow the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in Yaoundé Central Hospital at different times; and ensure interoperability and reusability of recorded data for medical decision support. [ABSTRACT FROM AUTHOR]

Background: Measures of diagnostic test accuracy provide evidence of how well a test correctly identifies or rules-out disease. Commonly used diagnostic accuracy measures (DAMs) include sensitivity and specificity, predictive values, likelihood ratios, area under the receiver operator characteristic curve (AUROC), area under precision-recall curves (AUPRC), diagnostic effectiveness (accuracy), disease prevalence, and diagnostic odds ratio (DOR) etc. Most available analysis tools perform accuracy testing for a single diagnostic test using summarized data. We developed a SAS macro for evaluating multiple diagnostic tests using individual-level data that creates a 2 × 2 summary table, AUROC and AUPRC as part of output. Methods: The SAS macro presented here is automated to reduce analysis time and transcription errors. It is simple to use as the user only needs to specify the input dataset, "standard" and "test" variables and threshold values. It creates a publication-quality output in Microsoft Word and Excel showing more than 15 different accuracy measures together with overlaid AUROC and AUPRC graphics to help the researcher in making decisions to adopt or reject diagnostic tests. Further, it provides for additional variance estimation methods other than the normal distribution approximation. Results: We tested the macro for quality control purposes by reproducing results from published work on evaluation of multiple types of dried blood spots (DBS) as an alternative for human immunodeficiency virus (HIV) viral load (VL) monitoring in resource-limited settings compared to plasma, the gold-standard. Plasma viral load reagents are costly, and blood must be prepared in a reference laboratory setting by a qualified technician. On the other hand, DBS are easy to prepare without these restrictions. This study evaluated the suitability of DBS from venous, microcapillary and direct spotting DBS, hence multiple diagnostic tests which were compared to plasma specimen. We also used the macro to reproduce results of published work on evaluating performance of multiple classification machine learning algorithms for predicting coronary artery disease. Conclusion: The SAS macro presented here is a powerful analytic tool for analyzing data from multiple diagnostic tests. The SAS programmer can modify the source code to include other diagnostic measures and variance estimation methods. By automating analysis, the macro adds value by saving analysis time, reducing transcription errors, and producing publication-quality outputs. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionsMetastatic retinoblastoma remains a significant challenge in pediatric oncology, with stark disparities in survival outcomes between high-income countries (HICs) and low-income countries (LICs). Delayed diagnosis and treatment, driven by socioeconomic factors and limitations in healthcare systems, contribute to poorer outcomes in LICs. Histopathological characteristics, including high-risk pathology factors (HRPFs) and the extent of ocular tumor invasion, are critical for predicting metastatic risk and guiding treatment strategies.This review examines the role of clinical, histopathological, and molecular characteristics in assessing metastatic risk in retinoblastoma. Literature on HRPFs, tumor invasion, and molecular subtypes was analyzed to understand their impact on risk stratification and therapy optimization, particularly in resource-limited settings.Retinoblastoma is increasingly recognized as a heterogeneous disease with at least two distinct molecular subtypes. High-risk cases frequently exhibit genetic alterations that underscore the need to incorporate molecular profiling into risk assessment. Current adjuvant therapy approaches, however, vary widely, and debates persist regarding their necessity based on tumor characteristics. Integrated strategies that combine clinical, histopathological, and molecular data show promise in improving management and survival outcomes.Addressing the disparities in metastatic retinoblastoma outcomes requires a multifaceted approach. By integrating clinical, histopathological, and molecular insights, management strategies can be optimized to improve survival, particularly in resource-limited settings where challenges are most pronounced. [ABSTRACT FROM AUTHOR]

Introduction: Video feedback, particularly with a head-mounted camera, has previously been described as a useful debriefing tool in well-funded health systems but has never been performed in a low-resource environment. The purpose of this randomized, intervention-controlled study is to evaluate the feasibility of using video feedback with a head-mounted camera during intestinal anastomosis simulation training in a low-resource setting. Methodology: This study recruited 14 first-year surgery residents in Senegal, who were randomized into control and camera groups. Both groups received reading materials and video lectures before performing a manual end-to-end intestinal anastomosis using a synthetic model. The control group received oral feedback, while the camera group's first attempt was recorded, reviewed, and discussed before the second attempt. The primary outcomes were OSATS scores and completion time. Results: There were no significant demographic differences between the groups. Both groups showed significant improvement in OSATS scores from the first to the second attempt (control group: p = 0.002; camera group: p = 0.0021). The camera group demonstrated a significant reduction in completion time on the second attempt (p = 0.0038), unlike the control group (p = 0.17). Both groups reported increased confidence in performing the task (control group: p = 0.003; camera group: p = 0.0029) and had positive perceptions of the workshop's effectiveness. Conclusion: This pilot study suggests that video feedback with a head-mounted camera is feasible and effective for debriefing during intestinal anastomosis simulation training in a low-resource setting, offering a low-cost, effective way to enhance technical skills. Further research with larger sample sizes is recommended to validate these findings and explore long-term impacts on surgical proficiency. [ABSTRACT FROM AUTHOR]

Background: Salmonella and Shigella are major enteric pathogens that cause diarrhea in children worldwide. They are pathogenic microbes that cause significant diarrheal morbidity and mortality in under five children in resource limited countries. Thus, this systemic review and meta-analysis aimed to investigate the prevalence of Salmonella and Shigella species and their multidrug resistance patterns in pediatric populations in Ethiopia. Methods: The articles were searched extensively in the electronic databases and grey literature using entry terms or phrases. Studies meeting the eligibility criteria were extracted in MS Excel and exported for statistical analysis into STATA version 14 software. The overall pooled prevalence of Salmonella and Shigella species was computed using a random-effects model. Heterogeneity was assessed using the Cochrane Q test and I2 statistics with corresponding p-values. Publication bias was assessed using a funnel plot and Egger's test. In addition, sensitivity analysis was performed to determine the impact of individual studies on the pooled effect size. Result: Of a total of 742 identified studies, 89 studies were eligible for full-text analysis. Of 89 studies, 21 were included for meta-analysis involving 5318 study participants. These eligible studies reported a total of 593 bacterial isolates. The overall pooled prevalence of Salmonella and Shigella among pediatrics in Ethiopia was 10.70% (95% CI: 8.96–12.45), with substantial heterogeneity (I2 = 82.1%, p < 0.001) across the studies. The pooled prevalence of Salmonella and Shigella individually among pediatrics in Ethiopia was 15.43% (95% CI: 10.42–20.72) and 15.83% (95% CI: 11.40–20.40), respectively. Moreover, the overall prevalence of multidrug resistance in Salmonella and Shigella isolates was 81.03% (95% CI: 77.39–84.67) with substantial heterogeneity of I2 of 95%, p < 0.0001 between the pooled prevalence of the two species. Conclusion: The pooled prevalence of Salmonella and Shigella and their multidrug resistance were alarmingly high in pediatric. The initial empirical treatment of pediatrics patients remains challenging and results high prevalence of antimicrobial resistance. Thus, appropriate infection prevention and control strategies should be implemented and treatment should be directed based on antimicrobial stewardship protocols. [ABSTRACT FROM AUTHOR]

Introduction: Effective antimicrobial stewardship programs require data on antimicrobial consumption (AMC) and utilization (AMU) to guide interventions. However, such data is often scarce in low-resource settings. We describe the consumption and utilization of antibiotics at a large tertiary-level hospital in Uganda. Methods: In this cross-sectional study at Kiruddu National Referral Hospital, we analyzed medicine delivery records for the period July 2021 to June 2022, accessed on 12/08/2022, to extract AMC data expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID). We used the WHO point prevalence survey (PPS) to analyze AMU data with a systematic sampling of outpatient department (OPD) for a period between June and August 2022 and selected all inpatient department (IPD) patients admitted before 8:00 AM on 27/11/2022. AMU data was analyzed as the proportion of individual antibiotic prescriptions, indications for prescriptions, and compliance with the national treatment guidelines. Both AMC and AMU data were categorized by the WHO AWaRe (access, watch, and reserve) criteria. Results: In the year 2021–2022, a total of 6.05 DID of antibiotics were consumed comprising 3.61 DID (59.6%) access, 2.44 DID (40.3%) watch, and 0.003 (0.1%) reserve antibiotics. The most consumed antibiotics comprised penicillin (1.61 DID, 26.7%), cephalosporins (1.51, 25%), and imidazole (1.10 DID, 18.1%). A total of 119/211 (56%) patients in the OPD and 99/172 (57.5%) patients in the IPD were prescribed antibiotics. Of the 158 OPD antibiotic prescriptions, 73 (46.2%) were access, 72 (45.6%) were watch, 0 (0%) were reserve, and 13 (8.2%) were unclassified antibiotics. Of the 162 IPD antibiotic prescriptions, 62 (38.3%) were access, 88 (54.3%) were watch, 01 (0.6%) was reserve, and 11 (6.8%) were unclassified antibiotics. Indications for antibiotic prescriptions in the OPD comprised respiratory tract infections (53, 38.1%), urinary tract infections (34, 26.6%), gastrointestinal infections (20, 14.4%), sepsis (17, 12.2%), and medical prophylaxis (12, 8.7%). The indications for antibiotic prescriptions in the IPD comprised sepsis (28.2%), respiratory tract infections (18.3%), burn wounds (14.1%), and gastrointestinal infections (14.1%). Conclusion: Prescription of watch antibiotics in both OPD and IPD hospital settings was high. Establishment of robust antimicrobial stewardship measures could help improve the rational prescription of antibiotics. [ABSTRACT FROM AUTHOR]

Background: Despite existing policies promoting companionship, it remains uncommon in Tanzania. Pregnant women select a trusted individual to accompany them during childbirth, providing emotional, physical, and spiritual support. The World Health Organization recommends birth companionship as integral to intrapartum care for positive maternal and fetal outcomes. Objective: This study aimed to explore the experiences of pregnant women and healthcare providers regarding childbirth companionship at a tertiary health facility in Tanzania. Methods: Participants were purposefully selected for qualitative exploratory interviews. Focused group discussions were conducted with pregnant women attending antenatal clinics, and in-depth interviews were held with healthcare providers at Mbeya Zonal Referral Hospital in Tanzania. Braun and Clarke's six-step thematic analysis approach was used to analyze the data. Results: Three major themes emerged: "Bonding and Learning with Spouse/Partner," "Assurance of Maternal Safety," and "Fear of Blame and Breach of Confidentiality." These themes highlight a strong desire among both pregnant women and healthcare providers for companionship during labor, particularly from male partners. Emotional support and safety were cited as key reasons. Fear, however, was identified as a major obstacle, with providers concerned about potential exposure of mistakes and pregnant women fearing a violation of their privacy rights regarding health matters. Conclusion: Pregnant women expressed a strong desire for companionship throughout labor. However, companionship faced challenges due to staff shortages and inadequate privacy in labor wards. There is a pressing need to enhance childbirth companionship practices and policies in low-resource settings. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has highlighted the need for more effective immunization programs, including in limited resource settings. This paper presents outcomes and lessons learnt from a COVID-19 vaccination campaign (VC), which used a tailored adaptive strategy to optimise vaccine uptake in the Boeny region of Madagascar. Methods: Guided by the Dynamic Sustainability Framework (DSF), the VC implementation was regularly reviewed through multi-sectoral stakeholder feedback, key informant interviews, problem-solving meetings, and weekly monitoring of outcome indicators to identify and apply key adaptations. Qualitative data on processes were collected and analysed using a rapid assessment approach. Outcome indicators, including pre- and post-VC vaccine hesitancy and trends in vaccine doses administered, were analysed using generalized linear models. Additionally, vaccination coverage, geographic reach, and target population characteristics, and sustainability indicators, such as staff trained, facilities equipped, and degree of integration of operational and educational materials were also tracked. Results: Key strategy adaptations included using a proactive campaign approach, community-led awareness and outreach, particularly in remote areas, and addressing cold chain, waste management, vaccine transport, and information technology (IT) equipment gaps. Over six months, 24,888 COVID-19 vaccines were administered. The adapted strategy led to an 8% increase in doses administered weekly (RR = 1.08, CI 95%: 1.01-1.15). However, vaccine hesitancy among the unvaccinated population remained unchanged (∆ = 0.02, CI 95%: -0.04-0.08). In terms of sustainability, 340 staff were trained, and 10 primary healthcare facilities were equipped and refurbished. Conclusions: Implementing collaborative, multi-sectoral vaccination strategies that integrate healthcare services with proactive outreach and community-driven campaigns are effective in increasing vaccine coverage in resource-limited settings. It demonstrates how theory-based adaptive strategies can enhance vaccination rates, even if they do not significantly impact COVID-19 vaccine hesitancy within the community. More generally, this initiative has important implications for adult vaccination programmes other than those related to COVID-19. [ABSTRACT FROM AUTHOR]

Background: Reference intervals (RIs) are crucial for distinguishing healthy from sick individuals and vary across age groups. Hemoglobinopathies are common in Pakistan, making the quantification of hemoglobin variants essential for screening. Direct RIs are established by measuring values from a healthy reference population, whereas indirect RIs, use statistical analysis of routine lab data to estimate values, making it feasible in settings where direct data is unavailable. Since Pakistan lacks locally established Hemoglobin A2 RIs for infants, this study aims to fill that gap using an indirect data mining method to improve diagnostic accuracy for hemoglobinopathies. Methods: It was a retrospective observational study. Hemoglobin A2 measurements from all patients aged birth to 1 year between January 2015 and December 2022 were retrieved from the laboratory management system at Aga Khan University Hospital. The study population represented the entire geographical distribution of the country. Hemoglobin A2 was measured using the Bio-Rad Variant™ II analyzer. RIs were computed using an indirect KOSMIC algorithm, which assumes non-pathologic samples follow a Gaussian distribution after Box-Cox transformation. Results: A total of 88,690 specimens were analyzed for HbA2. After excluding patients with multiple specimens, RIs were calculated for 22,713 infants, stratified into five age sub-groups. The 2.5th and 97.5th percentile results showed good agreement with RIs from Mayo Clinic Laboratories. Conclusions: This study supports data mining as an alternative method for establishing HbA2 RIs, especially in resource-limited settings. The results are specific to the studied population, instrument, and reagent, and they elucidate the fluctuations in HbA2 synthesis with age. These intervals will enhance clinical decision-making based on HbA2 results. [ABSTRACT FROM AUTHOR]

Climate change is an emerging global health crisis, disproportionately affecting low- and middle-income countries (LMICs) where health outcomes are increasingly compromised by environmental stressors such as pollution, natural disasters, and human migration. With a focus on promoting health equity, Global Surgery advocates for expanding access to surgical care and enhancing health outcomes, particularly in resource-limited and disaster-affected areas like LMICs. The healthcare industry—and more specifically, surgical care—significantly contributes to the global carbon footprint, primarily through resource-intensive settings, i.e. operating rooms that generate greenhouse gases and substantial medical waste. Therefore, Global Surgery efforts aimed at improving surgical access through an increase in surgical volumes may inadvertently exacerbate health challenges for vulnerable populations by further contributing to environmental degradation. This predicament is particularly pronounced in LMICs, who already suffer from a disproportionate share of the global burden of disease, and where the demand for surgery is rising without corresponding resilient infrastructure. LMICs face a double jeopardy of health inequity coupled with climate vulnerability. As a movement positioned to improve health around the world, Global Surgery has an increasingly significant role in envisioning and ensuring a sustainable future. Global Surgery initiatives must prioritise sustainable infrastructure in both high-income countries (HICs) and LMICs, all while accounting for the unequal polluting contributions between HICs and LMICs and, consequently, moral responsibilities moving forward. Moreover, through targeting upstream causes of poor health at urban and perioperative levels, Global Surgery's interventions may help to reduce the global burden of disease—avoiding preventable surgeries and their carbon footprints from the outset. Altogether, Global Surgery and climate change are two matters of social justice whose solutions must synergistically centralise the health of both the planet and its most vulnerable people. [ABSTRACT FROM AUTHOR]

AbstractAflatoxin B1 (AFB1) and fumonisin B1 (FB1) are toxic secondary products of fungi that frequently contaminate staple crops in resource-limited settings. Antenatal AFB1 and FB1 exposure may cause adverse birth outcomes. We conducted a retrospective substudy nested in a case-control cohort of HIV-infected and HIV-uninfected women ≥20 weeks gestation from Harare, Zimbabwe. Urinary aflatoxin M1 (AFM1) and FB1, biomarkers of AFB1 and FB1 exposure, respectively, were quantified in random antenatal urine via ELISA and grouped into tertiles. The adverse birth outcomes considered were low birth weight, preterm birth (PTB), small for gestational age, stillbirth, birth defects, neonatal death, neonatal jaundice and perinatal death (PD). We evaluated any associations between adverse birth outcomes and exposure to AFB1, FB1, or the AFB1-FB1 combination via a multivariable logistic regression controlled for potential confounders. We enrolled 94 HIV-infected and 81 HIV-uninfected women. In HIV-infected, AFM1 was detected in 46/94 (49%), and FB1 was detected in 86/94 (91%). In HIV-uninfected, AFM1 was detected in 48/81 (59%), and FB1 was detected in 74/81 (91%). Among all women, AFM1 tertile 3 was associated with PD (OR: 6.95; 95% CI: 1.21-39.78). In the same population, AFM1 tertiles 2 (OR: 13.46; 95% CI: 1.20-150.11) and 3 (OR: 7.92; 95% CI: 1.08-58.19) were associated with PTB. In HIV-infected, AFM1 tertile 2 was associated with PTB (OR: 64.73; 95% CI: 2.37-177.93). Our results revealed an association between AFB1 exposure and PD and PTB in women, including those infected with HIV. Public health and nutrition measures are necessary to mitigate mycotoxins. [ABSTRACT FROM AUTHOR]

Background: The blended learning (BL) approach to training health care professionals is increasingly adopted in many countries because of high costs and disruption to service delivery in the light of severe human resource shortage in low resource settings. The Covid-19 pandemic increased the urgency to identify alternatives to traditional face-to-face (f2f) education approach. A four-day f2f antenatal care (ANC) and postnatal care (PNC) continuous professional development course (CPD) was repackaged into a 3-part BL course; (1) self-directed learning (16 h) (2) facilitated virtual sessions (2.5 h over 3 days) and (3) 2-day f2f sessions. This study assessed the feasibility, change in healthcare providers' knowledge and costs of the BL package in Nigeria, Tanzania, and Kenya. Methods: A mixed methods design was used. A total of 89 healthcare professionals, were purposively selected. Quantitative data was collected through an online questionnaire and skills assessments, analyzed using STATA 12 software. Qualitative data was collected through key informant interviews and focus group discussions, analysed using thematic analysis. Results: Majority of participants (86%) accessed the online sessions using a mobile phone from home and health facilities. The median (IQR) time of completing the self-directed component was 16 h, IQR (8, 30). A multi-disciplinary team comprising of 42% nurse-midwives, 28% doctors, 20% clinical officers and 10% other healthcare professionals completed the BL course. Participants liked the BL approach due to its flexibility in learning, highly educative/relevant content, mixing of health worker cadres and CPD points. Aspects that were noted as challenging were related to personal log-in details and network connectivity issues during the self-directed learning and facilitated virtual sessions respectively. Conclusion: The blended learning approach to ANC-PNC in-service training was found to be acceptable, feasible and cost less to implement compared to face-to-face training approach in the study settings. The BL training approach was effective in improving the knowledge and skills of healthcare providers who participated in the training. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Interstitial lung disease (ILD) encompasses a heterogeneous group of disorders characterized by inflammation and fibrosis of lung tissue, leading to impaired gas exchange and respiratory failure. The GAP index, based on gender, age, and pulmonary function, predicts mortality and disease severity in patients with ILD. High-resolution computed tomography (HRCT) is a critical diagnostic tool that provides detailed information on lung morphology and disease extent. This study aims to investigate the relationship between HRCT patterns and the GAP index in patients with ILD, enhancing disease staging and prognostication. Objectives: 1. To identify various radiological patterns in ILD patients using HRCT of the thorax. 2) To correlate these radiological patterns with the GAP index and verify the relationship mentioned above. Materials and Methods: This retrospective observational study analyzed data from 154 patients with ILD treated at Victoria Hospital, Bangalore Medical College and Research Institute, from January 2021 to September 2023. The inclusion criteria included patients aged ≥ 18 years diagnosed with ILD based on the ATS/ERS criteria. Thoracic HRCT was performed using a Philips Ingenuity 128-slice CT scanner, and pulmonary function tests (PFTs) were conducted using a Power cube Diffusion Plus spirometer. The GAP score was calculated, and the HRCT patterns were compared with the GAP stages. Statistical analyses were performed using IBM SPSS Statistics software. Results: The study population had a mean age of 55.5 years, consisting of 68 males and 86 females. Shortness of breath (97.4%) and cough (87.7%) were the most common symptoms. Hypertension (31.2%) and diabetes mellitus (28.6%) were the most common comorbidities observed. The prevalence of definitive UIP sharply increased in stage 3 (58.8%) compared to stage 1 (9.5%) and stage 2 (41.5%), with a highly significant P value (<0.0001). In contrast, NSIP was more common in Stage 1 (39.3%) and decreases in later stages, with a significant P value (0.011). Over half of the patients were in GAP Stage 1 (54.5%), with significant correlations found between advancing GAP stages and an increased prevalence of honeycombing (P = 0.0005) and traction bronchiectasis (P = 0.010). The ground-glass opacity decreased with increasing GAP stage (P = 0.035). Conclusion: This study revealed a significant correlation between particular HRCT patterns and GAP index stages in patients with ILD, highlighting the importance of honeycombing and traction bronchiectasis as indicators of advanced disease. This approach is advantageous in both resource-limited settings, where HRCT availability is limited, and in advanced medical centers, as it can help minimize the need for frequent CT scans. [ABSTRACT FROM AUTHOR]

Background: In recent years, laparoscopic hernia repair, i.e. transabdominal pre-peritoneal and totally extraperitoneal repairs have been considered the method of choice, especially for recurrent hernias after open repair or bilateral inguinal hernias. However, they pose numerous challenges such as increased post-operative pain due to tacking or fixation of mesh, chronic pain syndrome due to entrapment of nerves and mesh migration or invagination. A 3-dimensional (3D) mesh was introduced to overcome the shortcomings of a 2-dimensional (2D) mesh which does not conform to inguinal anatomy. However, in a resource-limited country like India, the widespread use of a 3D mesh may not be possible owing to its high cost. Patients and Methods: We included a total of 55 patients in our study who underwent laparoscopic extended totally extraperitoneal repair hernia repair for 1 year beginning from December 2021 to November 2022 with a follow-up of a minimum of 1 year till November 2023. In our study group (n = 27), we used a novel technique of converting a 2D mesh to a 3D mesh, which was subsequently placed without fixation. In our control group (n = 28), we used a standard polypropylene mesh with one-point suture fixation. Results and Conclusions: All patients in our study showed satisfactory post-operative recovery. There was no significant difference in the post-operative pain (assessed by mean Visual Analogue Scores 1.24 ± 0.44 vs. 1.87 ± 0.56; P > 0.1) and the mean length of hospital stay in days (1.12 ± 0.33 vs. 1.16 ± 0.38; P > 0.1), respectively, in the study and control groups. None of our patients showed signs or symptoms of chronic pain or recurrence in our period of follow-up. Our technique of converting 2D to 3D mesh is a safe and feasible approach and maybe a potential alternative to a traditional 3D mesh in resource-limited settings. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance poses a global public health threat, compelling the search for alternative treatments, especially in resource-limited settings. The increasing ineffectiveness of traditional antibiotics has intensified the need to explore medicinal plants as viable therapeutic options. This study sought to compare the efficacy of certain medicinal plants used in Owerri, Nigeria, for treating pathogenic bacteria against traditional commercial antibiotics. We tested graded concentrations (25 mg/ml, 50 mg/ml, 75 mg/ml, and 100 mg/ml) of ethanolic extracts of Awolowo leaf (Chromolaena odorata), Bitter leaf (Vernonia amygdalina), and Lemon grass leaf (Cymbopogon citratus) against Salmonella spp, Klebsiella spp, Escherichia coli, and Staphylococcus aureus employing the agar well diffusion method to measure zones of inhibition. Commercial antibiotics studied included: Pefloxacin, Gentamycin, Ampiclox, Zinnacef, Amoxicillin, Rocephin, Ciprofloxacin, Streptomycin, Septrin and Erythromycin, Sparfloxacin Amoxicillin, Augmentin, and Tarivid. Each experiment was conducted in triplicate to ensure accuracy and reproducibility. Results were analyzed descriptively and presented as mean zones of inhibition and standard deviations. One to three plant species exhibited antibacterial activities (zones of inhibition) across 25–100 mg/ml concentrations. In contrast, some or all antibiotics only exhibited antibacterial activities at 100 mg/ml concentration (none at 25–75 mg/ml concentrations). Zones of inhibition (10.3–14.1 mm) of all three plant species against E.coli and Klebsiella at 100 mg/ml concentration were higher than those of 8–10 antibiotics. C. odorata had shown high zones of inhibition of 11.8 and 11.0 mm against Salmonella spp. and S. aureus at 100 mg/ml concentration, which were higher than those of eight antibiotics. The other two plant species (C. citratus and V. amygdalina) had exhibited low zones of inhibition against Salmonella spp. and S. aureus, which were higher than those of 3 or 4 antibiotics at 100 mg/ml concentration. In general, the antibacterial activities of the three plant species across 25–100 mg/ml concentrations were higher than those of many antibiotics. To a large extent, the efficacy of medicinal plant extracts across different concentrations against bacterial strains was higher than that of many antibiotics. Those plant species have therefore shown some potential to be used as alternative or complementary therapeutics to antibiotics in addressing antibiotic resistance. Since the promising findings were based on an in vitro study, we recommend clinical trials to establish safe and effective doses of those plant extracts in humans. [ABSTRACT FROM AUTHOR]

Background: Individuals diagnosed with tuberculosis (TB) and multidrug‐resistant (MDR) TB may struggle to return to work after they have completed a rehabilitation program. Multidrug‐resistant tuberculosis (MDRTB) has been seen as a condition that is resistant to treatment, hence causing individuals to be economically in‐active for considerable periods of time. Objective: The aim of the current study was to explore the views of individuals living with MDRTB, individuals with TB, and health professionals treating individuals with TB and MDRTB about the development of a vocational rehabilitation program. Method: The researchers used an exploratory descriptive research design, and semistructured interviews were conducted with five key informants and four participants who were diagnosed with pulmonary tuberculosis (PTB) and MDRTB. Thematic analysis was used in order to analyse the study findings. The current study is the second of two articles. The first article focused on barriers and facilitators linked to returning to work for individuals living with TB and MDRTB. The current article focuses on the development of a vocational rehabilitation program. Results: The findings of the original study revealed five themes; however, for the purpose of this article, only two themes will be presented, namely, Theme 1: promoting a holistic model and Theme 2: the use of resources for activity engagement. The latter theme contributed to the participant's view of the development of a vocational rehabilitation program. Conclusion: The study provided a description of the components of a vocational rehabilitation program that has been adapted from the Model of Occupational Self‐Efficacy (MOOSE). The above program has been designed for individuals diagnosed with PTB/MDRTB and has the potential to assist them in returning to work. It is suggested that vocational rehabilitation programs be incorporated into general medical programs that focus on improving the functioning of individuals diagnosed with PTB/MDRTB. [ABSTRACT FROM AUTHOR]

Introduction: Ethiopia has made notable progress in reducing maternal and perinatal mortality, yet challenges remain in meeting the 2030 Sustainable Development Goals. Persistent issues such as low service utilization, coupled with poor quality, fragmented care, and ineffective referral systems hinder progress. The "Improve Primary Health Care Service Delivery (IPHCSD)" project, implemented by JSI and Amref Health Africa since April 2022, seeks to address these gaps through a Networks of Care (NoCs) approach. This paper describes the lessons learned from implementing the NoCs approach to optimize primary health care in Ethiopia. Methods: The project incorporates embedded implementation science, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Key implementation strategies co-designed included strengthening community engagement, establishing NoCs, and introducing quality improvement initiatives using the Model for Improvement. Routine program monitoring data, NoCs process evaluation, and facility service statistics were utilized for this study. Service statistics were analyzed using Student's t-test and interrupted time-series analysis to compare maternal and child care outcomes before and after the NoCs intervention, with counterfactual estimates generated to assess the intervention's impact. Qualitative data from key informant interviews were transcribed, coded, and analyzed to identify themes and patterns using Atlas.ti. Results: The NoCs approach has significantly enhanced relational linkages between primary health care facilities and health care providers, fostering stronger collaboration and communication. This has fostered trust, improved care coordination, optimized primary health care performance, and increased health service utilization within woreda health systems. The interrupted time series analysis indicated that the rate of ANC 8+ visits was 29.8% per month higher than expected without the NoCs strategy (Coef: 2.39; p-value < 0.01) and an 18.4% increase in obstetric complications managed (Coef: 1.71; p-value = 0.050), with a 43% overall increase. Perinatal mortality decreased by 34%, from 31.3 to 20.1 per 1,000 births [t-test: 2.12; p-value: 0.040)]. Conclusion: The NoCs approach in Ethiopia has proven effective in enhancing the relational elements, care coordination, and quality of primary health care services, leading to better maternal and child health outcomes. The findings expand the existing body of research on NoCs implementation best practices and further confirm that it provides a scalable model for strengthening health services in low-resource settings. [ABSTRACT FROM AUTHOR]

Purpose: Ensuring high water quality is crucial for safeguarding public health, as contaminated water can pose significant risks to consumers' well-being. This study aims to evaluate the microbiological and chemical quality of bottled water brands commonly consumed in Dodoma, Tanzania. Design/methodology/approach: A total of 36 samples from 12 brands were collected between January and March 2023 and analyzed for microbiological and general water quality parameters. Findings: Microbial analysis found that 42% of brands tested positive for coliform bacteria, while opportunistic pathogens Aeromonas hydrophila and Pseudomonas aeruginosa were detected in 25% and 17% of samples, respectively. For chemical composition, 42% of brands exceeded the World Health Organization guideline value of 1.5 mg/L for fluoride. However, no other parameters exceeded national drinking water standards. Statistical analysis revealed significantly higher measured fluoride levels compared to values declared on product labels (paired t-test, p = 0.003). A moderate positive correlation between fluoride and conductivity (r = 0.52, p = 0.045) indicated possible geological influences on water chemistry. Research limitations/implications: To enhance the study's comprehensiveness, exploring temporal and spatial variations among water brands, including samples from typically clean environments such as supermarkets, could have been beneficial in identifying underlying factors. Additionally, investigating the entire manufacturing process, from production to end-user, could have provided insights into unforeseen deviations in quality. Furthermore, the use of pour plating techniques at 37°C for microbial analysis, while suitable for resource-limited settings, may not have fully captured coliform diversity compared to membrane filtration and differential temperature incubation as per standard methods. This could partly explain the detection of heterotrophs without higher coliform counts in some samples. Practical implications: This study provides baseline data on the bacteriological and inorganic chemical quality of bottled water in Dodoma. Detectable microbial contaminants and significant exceedances of fluoride guidelines in some products raise public health concerns. Originality/value: While existing studies focus on bottled water quality at production facilities, this research highlights the overlooked risks at retail points, where consumers are directly affected. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The initial 24-h period following admission to a hospital holds profound significance for pediatric patients, representing a critical window where proactive interventions can substantially influence outcomes. We devised a simple triage system, pediatric simple triage score (PSTS), to see whether rapid triage of sick pediatric patients with fever can be done using the new triage system in the emergency department (ED) to predict hospital admission. METHODS: This was a prospective observational study, conducted at the department of emergency medicine of a tertiary care teaching hospital in southern India. A prospective cohort of children presenting to the ED underwent assessment for temperature, oxygen saturation (SpO2), pulse rate, respiratory rate, sensorium, and hydration status. Sensorium was evaluated based on criteria such as poor cry, poor feeding, or decreased activity, while hydration status was assessed using indicators such as decreased urine output, dry mucous membranes, or reduced skin turgor. Subsequently, participants were triaged according to the National Institute for Health and Care Excellence (NICE) guidelines. We then monitored the admission outcomes, whether they were admitted to the intensive care unit (ICU), the ward, or discharged, based on clinical decisions made by the pediatric consultant. RESULTS: In this study involving 350 participants, the mean age was found to be 2.72 years (standard deviation [SD] ±1.78), with a range from 29 days to 5 years. The study population consisted of 60.86% males with a total of 213 patients. Examining vital signs, the mean heart rate was 135.07 beats/min (SD ± 21.58), with a range of 82–200 beats/min. The mean temperature was 37.57°C (SD ± 0.52), with values ranging from 36.80°C to 39.20°C. The mean respiratory rate was 36.28 breaths/min (SD ± 14.06), varying from 20 to 90 breaths/min. SpO2 averaged at 96.31% (SD ± 3.64), with values ranging between 70% and 100%. Abnormal sensorium was observed in 10.86% of the participants, while seizures were reported in 2.57%. Dehydration was present in 3.71% of the study population. Among the study participants, 24.57% were admitted to the ICU, 30.57% to the ward, and 44.86% were treated as outpatients. According to PSTS, 192 (54.86%) participants were triaged to green, 119 (34%) participants to yellow, and 39 (11.14%) participants to red. The PSTS demonstrated a sensitivity of 59.59% and a specificity of 72.61% in predicting hospital admission. The NICE triage system had a sensitivity of 80.31%, in predicting the admission (either ward/ICU), with a specificity of 72.61%. CONCLUSION: The PSTS demonstrated fair agreement with the NICE; it exhibited lower sensitivity and positive predictive value. However, the simplicity of the new system renders it potentially useful, especially in resource-limited settings. [ABSTRACT FROM AUTHOR]

Accurate detection of driver gene mutations is crucial for treatment planning and predicting prognosis for patients with lung cancer. Conventional genomic testing requires high-quality tissue samples and is time-consuming and resource-consuming, and as a result, is not available for most patients, especially those in low-resource settings. We aimed to develop an annotation-free Deep learning-enabled artificial intelligence method to predict GEne Mutations (DeepGEM) from routinely acquired histological slides. In this multicentre retrospective study, we collected data for patients with lung cancer who had a biopsy and multigene next-generation sequencing done at 16 hospitals in China (with no restrictions on age, sex, or histology type), to form a large multicentre dataset comprising paired pathological image and multiple gene mutation information. We also included patients from The Cancer Genome Atlas (TCGA) publicly available dataset. Our developed model is an instance-level and bag-level co-supervised multiple instance learning method with label disambiguation design. We trained and initially tested the DeepGEM model on the internal dataset (patients from the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China), and further evaluated it on the external dataset (patients from the remaining 15 centres) and the public TCGA dataset. Additionally, a dataset of patients from the same medical centre as the internal dataset, but without overlap, was used to evaluate the model's generalisation ability to biopsy samples from lymph node metastases. The primary objective was the performance of the DeepGEM model in predicting gene mutations (area under the curve [AUC] and accuracy) in the four prespecified groups (ie, the hold-out internal test set, multicentre external test set, TCGA set, and lymph node metastases set). Assessable pathological images and multigene testing information were available for 3697 patients who had biopsy and multigene next-generation sequencing done between Jan 1, 2018, and March 31, 2022, at the 16 centres. We excluded 60 patients with low-quality images. We included 3767 images from 3637 consecutive patients (1978 [54·4%] men, 1514 [41·6%] women, 145 [4·0%] unknown; median age 60 years [IQR 52–67]), with 1716 patients in the internal dataset, 1718 patients in the external dataset, and 203 patients in the lymph node metastases dataset. The DeepGEM model showed robust performance in the internal dataset: for excisional biopsy samples, AUC values for gene mutation prediction ranged from 0·90 (95% CI 0·77–1·00) to 0·97 (0·93–1·00) and accuracy values ranged from 0·91 (0·85–0·98) to 0·97 (0·93–1·00); for aspiration biopsy samples, AUC values ranged from 0·85 (0·80–0·91) to 0·95 (0·86–1·00) and accuracy values ranged from 0·79 (0·74–0·85) to 0·99 (0·98–1·00). In the multicentre external dataset, for excisional biopsy samples, AUC values ranged from 0·80 (95% CI 0·75–0·85) to 0·91 (0·88–1·00) and accuracy values ranged from 0·79 (0·76–0·82) to 0·95 (0·93–0·96); for aspiration biopsy samples, AUC values ranged from 0·76 (0·70–0·83) to 0·87 (0·80–0·94) and accuracy values ranged from 0·76 (0·74–0·79) to 0·97 (0·96–0·98). The model also showed strong performance on the TCGA dataset (473 patients; 535 slides; AUC values ranged from 0·82 [95% CI 0·71–0·93] to 0·96 [0·91–1·00], accuracy values ranged from 0·79 [0·70–0·88] to 0·95 [0·90–1·00]). The DeepGEM model, trained on primary region biopsy samples, could be generalised to biopsy samples from lymph node metastases, with AUC values of 0·91 (95% CI 0·88–0·94) for EGFR and 0·88 (0·82–0·93) for KRAS and accuracy values of 0·85 (0·80–0·88) for EGFR and 0·95 (0·92–0·96) for KRAS and showed potential for prognostic prediction of targeted therapy. The model generated spatial gene mutation maps, indicating gene mutation spatial distribution. We developed an AI-based method that can provide an accurate, timely, and economical prediction of gene mutation and mutation spatial distribution. The method showed substantial potential as an assistive tool for guiding the clinical treatment of patients with lung cancer. National Natural Science Foundation of China, the Science and Technology Planning Project of Guangzhou, and the National Key Research and Development Program of China. For the Chinese translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Objectives: Sleep disorder is a growing public health concern that requires attentive assessment and treatment. However, the length of assessment tools for sleep disorders, including insomnia, hinders their use in both research and clinical settings. Brief assessment measures expedite assessment time, reducing respondent burden, and save resources, especially in resource-limited settings. Methods: This study investigated the validity and reliability of a short three-item insomnia scale, the Insomnia Severity Index-3 (ISI-3) and established two cutoff scores in a sample of 238 healthcare providers in Oman (45.8% physicians and 54.2% nurses). Results: The ISI-3 demonstrated good convergent and divergent validity. The receiver operator characteristic recommended two cutoff scores of > 4 (a sensitivity of 0.87.3 and a specificity of 0.96.4) and > 6 (a sensitivity of 0.96.9 and a specificity of 0.97.1). Conclusions: The ISI-3 is a good assessment index of insomnia, especially when the utilization of the full insomnia index is unfeasible. [ABSTRACT FROM AUTHOR]

As occupational therapists gain recognition for their work in primary care, it is important to explore the services they provide within these settings. A qualitative study was employed whereby six licensed occupational therapists within the United States were invited via email to engage in semi-structured interviews. Interview transcripts were analyzed individually by six researchers and as a team using consensus coding. Four themes emerged: "Primary Care Benefits", "Occupational Therapy Process and Distinct Value", "Primary Care Interventions", and "Complexities of Primary Care: Patient Conditions and Challenges." Occupational therapists described a range of benefits to being positioned within primary care. Problem solving around patient barriers, funding and logistical challenges are important considerations. Emphasizing 'occupation-based practice' and 'doing' within therapy are vital for occupational therapists who wish to advocate for their services and apply their distinct skill set within primary care settings. [ABSTRACT FROM AUTHOR]

The article discusses the South-to-South cooperation between Pakistan and Nepal in implementing a police-based CPR initiative. The Pakistan Life Savers Program has successfully trained laypersons in CPR and bleeding control, leading to significant milestones in lifesaving skills training. Lessons learned from Pakistan have been applied in Nepal, highlighting the potential for similar programs in South Asian countries with limited healthcare infrastructure. The collaboration between the two countries has paved the way for further expansion and mutual support, emphasizing the role of High-Income Country institutions in facilitating South-to-South cooperation in global health. [Extracted from the article]

ObjectiveMethodsResultsConclusionTo investigate the outcomes of primary enucleation and adjuvant systemic chemotherapy, when deemed appropriate, on a cohort of children with unilateral intraocular Rb (AJCC 8th edition, cT2 and cT3) from diverse economic groupings.A prospective analysis including treatment-naïve Rb patients were presented to 11 centers from 10 countries from January 1 to December 31, 2019, and were followed-up thereafter. Only children with unilateral intraocular Rb that underwent primary enucleation were included in the present analysis. Systemic metastasis and survival were investigated.Of the 692 children with Rb, 191 (27.6%) were included in the study cohort. Among them, 24 (12.6%) were from low-income countries (LICs), 89 (46.6%) from lower-middle-income countries (LMICs), 59 (30.9%) from upper-middle-income countries (UMICs), and 19 (9.9%) from high-income countries (HICs). High-risk histopathological features were observed in 110 eyes (57.6%) following enucleation, and 102 of these children (92.7%) received adjuvant intravenous chemotherapy. The three-year survival rate for the entire cohort was 95.0%. Stratified by economic grouping, survival rates were 87.5% (LIC), 96.6% (LMIC), 93.2% (UMIC), and 100% (HIC). Children from LICs demonstrated a higher prevalence of HRHF compared to HICs. Residing in a lower-income country was associated with a higher risk of systemic metastasis and poorer outcomes.In the present multinational cohort of children with unilateral intraocular Rb who underwent upfront enucleation coupled with adjuvant chemotherapy as needed, overall survival was favorable, especially for children from low-income countries. Prompting early diagnosis, while the tumor remains intraocular can be life-saving, particularly in low-resource settings where primary enucleation and adjuvant chemotherapy can cure unilateral Rb. [ABSTRACT FROM AUTHOR]

Background: The increase in non-communicable disease burdens and aging populations has led to a rise in the need for palliative care across settings. In resource-limited settings such as Indonesia, however, notably in rural areas, there is a lack of professional palliative care. Little is known about specific palliative care navigation, as previous studies have mostly focused on cancer care navigation. A locally tailored approach is crucial. Aim: To explore how patients and families navigate palliative care and the problems they experience. Design: An ethnographic study using in-depth interviews and observations, analyzed using reflexive thematic analysis. Setting/participants: Interviews with 49 participants (patients, family caregivers, and health professionals) and 12 patient-family unit observations in Banyumas, Indonesia. The analysis: Patients and families navigated palliative care through different strategies: (1) helping themselves, (2) utilizing complementary and alternative medicine, (3) avoiding discussing psychological issues, (4) mobilizing a compassionate and advocating community, and (5) seeking spiritual care through religious practices. Conclusions: Our participants used intricate care networks despite limited resources in navigating palliative care. Several problems were rooted in barriers in the healthcare system and a lack of palliative care awareness among the general public. Local primary health centers could be potential palliative care leaders by building upon pre-existing programs and involving community health volunteers. Cultivating a shared philosophy within the community could strengthen care collaboration and support. [ABSTRACT FROM AUTHOR]

Integrated behavioral healthcare interventions have increased access to care for people with behavioral health conditions in primary care settings. However, they have not been widely implemented in low-barrier HIV care settings where undertreated behavioral health needs remain high. We conducted a formative qualitative evaluation, using in-depth interviews with purposively selected stakeholders (n = 13) and patients (n = 16), to identify anticipated barriers and facilitators to integrating care for depression and opioid use disorder for people with HIV via the Collaborative Care Model at a low-barrier HIV clinic. Patients and stakeholders expressed their enthusiasm for the Collaborative Care Model based on its perceived relative advantage over the standard of care referral system. Availability of resources, practical concerns about perceived fit with low-barrier HIV care, and anticipated suitability given other behavioral health comorbidities and patients' complex socioeconomic needs partially tempered stakeholder perceptions of appropriateness for the Collaborative Care Model. Patients and service delivery stakeholders were receptive to the Collaborative Care Model, but felt it was moderately appropriate in the context of low-barrier HIV care, which necessitated key adaptations to core model components to improve its contextual fit. [ABSTRACT FROM AUTHOR]

Purpose: To explore whether a low-cost ophthalmoscope (Arclight) can be used by naive nonophthalmic examiners to effectively screen for pediatric eye disease. Methods: Fifty-four children (108 eyes) were examined by five medical students using an Arclight. Gold standard examination was performed by an ophthalmologist using a slit lamp and indirect ophthalmoscope. Examinations performed included ophthalmoscopy of the optic disc, estimation of the cup-to-disc ratio (CDR), corneal light reflex test (CRT), Bruckner's reflex test (BRT), and evaluation of refractive error. We determined the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the nonophthalmologist's Arclight exam compared to the gold standard findings of comprehensive evaluation by pediatric ophthalmologists. Results: Using the Arclight, the optic nerve exam was successfully completed in 65% of patients. CDRs above and below 0.5 could be determined with 66.7% sensitivity and 84.4% specificity. Arclight CRT measurements were significant (P <.00001) predictors of strabismus, with 80% sensitivity, 95.1%, specificity, 80% PPV, and 95.1% NPV. BRT was not a significant predictor of amblyopia, with a 34.6% sensitivity, 85.7% specificity, 69.2% PPV, and 58.5% NPV. Refractive error was estimated with a success rate of 81% for emmetropia, 38% for myopia, and 21% for hyperopia. The Arclight ease-of-use was rated on average as 4.4 (SD = 0.9) on a scale of 1 to 5, with 1 being the hardest and 5 being the easiest. Conclusions: Our study shows the Arclight as an affordable and effective alternative to the traditional ophthalmoscope for assessing eye disease in children. This device can improve eye health services in under-resourced regions. [ABSTRACT FROM AUTHOR]

Background: Self‐harm is very common in young people and is associated with suicide. Rates of both self‐harm and suicide have increased in young people, particularly in females. There is a clear need to identify new approaches to prevent repeat self‐harm. Method: We significantly update and build on previous reviews with the aim of identifying issues in research relevant to clinical practice. We identify challenges in developing, implementing and evaluating treatments for self‐harm in children and adolescents, suggest a way forward for research, and provide clear and practical guidance for clinicians on how to apply current research evidence in the real world. Results: Currently, there is limited evidence for effective interventions, other than some support for dialectical behaviour therapy for adolescents (DBT‐A). To improve research and, by extension, clinical practice, future studies need to address psychosocial factors associated with youth self‐harm and suicide, investigate the critical mechanism(s) of action, ensure trials are sufficiently powered and representative, and involve young people more actively in the design, implementation and evaluation of these approaches. Consideration should also be given to alternative research designs, such as pragmatic or adaptive clinical trials, as well as registry‐based randomised controlled trials which leverage administrative data collected in routine clinical practice, to help meet these goals. Conclusions: Recommendations for practice include undertaking comprehensive assessment and formulation, and offering DBT‐A where indicated. There should be further development and evaluation (with input from young people) of Cognitive Behavioural‐based Therapy adapted for young people. Greater attention to the role of the therapeutic relationship and family involvement (where possible) is also an important considerations, irrespective of the specific therapeutic modality. Finally, more consideration should be given to improving staff training to ensure all clinical staff feel equipped to treat young people who self‐harm in a person‐centred and compassionate manner. [ABSTRACT FROM AUTHOR]

Food insecurity (FI) has short‐ and long‐term effects on maternal and child health, with persistent inequities within under‐resourced communities of colour (e.g., Hispanic and Non‐Hispanic Black). Interventions to mitigate maternal–child FI must engage the voices of under‐resourced communities of colour to improve implementation and tackle socio‐ecological drivers of inequities, leading to positive maternal–child outcomes. This exploratory sequential mixed‐methods study aimed to co‐create implementation strategies to tailor a culturally sensitive intervention to address FI during the first 1000 days of life in under‐resourced communities of colour in Las Vegas. A Community Advisory Board (CAB) engaged in a two‐step participatory process. First, through the concept mapping, hierarchical cluster analysis organized 125 strategies into seven thematic areas: policy and advocacy, access to food and resources, built environment, education across systems, social and peer support, cultural congruency and trust, and wellness and mental health. Second, through consensus‐building, strategies were combined by similarity (n = 94) and excluded if unrelated to health and nutrition (n = 9). The CAB reached a consensus on 22 strategies classified across three socio‐ecological levels. Examples of strategies at the community level (n = 16) included increasing utilization of federal nutrition assistance programmes; at the service level (n = 4), integrating FI screenings and referral coordination systems across services; and at the individual level (n = 2), providing mentorship, education, and support for families and moms. The co‐creation of a culturally sensitive intervention to reduce inequities in maternal‐child FI during the first 1000 days of life requires multi‐level strategies across three socio‐ecological levels in under‐resourced communities of colour in Las Vegas. Key messages: Implementation co‐creation can increase interventions' feasibility, acceptability, and ownership, ultimately reducing structural barriers and inequities.Using a concept mapping activity, the community advisory board (CAB) identified seven thematic areas for addressing maternal‐child food insecurity: policy and advocacy, access to food and resources, built environment, education across systems, social and peer support, cultural congruency and trust, and wellness and mental health.Using a consensus‐building process, the CAB reached a consensus on 22 strategies across three socio‐ecological levels. Examples of strategies at the community level (n = 16) included the reach and utilization of federal nutrition assistance programmes; at the service level (n = 4), integrating FI screenings and referral and coordination systems across services; and at the individual level (n = 2), developing groups that provide support for moms.The co‐creation of a culturally sensitive intervention to address maternal‐child food insecurity during the first 1000 days requires multi‐level strategies across three socio‐ecological levels. [ABSTRACT FROM AUTHOR]

Animal‐source foods (ASFs), contain high amounts of essential nutrients that are readily absorbed by the body. However, children in resource‐constrained settings often have limited access to these nutritious foods. This study aimed to investigate the reasons for the low consumption of ASFs among children in the Amhara region of Ethiopia. A community‐based mixed‐methods study was conducted, using exploratory qualitative methods supplemented by the analysis of secondary data from the Ethiopian Demographic and Health Survey (EDHS). The qualitative study employed a multiphase stepwise design and the maximum variation purposive sampling technique, enroling a diverse range of participants such as mothers and/or caregivers, household heads, religious and community leaders, health and nutrition experts, and others. The qualitative data were analysed using a thematic framework analysis method, while the quantitative data were analysed using SPSS v22 statistical software. Multivariable logistic regression analysis was performed to identify the predictors of ASFs among children under 5 years of age in the region. Despite the large and diverse livestock populations available, only 13.2% of children consumed at least one animal‐source food (ASF) in the prior day. The most consumed ASFs were dairy and eggs, whereas beef, organ meat, and seafood were the least consumed. Household demographics such as residence, literacy level, paternal age, and household wealth quintiles influenced the overall consumption of ASFs. The main reasons for the low consumption of ASFs among children were unaffordability and poor awareness among caregivers. In addition, religious misconceptions, price hikes, limited availability during certain seasons, low productivity, insufficient support from health professionals, and time constraints for caregivers were also mentioned as significant barriers to ASF consumption in the area. The consumption of ASFs among children in Ethiopia, particularly in the Amhara region, remains very low. This is mainly due to the caregivers' levels of awareness and unaffordability of ASFs. It is recommended that behavioural and sociocultural interventions be implemented that target caregivers to improve the consumption of ASFs among children. Key messages: In resource‐constrained settings such as Ethiopia, children often have limited access to nutritious animal‐source foods (ASFs).In the Amhara region, despite a large and diverse livestock population, only one in ten children consume at least one type of ASF. Particularly, they have very limited access to beef, organ meat (offal), and seafood.Affordability and caregivers awareness of ASFs are the main factors contributing to poor consumption.Additional factors, such as religious misconceptions, limited availability during certain seasons, low productivity, insufficient support from health professionals, and caregiver time constraints, further hinder ASF consumption. [ABSTRACT FROM AUTHOR]

During adolescence, access to safe environments is critical for healthy development. This study analyzed adolescents' perceptions of safety in personal and public spaces in the semi-rural community of Santa Ana, Colombia on the Island of Barú (95.8% of inhabitants live in poverty). We used thematic analysis to explore adolescents' experiences and reflections to identify the factors influencing their perception of safety across different community spaces. Four gender-segregated focus group discussions were held with 40 adolescents (20 male and 20 female) from ages 13 to 17 (M = 14.4, SD = 1.2). Most of them self-identified as Black (86%). The more recurrent spaces in the adolescents' conversations were the streets, the school, the local sports field, individual homes, and commercial sound system parties known as "Picos." Adolescents perceived the school as the safest space, while the "Picos" were the most unsafe. The other spaces were considered mixed, meaning that their perceived safety shifts and depends on the presence of certain factors. These factors were risky behaviors, group affiliation, designated authority roles, and the relevance of time. The authors discuss the importance of addressing the factors that inform adolescents' safety perception, particularly within low resource settings cross-culturally. [ABSTRACT FROM AUTHOR]

• Creatine is an inexpensive compound that can augment antidepressants' effects. • Creatine appears better than placebo in increasing the antidepressant efficacy of CBT. • Creatine is as safe and well-tolerated as placebo in depressed participants at 8 weeks. • Longer and adequately sized trials of creatine in depression are warranted. Pre-clinical and clinical evidence proposes that creatine monohydrate, an affordable nutraceutical, could be a useful adjunct to conventional antidepressant treatments. In this pilot feasibility and exploratory study, we investigate the 8-week effects of creatine in addition to cognitive-behavioural therapy (CBT) versus placebo plus CBT in depression. For the primary efficacy outcome of change in Patient Health Questionnaire-9 depression score at study endpoint, we used mixed-model repeated measures analysis of covariance. Logistic regressions were employed to assess acceptability (any-cause dropouts), tolerability (dropouts for adverse events), and safety (patients experiencing one or more adverse events). We calculated effect sizes adjusted for age, sex, and baseline depression score. One-hundred participants (50 females, mean age= 30.4 ± 7.4 years) with depression (mean PHQ-9 = 17.6 ± 6.3) were randomised to either creatine+CBT (N = 50) or placebo+CBT (N = 50). At 8 weeks, PHQ-9 scores were lower in both study arms, but significantly more so in participants taking creatine (mean difference= -5.12). Treatment discontinuations due to any cause and to adverse events, and proportion of participants with at least one adverse event were comparable between study arms. This hypothesis-generating trial suggests that creatine could be a useful and safe supplement to CBT for depression. Longer and larger clinical trials are warranted. [ABSTRACT FROM AUTHOR]

The article "Intra‐operative cardiac arrest – we need to do better" published in Anaesthesia discusses the rates of intra‐operative cardiac arrest and associated mortality from 2005 to 2022 at São Paulo State University Teaching Hospital, Brazil. The study found a reduction in the rate of intra‐operative cardiac arrest over the 18‐year period, with a rate of 19.26 per 10,000 anaesthetics. The causes of peri‐operative cardiac arrest were mainly related to cardiac surgery complications, sepsis, ruptured aneurysm, and exsanguinating hemorrhage. The article emphasizes the need for improved resuscitation planning, risk stratification, and training to enhance outcomes for patients experiencing peri‐operative cardiac arrest. [Extracted from the article]

We examined the role of network communication about HIV-related topics in mediating the efficacy of a social network intervention on HIV seroconversion among people who inject drugs (PWID) in Ukraine, where Eastern Europe's second-largest HIV epidemic is concentrated among PWID. We used randomized controlled trial data from 1200 HIV-negative PWID (Ukraine; 2010–2012) in an inverse-odds weighted analysis to examine mediation by network communication. Network communication mediated 24 % (95 % CI= 19.22–29.38) of the intervention's effect. Integrating training to support network communication about additional HIV prevention resources could enhance the impact of social network HIV prevention interventions among PWID. • We assessed a mechanism through which a social network intervention reduced HIV seroconversion among PWID. • Network communication about HIV risk reduction mediated 24 % of the intervention's effect. • Our findings support increasing communication about HIV risk reduction in social networks of PWID. • Leveraging existing social networks could impact HIV harm reduction among PWID. [ABSTRACT FROM AUTHOR]

Background: High dose rate (HDR) intracavitary brachytherapy (ICBT) plays a crucial role in cervix cancer treatment, with variations in fractionation schedules across different radiation societies. This study aims to assess the effectiveness and tolerability of a 7 Gy per fraction twice daily schedule over two successive weeks versus an 8 Gy per fraction once weekly schedule over three successive weeks. Patients and Methods: From 2020 to 2022, 87 patients with uterine cervix cancer (Stages II and III) underwent concomitant external beam radiotherapy (EBRT) and chemotherapy, followed by HDR-ICBT. Patients were randomised into two arms: Arm A (8 Gy per fraction once weekly for 3 fractions) and Arm B (7 Gy per fraction twice daily once a week for 4 fractions). Local control is defined as any patient free from local progression (CR + PR + SD) in the first year after ending brachytherapy (BTH). Results: The median follow-up was 16·5 months. Local control at 1 year was 78·7% in Arm A and 89·2% in Arm B (p = 0·24). No clinically significant differences in rectal and bladder toxicities were observed between the two arms (p = 0·40). Conclusion: There were limited treatment machines and other BTH challenges in Egypt, and the HDR BTH schedule of 7 Gy per fraction twice daily over 2 successive weeks presents an acceptable alternative to the current national standard of 8 Gy per fraction once weekly over 3 weeks. Both schedules demonstrate comparable local control, late toxicity and progression-free survival. Notably, the 7 Gy per fraction twice daily per week for 4 fractions offers the advantage of a reduced total treatment time. [ABSTRACT FROM AUTHOR]

"Medical deserts" are areas with low healthcare service levels, challenging the access, quality, and sustainability of care. This qualitative narrative review examines how artificial intelligence (AI), particularly large language models (LLMs), can address these challenges by integrating with e-Health and the Internet of Medical Things to enhance services in under-resourced areas. It explores AI-driven telehealth platforms that overcome language and cultural barriers, increasing accessibility. The utility of LLMs in providing diagnostic assistance where specialist deficits exist is highlighted, demonstrating AI's role in supplementing medical expertise and improving outcomes. Additionally, the development of AI chatbots offers preliminary medical advice, serving as initial contact points in remote areas. The review also discusses AI's role in enhancing medical education and training, supporting the professional development of healthcare workers in these regions. It assesses AI's strategic use in data analysis for effective resource allocation, identifying healthcare provision gaps. AI, especially LLMs, is seen as a promising solution for bridging healthcare gaps in "medical deserts," improving service accessibility, quality, and distribution. However, continued research and development are essential to fully realize AI's potential in addressing the challenges of medical deserts. [ABSTRACT FROM AUTHOR]

Background: Engaging fathers(to-be) can improve maternal, newborn, and child health outcomes. However, father-focused interventions in low-resource settings are under-researched. As part of an integrated early childhood development pilot cluster randomised trial in Nairobi's informal settlements, this study aimed to test the feasibility of a text-only intervention for fathers (SMS4baba) adapted from one developed in Australia (SMS4dads). Methods: A multi-phased mixed-methods study, which included an exploratory qualitative phase and pre-post evaluation of the adapted SMS4baba text-only intervention was conducted between 2019 and 2022. Three focus-group discussions (FGDs) with 19 fathers were conducted at inception to inform SMS4baba content development; two post-pilot FGDs with 12 fathers explored the acceptability and feasibility of SMS4baba implementation; and 4 post-intervention FGDs with 22 fathers evaluated SMS4baba programme experiences. In the intervention phase, 72 fathers were recruited to receive SMS4baba messages thrice weekly from late pregnancy until over six months postpartum. A pre-enrolment questionnaire captured fathers' socio-demographic characteristics. Pre-post surveys were administered telephonically, and outcome measures evaluated using a paternal antenatal attachment scale, generalised anxiety disorder scale (GAD-7), patient health questionnaire (PHQ-9), and researcher-developed questionnaire items assessing paternal involvement, childcare and parenting practices. Qualitative data were analysed using a thematic approach. Statistical analysis performed included descriptive statistics, tests of association, and mixed model regression to evaluate outcomes. Results: Fathers perceived SMS4baba messages as educational, instilling new knowledge and reinforcing positive parenting, and helped fathers cope with fatherhood transition. High levels of engagement by reading and sharing the texts was reported, and fathers expressed strong approval of the SMS4baba messages. SMS4baba's acceptability was attributed to modest message frequency and utilising familiar language. Fathers reported examples of behaviour change in their parenting and spousal support, which challenged gendered parenting norms. Pre-post measures showed increased father involvement in childcare (Cohen's d = 2.17, 95%CI [1.7, 2.62]), infant/child attachment (Cohen's d = 0.33, 95%CI [-0.03, 0.69]), and partner support (Cohen's d = 0.5, 95%CI [0.13, 0.87]). Conclusion: Our findings provide support for father-specific interventions utilising digital technologies to reach and engage fathers from low-resource settings such as urban informal settlements. Exploration of text messaging channels targeting fathers, to address family wellbeing in the perinatal period is warranted. Trial registration: This study was part of the integrated early childhood development pilot cluster randomised trial, registered in the Pan African Clinical Trial Registry on 26/03/2021, registration number PACTR202103514565914. [ABSTRACT FROM AUTHOR]

Background: Leprosy (Hansen's disease) is an infectious disease most common in resource-limited countries caused by the acid-fast bacilli Mycobacterium leprae and Mycobacterium lepromatosis that frequently affects the skin and peripheral nerves. Prompt diagnosis and treatment with multidrug therapy is crucial to reduce disease transmission and sequelae, which include nerve function impairment, ocular injury, and stigmatizing physical deformities. Traditional treatment of multibacillary leprosy consists of 12–24 months of multidrug therapy with dapsone, rifampin, and clofazimine. However, this regimen is associated with high pill burden and side effects that limit adherence. Case presentation: We report a case of multibacillary leprosy in a previously healthy 30-year-old Hispanic man who recently immigrated to the USA from South America and presented with progressive nodular skin lesions on his face and extremities. He was treated with a monthly regimen of rifampin, moxifloxacin, and minocycline. At follow-up there was significant improvement of his cutaneous lesions without signs of reversal reaction or erythema nodosum leprosum. Conclusions: This case report adds to the growing repertoire of literature supporting the use of rifampin, moxifloxacin, and minocycline. Further studies are needed to assess the efficacy of this antimycobacterial regimen and monitor rates of relapse and delayed immunologic reactions, which may occur 5–10 years after completion of treatment. [ABSTRACT FROM AUTHOR]

In resource-limited areas, where accurate weight-for-height Z-scores are hard to obtain, Mid-Upper Arm Circumference (MUAC) is a simple tool to identify wasted children. MUAC alone, however, may miss identification of many wasted children, leading to untimely intervention and potentially death. Our study aimed to identify the best-performing case definition to detect wasting by Weight-for-Height z-scores (WHZ) in Filipino children aged 6–59 months. We analyzed the 2018–2019 Expanded National Nutrition Survey to assess the diagnostic performance of MUAC cutoffs and a case definition combining MUAC and weight-for-age z-score (WAZ) in identifying moderate and severe wasting compared to the WHZ criterion. The optimal cutoff and case definition was identified as having the highest area under the receiver operating characteristic curve (AUROC). Our findings showed that the current MUAC cutoffs poorly identify severe (sensitivity: 13%; specificity: 99%; AUROC: 0.558) and moderate (sensitivity: 22%; specificity: 96%; AUROC: 0.586) wasting (N = 30,522) in Filipino children. Instead, the optimal MUAC cutoff for severe and moderate wasting were <13.6cm (sensitivity: 62%; specificity: 76%; AUROC: 0.690) and 14.0cm (sensitivity: 80%; specificity: 67%; AUROC: 0.737). There was no effect of sex on MUAC cutoffs, but cutoffs increased with age. We found that the combination of WAZ < -2 or MUAC ≤ 11.7cm (Sensitivity: 80%; Specificity: 80%; AUROC: 0.800) for severe wasting and WAZ < -2 or MUAC ≤ 12.7cm (Sensitivity: 84%; Specificity: 78%; AUROC: 0.810) for moderate wasting significantly improved sensitivity for acceptable decreases in specificity. In summary, implementing alternative case definitions solely based on expanding MUAC insufficiently improves diagnostic accuracy for identifying wasted children by WHZ criteria. Combining WAZ with MUAC could increase the number of eligible children identified and treated by the Philippine Integrated Management of Acute Malnutrition. Further studies are advised to understand the practicality and cost-effectiveness of using the proposed alternative case definitions in the Philippines. [ABSTRACT FROM AUTHOR]

Background: Despite declining COVID-19 incidence, healthcare workers (HCWs) still face an elevated risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. We developed a diagnostic multivariate model to predict positive reverse transcription polymerase chain reaction (RT-PCR) results in HCWs with suspected SARS-CoV-2 infection. Methods: We conducted a cross-sectional study on episodes involving suspected SARS-CoV-2 symptoms or close contact among HCWs in Bogotá, Colombia. Potential predictors were chosen based on clinical relevance, expert knowledge, and literature review. Logistic regression was used, and the best model was selected by evaluating model fit with Akaike Information Criterion (AIC), deviance, and maximum likelihood. Results: The study included 2498 episodes occurring between March 6, 2020, to February 2, 2022. The selected variables were age, socioeconomic status, occupation, service, symptoms (fever, cough, fatigue/weakness, diarrhea, anosmia or dysgeusia), asthma, history of SARS-CoV-2, vaccination status, and population-level RT-PCR positivity. The model achieved an AUC of 0.79 (95% CI 0.77–0.81), with 93% specificity, 36% sensitivity, and satisfactory calibration. Conclusions: We present an innovative diagnostic prediction model that as a special feature includes a variable that represents SARS-CoV-2 epidemiological situation. Given its performance, we suggest using the model differently based on the level of viral circulation in the population. In low SARS-CoV-2 circulation periods, the model could serve as a replacement diagnostic test to classify HCWs as infected or not, potentially reducing the need for RT-PCR. Conversely, in high viral circulation periods, the model could be used as a triage test due to its high specificity. If the model predicts a high probability of a positive RT-PCR result, the HCW may be considered infected, and no further testing is performed. If the model indicates a low probability, the HCW should undergo a COVID-19 test. In resource-limited settings, this model can help prioritize testing and reduce expenses. [ABSTRACT FROM AUTHOR]

Background: Standardized and systematic quality assessments of chronic pain management, particularly among older adult populations, are lacking in resource-limited community settings. A specific set of indicators to evaluate the quality of chronic pain management in this population has yet to be developed. Therefore, the present study constructed a set of indicators to assess the quality of chronic pain management in Chinese community-dwelling older adults, providing a standardized reference and guidance for community health centers to manage chronic pain in this population. Methods: The indicator set was developed in three steps. Step 1 involved preparation by forming a research team and establishing the guiding theory. Step 2 included developing an expert inquiry questionnaire based on a literature review and semi-structured interviews. Step 3 completed the construction of the indicator set through the Delphi method and hierarchical analysis to quantify the relative importance of each indicator and ensure the development of a scientifically validated and practically applicable evaluation model. Results: The final set of indicators for evaluating the quality of chronic pain management among community-dwelling older adults in China comprised three primary indicators: structural quality indicator, process quality indicator, and outcome quality indicator. Structural quality indicators included 3 secondary and 11 tertiary indicators; process quality indicators included 4 secondary and 21 tertiary indicators; and outcome quality indicators included 2 secondary and 4 tertiary indicators. Across two rounds of questionnaires, the response rate was 100%, with expert authority coefficients of 0.924 and 0.938, coefficients of variation ranging from 0 to 0.32 and 0 to 0.20, and Kendall's concordance coefficients of 0.302 and 0.220, respectively. Hierarchical analysis showed that the consistency ratios of all indicators were < 0.1000, indicating a balanced distribution of indicator weights. Conclusions: This study introduces a preliminary framework, based on the "Structure-Process-Outcome" theory, to evaluate chronic pain management in Chinese community-dwelling older adults. Its reliance on expert opinions without empirical validation, exclusion of patient perspectives, and focus on Chinese communities limit its applicability and generalizability. Future research should address these limitations by incorporating patient feedback, empirically validating indicators, and evaluating their applicability across diverse populations. [ABSTRACT FROM AUTHOR]

Introduction: Brucellosis and Rift Valley fever (RVF) are neglected zoonotic diseases (NZD) that threaten public health, animal health, and production in resource-limited countries including Namibia. Methods: The objective of this cross-sectional study was to determine Brucella spp. and RVFV seroprevalence in cattle at the wildlife-livestock interface in the Kabbe South constituency (Zambezi region) of Namibia. Cattle sera (n = 371) were randomly collected from 18 cattle herds in six constituency areas and tested for antibodies against Brucella [complement fixation test (CFT) and indirect enzyme-linked immunosorbent (ELISA) assay in parallel] and Rift Valley fever virus (competitive ELISA). Results: Apparent individual animal prevalence for Brucella spp. was 5.9% (95% CI: 3.95%−8.81%, 22/371) and 20.8% (95% CI: 16.9%−25.2%, 77/371) based on the CFT and I-ELISA, respectively. For RVFV, apparent and true animal prevalence were 41.0% (95% CI: 36.1%−46.0%, 152/371) and 47.6% (95% CI: 41.8%−53.6%), respectively. Animal and true prevalence of Brucella spp. based on the CFT and ELISA in parallel were 22.6% (95% CI: 18.7%−27.2%, 84/371) and 19.7% (95% CI: 15.6%−24.4%), respectively. About 10.8% (40/371) of cattle tested positive for both Brucella spp. and RVFV antibodies. Prevalence of Brucella -positive cattle herds was 83.3% (15/18). Within herd Brucella spp. seroprevalence was 0%−70%. All cattle herds tested positive for RVFV, with prevalence of 1.7% to 70%. Binomial logistic regression revealed that sex was a significant predictor (p < 0.05) for RVFV seropositivity, but not for Brucella spp. seropositivity (p > 0.05). Test agreement between CFT and I-ELISA when used for the detection of anti- Brucella antibodies was poor (k = 0.2322). Discussion: Brucella spp. and RVFV infections were prevalent in communal pastoral cattle at the human-wildlife-livestock interface in the Zambezi region suggesting a higher likelihood of occurrence of reproduction losses in cattle and zoonotic disease in humans. We recommend the enforcement of the requirements for the vaccination of heifers against brucellosis in the affected communal areas to reduce the risk of human infection. The use of One Health principles for the surveillance, prevention and control of Brucella spp. and RVFV infections can promote the effective control of these zoonotic infections at the interface. [ABSTRACT FROM AUTHOR]

Aims: The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90‐day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. Methods: Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. Results: Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212–45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow‐up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p = 0.017). More severe AKI was associated with type 2 diabetes (p = 0.0042), hypertension (p < 0.0001) and multiple comorbidities (p = 0.0014). Persons with no comorbidities had less severe AKI (p = 0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35–0.99 and p = 0.047). Conclusions: AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka. [ABSTRACT FROM AUTHOR]