Pesticide exposure and acute health problems among pesticide processing industry workers in Ethiopia

Occupational exposure to pesticides` manufacturing, formulating and applications can have a potential to harm humans` health in acutely or chronically. This study aims to assess pesticide exposure and acute pesticide intoxication among pesticide processing industry workers in Ethiopia. A cross-sectional study was conducted among 90 male pesticide processing industry workers` through face-to-face interviews. Data were collected using kobo Collect v2024.1.3 and exported to SPSS version 27 for analysis. Descriptive statistics and binary logistic regression were applied for statistical data analysis. The overall prevalence of acute pesticide intoxication (API) was 80 % (95 % CI 71.1 % - 87.4 %). Approximately, 60 %, 46.7 %, 42.2 %, 38.9 % and 33.3 % of the study participants reported experiencing pesticide exposure-related muscle weakness, headache, eye irritation, skin irritations and upper respiratory tract irritation, respectively. The factor found to be associated with pesticide intoxication was the improper utilization of personal protective equipment (PPE) regardless of time and season (AOR, 11; 95 % CI, 2.29, 48.83). Pesticide exposure-related acute health effects are a significant occupational health concern in this study. Inadequate and improper use of PPE increases the risk of these health effects. Therefore, proper PPE utilization and strict enforcement are crucial for protection.

Improving outcomes with early and intensive metabolic control in patients with type 2 diabetes: a long-term modeling analysis of clinical and cost outcomes in Italy

Objectives

This analysis quantifies the potential long-term clinical and cost benefits of early and intensive metabolic control (EIMC) versus conventional management in patients newly diagnosed with type 2 diabetes in Italy.

Methods

The PRIME T2D Model was used to project clinical and cost outcomes over long-term time horizons for a newly diagnosed cohort of patients receiving EIMC or conventional management. EIMC was associated with a mean glycated hemoglobin reduction of 0.6% from baseline and a mean weight loss of 9.5 kg (8.2%) for a duration of 6 years, before gradually returning to the same levels as the conventional management arm over 6 years. Modifiable risk factors were assumed to progress over time based on published regression functions. Direct and indirect costs associated with diabetes-related complications were accounted in 2021 Euros (EUR), with unit costs and health state utilities derived from published sources. Future costs and clinical benefits were discounted at 3% annually.

Results

For the population diagnosed with type 2 diabetes in 2021 (estimated at 216,417 cases), EIMC was projected to add approximately 33,112 years of life and 55,403 quality-adjusted life years versus conventional management. Cost savings with EIMC were estimated at EUR 494 million, EUR 608 million and EUR 628 million in the incident population at 10- and 20- and 50-year time horizons, respectively.

Conclusions

According to this modeling study, early and intensive metabolic control has the potential to substantially improve clinical outcomes and reduce economic burden compared with conventional management of patients with type 2 diabetes in Italy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01553-w.

SIRT2 as a Potential Biomarker in Lung Adenocarcinoma: Implications for Immune Infiltration

SIRT2 play important roles in cell cycle and cellular metabolism in the development of non-small cell lung cancer (NSCLC), and SIRT2 exhibits its therapeutic effect on NSCLC tumors with high expression of SIRT2. Nevertheless, the clinical relevance of SIRT2 in lung adenocarcinoma (LUAD), particularly its impact on tumor growth and prognostic implications, remains obscure. This investigation entailed a comprehensive analysis of SIRT2 mRNA and protein expression levels in diverse tumor and corresponding healthy tissues, utilizing databases such as TIMER 2.0, UALCAN, and HPA. Prognostic correlations of SIRT2 expression in LUAD patients, stratified by distinct clinicopathological characteristics, were evaluated using the KM Plotter database. Additionally, the TCGA and TIMER 2.0 databases were employed to assess the relationship between SIRT2 and immune infiltration, as well as to calculate immunity, stromal, and estimation scores, thus elucidating the role of SIRT2 in modulating tumor immunotherapy responses. Furthermore, Gene Set Enrichment Analysis (GSEA) was utilized to elucidate SIRT2's biological functions in pan-cancer cells. Our findings revealed a marked reduction in both mRNA and protein levels of SIRT2 in LUAD tumors relative to healthy tissue. Survival analysis indicated that diminished SIRT2 expression correlates with adverse prognostic outcomes in LUAD. Furthermore, SIRT2 expression demonstrated a significant association with various clinicopathologic attributes of LUAD patients, influencing survival outcomes across different clinicopathologic states. Functional enrichment analyses highlighted SIRT2's involvement in cell cycle regulation and immune response. Notably, SIRT2 exhibited a positive correlation with immune cell infiltration, including natural killer (NK) cells, macrophages, and dendritic cells (DCs). In summary, SIRT2 was a potential prognostic biomarker for LUAD and and a new immunotherapy target.

The biomedical applications of artificial intelligence: an overview of decades of research

A significant area of computer science called artificial intelligence (AI) is successfully applied to the analysis of intricate biological data and the extraction of substantial associations from datasets for a variety of biomedical uses. AI has attracted significant interest in biomedical research due to its features: (i) better patient care through early diagnosis and detection; (ii) enhanced workflow; (iii) lowering medical errors; (v) lowering medical costs; (vi) reducing morbidity and mortality; (vii) enhancing performance; (viii) enhancing precision; and (ix) time efficiency. Quantitative metrics are crucial for evaluating AI implementations, providing insights, enabling informed decisions, and measuring the impact of AI-driven initiatives, thereby enhancing transparency, accountability, and overall impact. The implementation of AI in biomedical fields faces challenges such as ethical and privacy concerns, lack of awareness, technology unreliability, and professional liability. A brief discussion is given of the AI techniques, which include Virtual screening (VS), DL, ML, Hidden Markov models (HMMs), Neural networks (NNs), Generative models (GMs), Molecular dynamics (MD), and Structure-activity relationship (SAR) models. The study explores the application of AI in biomedical fields, highlighting its enhanced predictive accuracy, treatment efficacy, diagnostic efficiency, faster decision-making, personalised treatment strategies, and precise medical interventions.

Mitigating the environmental effects of healthcare: the role of the endocrinologist

Human health depends on planetary health, and yet healthcare provision can have unintended consequences for the health of the planet. Emissions from the healthcare sector include greenhouse gases, air pollution and plastic pollution, alongside chemical contamination. Chemical pollution resulting in endocrine disruption has been associated with plastics, which are a source of concerning additives such as phthalates, bisphenols, perfluoroalkyl and polyfluoroalkyl substances, and flame retardants (all routinely found in healthcare products). Many endocrine-disrupting chemicals are persistent and ubiquitous in the environment (including water and food sources), with potential secondary harms for human health, including disrupting reproductive, metabolic and thyroid function. Here we review evidence-based strategies for mitigating environmental effects of healthcare delivery. We focus on what endocrinologists can do, including reducing demand for healthcare services through better preventative health, focusing on high-value care and improving sustainability of medical equipment and pharmaceuticals through adopting circular economy principles (including reduce, reuse and, as a last resort, recycle). The specific issue of endocrine-disrupting chemicals might be mitigated through responsible disposal and processing, alongside advocating for the use of alternative materials and replacing additive chemicals with those that have lower toxicity profiles, as well as tighter regulations. We must work to urgently transition to sustainable models of care provision, minimizing negative effects on human and planetary health.

Frailty and prescriptions of secondary prevention medications in older people with diabetes and coronary heart disease-An observational study in Vietnam

OBJECTIVES

This study sought to quantify the prevalence of frailty among type 2 diabetes (T2D) patients with coronary heart disease (CHD) and examine the relationship between frailty and the prescription of secondary prevention medications.

METHODS

A prospective observational study was conducted at a tertiary hospital in Vietnam from November 2022 to June 2023. Patients aged 60 years or above with T2D and CHD were included for analysis. Multivariable logistic regression was applied to examine the association between frailty and the prescription of secondary prevention medications: antiplatelets, statins, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEIs/ARBs). Frailty was measured using the Clinical Frailty Scale (CFS) version 2.0.

RESULTS

There were 274 participants included in this analysis. Participants had a median age of 72.0 years, 28% were female and 59% were frail. The prescription rates of cardiovascular medicines for frail versus non-frail participants were as follows: antiplatelets (66% vs. 94%, p < .001), statins (96% vs. 92%, p = .21), beta-blockers (81% vs. 88%, p = .13), ACEIs/ARBs (75% vs. 81%, p = .22) and for all four types (42% vs. 64%, p < .001). In the multiple adjusted regression models, increased CFS score was associated with reduced prescriptions of beta-blockers, ACEIs/ARBs and all four types of medications.

CONCLUSIONS

Frailty was common among older Vietnamese patients with CHD and diabetes, and significantly affected the prescription of secondary prevention medicines. Future research should explore the link between frailty and secondary prevention medicines in a larger, more diverse population.

Nurses as UN champions: Increasing nursing presence and influence at the United Nations

BACKGROUND

Representing half of the global health workforce, nurses are critical to health promotion, disease prevention, and the economic and social needs of populations. However, nursing expertise is underutilized in the UN System, and nurses are underprepared for roles in policy to influence global health and sustainable development. Innovative education strategies are necessary to address the sidelining of nursing expertise in these spaces and build nursing literacy in shaping global policy.

AIM

This quality improvement project aimed to develop and evaluate a model to build a USA-based school of nursing's literacy and engagement with the United Nations (UN) System.

METHODS

A Doctor of Nursing Practice (DNP) student developed an innovative educational model, the United Nations Essentials for Global Nursing Leadership, in partnership with a school of nursing (SON), to build faculty knowledge and skills on initiating and sustaining bidirectional engagement with the UN. In 2023, SON faculty piloted the model, and pre-/post-intervention survey data were utilized for improvement.

RESULTS

Participants reported increased knowledge, awareness, and confidence related to the UN System and their ability to engage as policy influencers, health diplomats, and global citizens. In total, 100% of participants volunteered to hold the role of UN champion for the SON.

DISCUSSION

This innovative model advances nursing knowledge and coherence in the UN System and key areas of policy, diplomacy, and global governance for meaningful UN engagement. CONCLUSION AND IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY: Models that invest in closing the global nursing leadership preparation gap can raise the profession's visible UN presence and strategic policy influence at a critical time for people and the planet.

Adverse associations of pre-pregnancy exposure to PM2.5 and its components with fetal growth alleviated by residential greenness: a prospective cohort study

Maternal exposure to fine particulate matter (PM2.5) and residential greenness both influence fetal growth. No previous studies have examined their sex-specific and interaction effects. We aim to evaluate the sex-specific effects in these associations and exposure interactions. This study involved 1,275 mother-child pairs enrolled in the Ma'anshan birth cohort in China. Pre-pregnancy exposure to PM2.5 and its components was assessed using a spatiotemporal model based on maternal addresses, while residential greenness was estimated through the normalized difference vegetation index (NDVI) based on satellite data. Fetal parameters-including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW)-were measured during pregnancy via ultrasound. To examine associations between these exposures and both continuous and categorical outcomes, generalized estimating equations (GEE) and generalized linear regression were applied. Subgroup analyses were conducted to evaluate sex-specific effects. Pre-pregnancy exposure to PM2.5, OM, BC, SO42-, NH4+, and NO3- was correlated with decreased Z-scores of fetal parameters (BPD, FL, EFW, AC) during the second trimester, particularly in male fetuses. In the third trimester, we found that the Z-scores of AC (0.081, 95% CI: 0.001, 0.160) and EFW (0.097, 95% CI: 0.008, 0.185) increased with each interquartile range (IQR) increase in residential greenness. We observed the effect modification of PM2.5 and its components on the relationship between residential greenness and fetal growth in utero. Residential greenness can mitigate the adverse effects of PM2.5 and its components prior to pregnancy on fetal growth. Our findings suggest that increased residential greenness during pregnancy preparation may help alleviate air pollution's detrimental effects on fetal growth.

Mercury exposure and childhood outcomes: An overview of systematic reviews

OBJECTIVE

The objective of this review was to summarize recent and relevant systematic reviews (SRs) that assessed relationships between mercury (Hg) exposure during pregnancy, lactation, and childhood and child outcomes.

EVIDENCE REVIEW

Three electronic databases were searched for SRs published between January 2018 to December 2024 about Hg exposure (of any form or source, including seafood), during pregnancy, lactation or childhood and child outcomes including: anthropometrics, neurodevelopment, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), exposure biomarkers, cardiometabolic health, immunity, and birth outcomes. All articles were screened at title/abstract and full-text levels by two independent reviewers. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 critical appraisal tool was used to assess the methodological quality of the included SRs.

FINDINGS

Twenty-nine SRs of observational studies were identified that assessed Hg during pregnancy (n = 19) and/or childhood (n = 17). During pregnancy, results from the SRs suggested that higher Hg may be associated with higher risk of birth defects, pre-term birth, ADHD, ASD, and low birth weight, length, and head circumference. Results varied for neurodevelopment outcomes in the child, likely due to co-exposure with seafood during pregnancy, variation in response by sex of the child, and etiological differences among developmental domains. During childhood, SRs suggested that higher Hg may be associated with higher risk of ADHD and adverse neurodevelopment, growth, and body composition outcomes. Also, Hg concentrations were higher in children with ASD than those without in case-control studies but longitudinal data were lacking. Evidence on methylmercury exposure from seafood during pregnancy and childhood was limited and inconclusive.

CONCLUSION AND RELEVANCE

Mercury exposure during pregnancy and childhood is recognized as a major public health concern. However, more research is needed that specifically examines methylmercury from seafood to better inform future dietary recommendations.

Short-term microplastic exposure: A double whammy to lung metabolism and fecal microflora in diabetic SD rats

Diabetes has become a global health crisis, affecting over 800 million people, with serious complications such as vascular and neurological damage. While diabetes management has been extensively studied, the impact of environmental pollutants, particularly microplastics (PS), on diabetic health remains poorly understood. PS, defined as plastic particles smaller than 5 mm, are pervasive and can enter the body through inhalation or ingestion, posing potential risks. However, the effects of PS exposure, particularly in diabetes, have not been adequately explored. Most studies focus on high-concentration, long-term exposure, which does not reflect typical human exposure levels. This study investigates the effects of short-term PS exposure on diabetic SD rats, using histological, apoptotic, and omics techniques, including metabolomics, lipidomics, and 16S rDNA sequencing. Our results show that short-term PS exposure exacerbates lung and intestinal damage in diabetic rats, with significant alterations in the gut microbiome. We also observed correlations between differential metabolites and microbiota changes. These findings provide novel evidence that short-term PS exposure, at concentrations reflecting daily contact, worsens metabolic dysfunction and intestinal dysbiosis in diabetes. This study emphasizes the need to consider environmental pollutants in diabetes management and highlights potential strategies for prevention and therapy.

Green treatments for polyaromatic hydrocarbons in e-wastes

Rapid elevation of global population along with increased urbanization and industrialization afflict the water resources leading to the blooming of wastewater. Two or more aromatic rings fused with organic compound Polycyclic Aromatic Hydrocarbons (PAHs) emerged worldwide through anthropogenic processes, mainly due to the incomplete combustion of organic fuels. In accordance with the United States Environmental Protection Agency (USEPA), there are 16 PAHs that are deemed as primary pollutants. These are toxic to the living organisms due to their pervasive existence, rebelliousness, potential for bioaccumulation and carcinogenic venture. Several methods including fixation, incineration and oxidation are put forward to remove PAHs. Occasionally some fictional toxic products are produced by the incomplete removal of PAHs. Bioremediation is one of the ecological techniques to remove the PAHs. Microbial biodegradation is considered as an effective and inexpensive technique to remove PAHs along with other hydrocarbons and xenobiotic compounds and are accomplished by few PAHs degrading bacteria including Haemophilus spp., Mycobacterium spp., Paenibacillus spp., Pseudomonas aeruginosa, P. fluorescens, Rhodococcus spp. along with few biosurfactant-producing microbes. The novel biochemical events involved in hydrocarbon catabolism are microbial physical adaptation, their acquisition and uptake. The bioremediation efficacy can be further ameliorated through genetic modification of the microbes. This chapter will focus on the eco-friendly treatment for the PAHs remediation in in situ and ex situ. This chapter will explore the remediation of the PAH by-products through the multi-process conjunctional treatment processes under the green therapy.

Particulate matter 2.5 (PM2.5) - associated cognitive impairment and morbidity in humans and animal models: a systematic review

Particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5) is one of the criteria air pollutants that (1) serve as an essential carrier of airborne toxicants arising from combustion-related events including emissions from industries, automobiles, and wildfires and (2) play an important role in transient to long-lasting cognitive dysfunction as well as several other neurological disorders. A systematic review was conducted to address differences in study design and various biochemical and molecular markers employed to elucidate neurological disorders in PM2.5 -exposed humans and animal models. Out of 340,068 scientific publications screened from 7 databases, 312 studies were identified that targeted the relationship between exposure to PM2.5 and cognitive dysfunction. Equivocal evidence was identified from pre-clinical (animal model) and human studies that PM2.5 exposure contributes to dementia, Parkinson disease, multiple sclerosis, stroke, depression, autism spectrum disorder, attention deficit hyperactivity disorder, and neurodevelopment. In addition, there was substantial evidence from human studies that PM2.5 also was associated with Alzheimer's disease, anxiety, neuropathy, and brain tumors. The role of exposome in characterizing neurobehavioral anomalies and opportunities available to leverage the neuroexposome initiative for conducting longitudinal studies is discussed. Our review also provided some areas that warrant consideration, one of which is unraveling the role of microbiome, and the other role of climate change in PM2.5 exposure-induced neurological disorders.

Causal relationship between gut microbiota and lung squamous cell carcinoma: a bidirectional two-sample Mendelian randomization study

PURPOSE

This study aims to explore the potential causal relationship between gut microbiota and lung squamous cell carcinoma (LUSC).

METHODS

A bidirectional two-sample Mendelian randomization analysis was conducted using genome-wide association study (GWAS) data from gut microbiota and LUSC. Gut microbiota served as the exposure factor, with instrumental variables selected from a GWAS involving 18 340 participants. LUSC data were drawn from a European cohort including 29 266 LUSC cases and 56 450 controls. Inverse-variance weighted (IVW) method was used as the primary method, with the Benjamini-Hochberg method applied to adjust for multiple comparisons. An independent dataset (ieu-a-967, containing 3275 LUSC cases and 15 038 controls) was used for replication analysis to ensure robustness.

RESULTS

IVW analysis found that Butyricicoccus (OR = 0.79, 95% CI: 0.63-0.99, P = .042) and Coprobacter (OR = 0.85, 95% CI: 0.74-0.97, P = .018) were significantly protective against LUSC. In contrast, Victivallis (OR = 1.11, 95% CI: 1.00-1.23, P = .045) and Ruminococcus (OR = 1.28, 95% CI: 1.03-1.60, P = .028) increased LUSC risk. Replication analysis in the independent dataset confirmed significant associations for Ruminococcus and Coprobacter. No reverse causality or pleiotropy was detected.

CONCLUSION

This study provides evidence of a causal relationship between specific gut microbiota and LUSC risk, highlighting new microbial targets for potential prevention and treatment strategies in lung cancer. Key messages What is already known on this topic?  Previous studies have suggested potential links between gut microbiota composition and the development of various cancers, including lung cancer. However, the exact causal relationship between specific gut microbiota and lung squamous cell carcinoma (LUSC) has remained unclear. Traditional observational studies have struggled to determine the direction of causality due to confounding factors, making further investigation necessary through more robust methods such as Mendelian randomization (MR). What this study adds?  This bidirectional MR study provides novel genetic evidence indicating that certain gut microbiotas are causally associated with LUSC risk. Specifically, Butyricicoccus appears to reduce the risk of LUSC, while Victivallis increases the risk. These findings highlight the role of the gut-lung axis in LUSC and open up new avenues for exploring gut microbiota as potential modulators of lung cancer risk. How this study might affect research, practice, or policy?  The implications of this study may significantly influence future research into cancer prevention strategies by targeting gut microbiota. Additionally, it could inform clinical practices aimed at modulating gut microbiota to lower the risk of LUSC, potentially influencing dietary or probiotic interventions to reduce cancer susceptibility. Furthermore, these results might shape public health policies that focus on the gut-lung axis as a novel avenue for cancer prevention and management.

Nurses' knowledge, attitudes, and practices regarding deep vein thrombosis and the nursing management

Deep vein thrombosis (DVT) remains a significant challenge in healthcare settings, with proper nursing management playing a crucial role in patient outcomes. Deep vein thrombosis (DVT) remains a significant challenge in healthcare settings, with proper nursing management playing a crucial role in patient outcomes. To assess the knowledge, attitudes, and practices (KAP) of nurses regarding deep vein thrombosis (DVT) and its nursing management. A cross-sectional survey was conducted in Zhejiang Province between August and September 2024. Data were collected using a researcher-developed questionnaire that was validated through expert consensus and pilot testing (Cronbach's α = 0.949). A total of 568 valid questionnaires were analyzed. Among the participants, 272 (47.9%) reported having experience in caring for DVT patients. The mean scores showed that 75.9% of participants achieved adequate knowledge levels, 82.5% demonstrated positive attitudes, and 83.9% exhibited proactive practices. All indicating satisfactory levels within their respective ranges. Multivariate logistic regression showed that involving in the care of DVT patients, with relative have a history of DVT, and participation in the training of DVT care were independently associated with knowledge. Concurrently, knowledge was independently associated with attitude. Moreover, knowledge and attitude were independently associated with proactive practice (All P < 0.05). Nurses demonstrated adequate knowledge, positive attitudes, and proactive practices regarding DVT and its nursing management. Targeted training programs and experiential opportunities, particularly for nurses with limited exposure to DVT care, should be prioritized to further enhance their knowledge and practices, ultimately improving patient outcomes.

Developing an integrated depression and tuberculosis care pathway using a co-design approach in a low-resource setting

BACKGROUND

Evidence suggests the use of a participatory approach for the improvement of TB care, however, there is limited evidence on how integrated depression screening and care could be delivered with TB services. Thus, this study co-designed an integrated care pathway for depression case finding and treatment in TB services, that can be delivered by non-mental health specialists within a low resourced settings.

METHODS

We conducted a total of 10 'co-design' workshops with people with TB, carers, tuberculosis and mental health healthcare providers between June and August 2021 in Dhaka, Bangladesh and Peshawar, Pakistan. We adapted the 'Hasso Plattner Institute of Design at Stanford University' for our codesign process. Information gathered during the workshop, through recordings and contemporaneous notes taking, was collated, and analysed to develop the integrated care pathways and materials for impmenting the carepathway.

RESULTS

We co-designed and developed a culturally adaptable care pathway that integrates depression screening into tuberculosis (TB) care, working closely with people affected by TB and healthcare workers in primary, secondary, and tertiary care settings in Bangladesh and Pakistan. We used PHQ-9 only to identify and screen for depression among people with TB in Bangladesh, whereas both PHQ-2 and PHQ-9 were used for depression screening among the Pakistani population. A trained paramedic or laboratory technologist (Bangladesh) and DOTS Facilitator (Pakistan), working within the TB facilities were identified and agreed to deliver the integrated depression screening services.

CONCLUSION

Stakeholders valued the opportunity to jointly design a care pathway. Iterative and coordinated working with these stakeholders enabled the researchers to understand better, explore and refine the co-design process. This approach assisted in mobilising knowledge about depression and integrating screening for depression within the existing usual TB care pathway, using the lived experience of people with TB and health workers' expertise.

Diverse Trends in Antihypertensive Medication Usage Among U.S. Adults With Hypertension by Socioeconomic Status and Comorbidities, 1999-2020

BACKGROUND

Hypertension is a global health concern, and antihypertensive medications are vital for its management. This study examined evolving trends in antihypertensive medication usage among adults with hypertension from 1999 to 2020.

METHODS

Data from ten National Health and Nutrition Examination Survey (NHANES) survey cycles were obtained for adults aged 18 years and older with hypertension. The study analysed demographic, drug classification, and demographic variables. All statistical analyses, including logistic regression, were used to assess trends.

RESULTS

Among 18,221 hypertensive participants, diverse characteristics were observed. The use of angiotensin converting enzyme inhibitors increased from 26.18% in 1999 to 32.76% in 2020 (linear P = 0.001). Angiotensin receptor blocker use rose from 10.36% to 26.57%. Beta blocker usage increased from 28.98% in 1999 to 42.50% in 2010, plateauing at approximately 40% from 2011 to 2020 (quadratic P < 0.001). Calcium channel blocker utilization increased from 16.70% in 1999 to 20.46% in 2020 (linear P < 0.001). Diuretic use decreased from 32.70% in 1999 to 26.34% in 2020 (quadratic P = 0.009). The use of antihypertensive medications varies across different demographic groups and comorbidities.

CONCLUSION

ACEI, ARB, and CCB usage increased, while DU usage decreased. BB utilization stabilized at a high rate. Antihypertensive drug use displayed diverse trends across demographic groups and comorbidities.

Implementation status, drivers and barriers to the sick children quality of care improving interventions in the Oromia region, Ethiopia: case study design

BACKGROUND

Improving quality of sick child care is the primary aim of Integrated Community Case Management services and implementation fidelity is critical to translating an evidence-based intervention to practice. A community-based complex intervention was implemented at the health posts of four agrarian regions of Ethiopia from 2017 to 2018 to improve the coverage and utilization of quality child health services. This study aimed to examine the implementation status of child health care quality improvement interventions in program areas of Oromia region, Ethiopia.

METHODS

A case study design using quantitative and qualitative research methods was conducted from September to October 2018. Implementation data were collected using observations, document reviews, and program staff interviews. Program staffs including health extension workers and their supervisors were included in surveys, and purposefully selected key informants from health posts to zonal health office level were included in the qualitative component of the research. The analysis framework was focused on the fidelity of the interventions' content, frequency, duration, and coverage, as well as the potential moderating factors of implementation using the model proposed by Carroll et al. conceptual framework for implementation fidelity.

RESULTS

Performance Review Clinical Mentoring was implemented according to the plan (every 6 months) in all of the districts and around nine in ten (88%) of the core contents were implemented. Though mentoring was provided by trained mentors, the duration of mentoring was less than the plan to fully implement all of the core activities. Overall, the mentoring program has reached 88% of health extension workers. Slightly greater than three-fourths of health extension workers have been supervised (76%) according to the plan and 80% of health posts were supplied with required iCCM medicines regularly. Staff turnover, topographical challenges, lack of transportation, competing priorities, weak support and feedback from the District health office, and security problems were frequently mentioned challenges to implementation. Whereas, the existence of continual partner support, the presence of integration and coordination of activities, and changes observed were the facilitators of implementation.

CONCLUSIONS

The implementation status of the Performance Review Clinical Mentoring Meeting was sufficient, while moderate adherence was observed in supportive supervision and supply of medicines. All of the providers were reached with sick children management training. Therefore, the implementation of community-based interventions should be aware of operational challenges in order to improve and sustain the program's performance.

Habitat-based radiomics from contrast-enhanced CT and clinical data to predict lymph node metastasis in clinical N0 peripheral lung adenocarcinoma ≤ 3 cm

This study aims to develop an integrated model combining habitat-based radiomics and clinical data to predict lymph node metastasis in patients with clinical N0 peripheral lung adenocarcinomas measuring ≤ 3 cm in diameter. We retrospectively analyzed 1132 patients with lung adenocarcinoma from two centers who underwent surgical resection with lymph node dissection and had preoperative computed tomography (CT) scans showing peripheral nodules ≤ 3 cm. Multivariable logistic regression was employed to identify independent risk factors for the clinical model. Radiomics and habitat models were constructed by extracting and analyzing radiomic features and habitat regions from contrast-enhanced CT images. Subsequently, a combined model was developed by integrating habitat-based radiomic features with clinical characteristics. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). The habitat model exhibited promising predictive performance for lymph node metastasis, outperforming other standalone models with AUCs of 0.962, 0.865, and 0.853 in the training, validation, and external test cohorts, respectively. The combined model demonstrated superior discriminative ability, achieving the highest AUCs of 0.983, 0.950, and 0.877 for the training, validation, and external test cohorts, respectively. The integration of habitat-based radiomic features with clinical data offers a non-invasive approach to assess the risk of lymph node metastasis, potentially supporting clinicians in optimizing patient management decisions.

Health impacts of exposure to synthetic chemicals in food

Humans are widely exposed to synthetic chemicals, especially via food. The types of chemical contaminants in food (including food contact chemicals) are diverse, and many of these are known to be hazardous, with mounting evidence that some contribute to noncommunicable diseases. The increasing consumption of ultra-processed foods, which contain synthetic chemicals, also contributes to adverse health. If the chemical contamination of foods were better characterized, then this issue would likely receive more attention as an important opportunity for disease prevention. In this Review, we discuss types and sources of synthetic food contaminants, focusing on food contact chemicals and their presence in ultra-processed foods. We outline future research needs and highlight possible responses at different food system levels. A sustainable transition of the food system must address the health impacts of synthetic chemicals in food; we discuss existing solutions that do justice to the complexity of the issue while avoiding regrettable substitutions and rebound effects.

In vitro anti-tumour activities of a novel recombinant immunotoxin targeting differentially overexpressed Leucine-rich repeat-containing G-protein-coupled receptor 5 in cervical cancer

Cervical cancer is the fourth most common cancer among women worldwide and is associated with infection by high-risk human papillomaviruses (HPV). In 2022, an estimated 660,000 new cases and around 350,000 deaths were recorded. The burden of this disease remains disproportionately high in low- and middle-income countries, highlighting significant disparities in access to national HPV vaccination, screening, treatment, and social and economic determinants. Leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5) is a receptor that is differentially overexpressed in various cancers, including cervical cancer and is associated with tumour progression, metastasis, and poor prognosis. Targeting LGR5 with a novel recombinant immunotoxin offers a promising therapeutic approach.ObjectiveThe study aims to develop a novel recombinant anti-LGR5 immunotoxin candidate based on a truncated form of Pseudomonas exotoxin A (ETA).MethodsTo develop this LGR5-specific recombinant immunotoxin, a corresponding single chain antibody fragment (αLGR5(scFv)) fused to ETA, was expressed under osmotic stress in the presence of compatible solutes in Escherichia coli BL21 DE3 cells. Expression was monitored by Western blot analysis facilitated by an N-terminal 10x-His tag. Purification was done using immobilized metal affinity chromatography (IMAC) and size exclusion chromatography (SEC). The recombinant immunotoxin (rIT) was assessed for cell surface binding on cervical cancer cell lines using confocal microscopy and flow cytometry. The rIT was then used in an XTT cell viability assay to assess targeted cell killing.Results and discussionUpon confirmation of full-length protein by Western blot, purified protein was used to confirm binding on LGR5-positive cervical cancer cell lines via confocal microscopy and flow cytometry using anti-His PE antibody as a secondary antibody. Selective cell-killing of this novel recombinant immunotoxin was illustrated by the dose-dependent reduction in cell viability at IC50 values in nanomolar concentrations on antigen-positive but not antigen-negative cell lines.ConclusionsIn conclusion, the rIT described is a promising candidate to treat cervical cancer, which however, would finally need to be confirmed by preclinical in vivo studies.

Sexual and reproductive health knowledge and behaviors and prevalence of sexually transmitted infections among adolescents and young adults from Angola

BACKGROUND AND OBJECTIVE

There is little information on sexual and reproductive health knowledge (SRHK) and practices in Angola and no data on the prevalence of sexually transmitted infections. The objective of this study was to assess the SRHK and behaviors, and estimate the prevalence of four sexually transmitted infections (STIs) among adolescents and young adults from 4 municipalities in Benguela province, Angola prior to an educational intervention.

MATERIAL AND METHODS

We performed a cross-sectional study to assess SRHK and sexual behavior using a structured questionnaire among adolescents and young adults aged 15 to 25 years old from two urban and two rural municipalities of Benguela province. We also evaluated the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis using rapid tests.

RESULTS

A total of 1400 youths were included in the study. Overall, 818 (58.4%) participants had adequate SRHK. Urban origin [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.35-2.04], older age (OR 1.14, 95% CI 1.09-1.20), being female (OR 2.06, 95% CI 1.57-2.71) and having journals and internet as the main sources of information (OR 1.37, 95% CI 1.00-1.86 and OR 2.33, 95% CI 1.69-3.21, respectively) were significantly associated to a good SRHK in the multivariate analysis. Four hundred and fifty-three [45.9% of those who have had sexual intercourse (n = 986)] reported risky sexual behavior. We observed that risky sexual behavior was associated with male gender (OR 2.89 95% CI 2.13-3.92, P< .001). Prevalence of STI was: 5 (0.35%) for HIV, 190 (13.6%) for HBV, 4 (0.3%) for HCV, and 20 (1.4%) for syphilis.

CONCLUSION

SRHK was higher than expected although in-depth knowledge was uncommon, especially in men from rural areas with lack of access to journals or the internet. Unsafe sexual behavior was widespread among our sample. Prevalence of HBV was higher than expected. Sexual education campaigns using both digital and non-digital approaches should be focused on reaching the young population dispersed in rural areas where internet connection is difficult and should be accompanied by HBV vaccination promotion.

Enhancing the nutraceutical and nutritional features of wheat germ to reduce atopic asthma symptoms in children

BACKGROUND

The rise in childhood asthma has increased interest in nutraceutical treatment options such as specific nutritional supplements, as medical treatments may not always produce the desired results. Despite treatment, between 30 and 50% of children with asthma do not attain adequate control.

OBJECTIVES

For the first time, the effects of adding fermented wheat germ to the daily diet of children with atopic asthma on respiratory function-related disease symptoms, serum IgE, and eosinophil levels were studied.

METHODS

The study comprised 52 patients (control group n = 26, experimental group n = 26) aged 12-18 years with a clear diagnosis of atopic asthma. The experimental group consumed 100 g of fermented wheat bread with 5% wheat germ every day for three months, while the control group consumed standard bread. The groups were assessed at baseline and at the end of each month with spirometry (FVC, FEV1, PEF), serum eosinophil and IgE measurements, and the application of the Asthma Control Test (ACT) scale.

RESULTS

There was no significant difference between the control and experimental groups in terms of any measurement. The experimental group had significant increases in PEF (p < 0.05), FVC, and IgE levels (p < 0.001) compared to monthly measurements. Both groups showed statistically significant improvements in ACT and FEV1 (p < 0.001). Nonetheless, the control and experimental groups showed no significant difference in time-dependent eosinophil levels (p > 0.05).

CONCLUSIONS

Although the inclusion of fermented wheat germ to asthmatic children's diets has been shown to improve PEF and IgE levels, these findings require further investigation.

Nursing regulation in Canada: Insights from a scoping review

Canadian nursing regulators have implemented various innovations to reform regulatory approaches to address workforce challenges, system demands, governance reforms, and a drive for efficiency. Given the significant role that regulators play in influencing patient safety, workforce, and health system outcomes, decision-making must be evidence-informed. This review examined the nature, extent, and range of literature related to nursing regulation in Canada and how the existing scholarship aligns with emerging regulatory and health system trends to inform the development of a research agenda. The review was conducted following the JBI methodology for scoping reviews and with the support of a medical research librarian. A total of 195 sources, including scholarly (n = 156, 80%) and grey literature sources (n = 39, 20%), were included and reviewed. Just over half of the included scholarly sources were empirical studies (n = 80, 51.3%). The number of publications has steadily increased over the last few decades, and the majority of sources were situated in a provincial/territorial context (n = 104, 53.3%), followed by the national (n = 67, 34.4%) and global context (n = 24, 12.3%). The majority of the literature was led by scholars or professional groups unaffiliated with nursing regulators (n = 129, 66.2%). In contrast, nursing regulators led, commissioned, or were involved in a smaller portion of sources (n = 66, 33.8%). The largest category of literature focused on regulatory models, governance structures, and reforms (n = 59, 30.3%); followed by registration and licensure (n = 57, 29.2%); nursing roles and standards (n = 53, 27.2%); conduct, complaints, and discipline (n = 13, 6.7%); continuing competence programs (n = 11, 5.7%); and education program approval/accreditation (n = 2, 1%). The current literature base related to nursing regulation in Canada is largely descriptive and non-empirical and may not provide sufficient evidence to inform regulatory decision-making. This highlights opportunities for regulators and researchers to enhance collaboration to co-create research agendas that can maximize knowledge development and mobilization efforts.

Comparison of the distribution of the dental hygienist workforce and population in Ontario: a geospatial analysis

OBJECTIVES

This study conducted a geospatial analysis of the distribution of the dental hygienist workforce relative to the distribution of the population in Ontario, Canada, aiming to address workforce imbalances and inform regional and international workforce planning.

METHODS

Geospatial analysis techniques were employed to examine the dental hygienist workforce distribution using anonymized datasets from the College of Dental Hygienists of Ontario (the professional regulatory body) and the Canadian census. The data were linked using the forward sortation area (FSA) component of Canadian postal codes, covering 520 FSAs across Ontario. Analyses were conducted at three levels, based on different aggregations of postal code data.

RESULTS

The study found significant variations in the distribution of dental hygienists across Ontario. The analysis revealed pockets of high dental hygienist density, mostly in urban areas, and areas with low dental hygienist rates, especially in rural and remote locations. The overall provincial rate was 97 dental hygienists per 100,000 population, with variation across the 520 FSAs, from zero to 20,000 dental hygienists per 100,000 population (or zero to 739 dental hygienists per 100,000 population if five outlier FSAs were removed).

CONCLUSIONS

The study underscores the complexity of dental hygienist workforce distribution in Ontario, revealing significant geographical disparities that suggest areas of both oversupply and undersupply. These insights provide actionable guidance for workforce policies and regulatory strategies, such as targeted incentives and public health initiatives, to address the mismatch between workforce supply and population needs. The findings highlight the importance of regular geospatial analyses to track changes in workforce distribution over time. The rigorous methodological approach and comprehensive evaluation of potential limitations offer valuable guidance for similar analyses in other jurisdictions. By providing a detailed framework and insights that extend beyond Ontario, this study contributes to the global understanding of dental hygienist workforce dynamics and supports the development of informed policies on a broader scale.

Genomic changes of Lassa virus associated with mammalian host adaptation

BACKGROUND

Lassa virus (LASV) causes a severe haemorrhagic fever in humans, with estimates of 100,000 to 300,000 infections annually in endemic regions and accounting for around 5000 deaths. The natural reservoir is the Mastomys rat, but through zoonotic transmissions humans are accidental hosts. Regular outbreaks continue to exert pressures on public health systems, with its ability to cause nosocomial infections posing risks to healthcare workers. It is a concern that larger outbreaks and introduction of LASV to new territories will intensify, including risk of adaptation to new mammalian host reservoirs.

RESULTS

To evaluate genetic changes in LASV during adaptation to a new host, a guinea pig model of infection was utilised. Initial infection with LASV stocks cultured from cell culture resulted in only mild or subclinical disease. To study the susceptibility in naïve animals, the virus was serially passaged which increased clinical signs during disease progression ultimately resulting in severe disease. An RNAseq and consensus mapping approach was undertaken to evaluate nucleotide changes in LASV genome from each animal at each passage.

CONCLUSIONS

During adaptation to guinea pigs, no significant new mutations occurred. Instead, a selection pressure on two genes of the L segment was observed resulting in their increased frequency in the genome population during passaging.

Are Access Costs and Income Associated With Treatment Decision-Making and Clinical Outcomes in Rural Patients Presenting With Upper Gastrointestinal Malignancy?

BACKGROUND AND OBJECTIVE(S)

Few studies evaluate the price elasticity of demand or the relationships between costs of access, patient income, treatment decision making and outcome in rural patients with upper gastrointestinal malignancy.

METHODS

We queried the National Cancer Database to identify rural patients presenting with clinical stages I-III esophagus, stomach, pancreas, hepatocellular (HCC) and cholangiocarcinoma between 2004 and 2020. Access cost was defined as (distance to treating center) × (regional gas price)/(regional vehicle fuel efficiency). Patients within the highest (HAC) and lowest (LAC) cost quintiles were selected for analysis. These were subcategorized based on income quartile: High income/High Access Cost (HI/HAC), High Income/Low Access Cost (HI/LAC), Low Income/High Access Cost (LI/HAC), Low Income/Low Access Cost (LI/LAC).

RESULTS

A total of 9582 patients met inclusion criteria. Median access cost was $26.61 (IQR: [$10.57-$73.70]). Patients in the HI/HAC cohort were more likely to undergo treatment at academic centers (79.5%, HI/HAC, 49.6%, HI/LAC, 78.5%, LI/HAC, 38.0%, LI/LAC), undergo neoadjuvant chemotherapy (23.8%, 12.6%, 17.7%, 10.4%) undergo surgery (46.6%, 29.6%, 39.7%, 20.8%), undergo liver transplantation for HCC (30.2%, 5.86%, 18.1%, 2.04%) and demonstrated higher rates of 5-year overall survival (42.4%, 25.6%, 32.2%, 19.0%) than those with HI/LAC, LI/HAC, and LI/LAC cohorts (all p < 0.01).

CONCLUSIONS

Among rural patients undergoing treatment for upper gastrointestinal malignancy elasticity of demand for service varies. Patients willing and able to pay for travel are more likely to receive neoadjuvant chemotherapy, undergo resection and demonstrate improved overall survival.

Subjective mental workload profile and its relationship with quality of work life among nurses: The mediating role of general health

BACKGROUND

 Nursing is widely recognized as a high-stress profession that encompasses a variety of cognitive, emotional, and physical demands.

OBJECTIVE

 This study seeks to provide a comprehensive understanding of the interactions between subjective mental workload (SMWL), general health (GH), and quality of work life (QWL).

METHODS

 This descriptive-analytical, cross-sectional study examines the relationship between SMWL, GH, and QWL among nurses working in several public hospitals in Iran. The study involved 283 nurses, with data collected through self-administered questionnaires and face-to-face interviews. SMWL was assessed using the SURG-TLX questionnaire, QWL was evaluated with Walton's 35-item tool, and GH was measured using the Goldberg General Health Questionnaire (GHQ-28). Structural equation modeling (SEM) was employed for data analysis.

RESULTS

 The findings revealed a significant negative effect of SMWL on both GH (β = -0.283; p = 0.038) and QWL (β = -0.211; p = 0.041). In contrast, better GH was positively associated with higher QWL (β = 0.747; p < 0.001). GH was found to mediate the relationship between SMWL and QWL, explaining 43% of the total effect.

CONCLUSION

 These results highlight the importance of improving GH to enhance QWL and job satisfaction among nurses by alleviating the adverse effects of high SMWL. The study emphasizes the need for targeted interventions to boost GH, thereby creating a more supportive work environment. Future research should delve deeper into these dynamics through longitudinal studies to validate these findings over time.

Chronic exposure to nicotine in diet enhances the lethal effect of an entomopathogenic fungus in the ant Cardiocondyla obscurior

Nicotine is a naturally occurring alkaloid that has acute toxic effects for insects and affects their behaviour even in sublethal amounts. In addition, nicotine is shown to accumulate and pollute environments through the use of commercially produced pesticides and tobacco products. We investigated how nicotine-polluted diets in two different concentrations impacted colony fitness in the ant Cardiocondyla obscurior, compared to a nicotine-free diet. We measured brood production and development, changes in relative abundances of bacterial endosymbionts, and worker survival in combination with a fungal pathogen. Chronic exposure to nicotine caused a concentration-dependent effect in enhancing the lethality of the fungal infection, with higher concentrations causing higher mortality in infected colonies. In the absence of pathogens, nicotine had no effect on worker survival. Furthermore, nicotine did not affect brood production or development, nor clearly affect the abundances of the bacterial endosymbionts. Our results show that nicotine pollution in the environment can negatively affect ant fitness through synergistic effects in combination with a fungal pathogen. Pathogens play a significant part in the decline of insects, and the influence that nicotine pollution may have in exacerbating them should receive more attention.

Conundrum and chances of diabetes management in the Western Pacific Region: A narrative review

The prevalence of diabetes is increasing globally, and glucose management is essential for the treatment of diabetes. Most guidelines recommend early intensive therapy and individualized approaches. Although many countries have implemented various guidelines and educational programs to enhance glucose management, the target achievement rate still remains very low. Studies from several countries and regions have identified various factors that influence blood glucose management, either positively or negatively. These factors have been comprehensively incorporated into guidelines to assist people with diabetes and healthcare professionals in following them and/or developing additional guidelines through further research. We and others have suggested that diverse factors should be considered-including comorbidities, age, complications, life expectancy, and pathophysiologic characteristics, such as ethnic differences in insulin sensitivity and secretion. The Western Pacific (WP) region, comprising countries with significant cultural and racial diversity, necessitates customized programs and community-based management strategies. In this review, we present specific challenges and opportunities for diabetes management identified through a systematic review of the literature from the WP region, along with those common to other regions. To improve healthcare policy and management in the WP region, it is essential to address regional characteristics and the factors that act as either barriers or facilitators to develop strategies for early intensive and individualized therapeutic approaches. Moreover, additional studies on diabetes pathophysiology and management-including pharmacotherapy-are urgently needed.

The Unmet Critical Care Burden at a Central Hospital in a Resource-Limited Setting: A Point Prevalence Study

INTRODUCTION

The unmet burden of critical illness in low-resource settings is unknown. The Modified Early Warning Score (MEWS) is a validated tool that quantifies patient risk for critical illness and higher level of care. This study evaluates the burden of critical illness outside of the ICU using MEWS and predictors of mortality among adult inpatients at a central hospital in Malawi, where ICU capacity is limited.

METHODS

We conducted a prospective cohort study among adult inpatients (≥ 13 years) across medical, surgical, and obstetrics-gynecology wards. MEWS was used to assess critical illness based on respiratory and heart rates, temperature, systolic blood pressure, and mental status. Data were collected over three days in 2024, with follow-ups on Day 7 and Day 30. Statistical analyses included chi-squared, Mann-Whitney, and logistic regression.

RESULTS

Among 315 patients, 62.9% were female, median age was 33 (24-48) years, and 17.5% met critical illness criteria outside of an ICU setting. Critically ill patients had significantly higher inhospital mortality (18.2% vs. 5.4% and p = 0.001) and 30-day mortality (20% vs. 7.3% and p = 0.004). Increasing MEWS strongly predicted mortality (OR = 1.38, 95% CI [1.15, 1.65], and p = 0.001). MEWS is the strongest predictor of critical illness in surgical patients, with the highest mortality increase compared to medicine patients who had similar mortality between both groups.

CONCLUSION

There is a high-unmet burden of critical illness outside of the ICU in our setting, with a resulting high mortality. MEWS effectively stratifies patient risk, particularly in surgical patients. Early identification and intervention and increasing critical care capacity are imperative.

Exploring the Impact of COVID-19 on Acute Care Nurses: An Integrative Review

AIM

To analyse, critique, and synthesise available research to create a unique framework of the impacts of COVID-19 on acute care nurses.

METHODS

Whittemore and Knafl's framework was used to organise this review. The Mixed Methods Appraisal Tool was used for quality analysis.

DATA SOURCES

CINAHL, MEDLINE, Web of Science, Scopus and the National Institute of Health COVID-19 database were searched.

RESULTS

Twenty-five articles were included. Impacts on acute care nurses came from changes, access to resources, interrupted relationships, and the virus itself. The outcomes from nurses were categorised as positive, physical, emotional responses, leaving and mental disorders. These outcomes were mediated by making connections, coping, learning and experience, and finding meaning.

CONCLUSION

Nurses working in acute care during COVID-19 were faced with immense stressors in a tumultuous and dangerous time. The vastly negative outcomes were less surprising than the fact nurses were left to find mitigating factors on their own. Given the large attrition from nursing that occurred and is still occurring, health systems that can both lessen the impacts and strengthen the buffering effects of mediating factors may fare better when the next pandemic comes.

IMPLICATIONS

Lessons learned can be used to prepare for future pandemics. Nurses should be at the forefront of all planning whether through education, policy, or research. Having a framework allows for a more comprehensive understanding and provides an underpinning for future action. The possibility for impact spans nurses across the globe who have worked, and who may work, during a pandemic. This framework provides a basis for changes related to pandemic planning throughout nursing domains.

REPORTING METHOD

The researcher has adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. No Patient or Public Contribution.

Associations between dietary patterns and environmental contaminants in children from the Norwegian Environmental Biobank: a cross-sectional analysis

Diet is a well-known source of environmental contaminants. This cross-sectional study explored children's dietary patterns and their association with contaminant exposure in the Norwegian Environmental Biobank. Parent-completed questionnaires provided data on children's frequency of intake of 36 foods and beverages, and socio-demographics. Several environmental contaminants were measured in urine, plasma, and whole blood from the children. Data were available for 658 children aged 7-14 years. Two dietary patterns, denoted "healthy" and "unhealthy," were identified using data driven factor analysis. We examined associations between child dietary patterns and contaminant concentrations using linear regression, adjusting for participant characteristics. The healthy pattern was positively associated with plasma perfluorononanoate (PFNA) concentration, whereas the unhealthy pattern was positively associated with urinary bisphenol A (BPA) concentration. Likelihood of exceeding health-based guidance value (HBM-GV) was examined using generalized linear model Poisson regression. The sum of the four most prevalent per- and polyfluoroalkyl substances (Ʃ4PFAS) increased with higher healthy pattern scores, with a relative risk (RR) of 1.18 (95% CI: 1.06, 1.31) per standard deviation. Multiple regression analyses showed that egg and fish/shellfish consumption were associated with higher Ʃ4PFAS, with 4% and 5% higher concentrations per additional weekly serving, respectively (P<0.001). For the sum of urinary di(isononyl)cyclohexane-1,2-dicarboxylate (ƩDINCH), 10% increase was observed per weekly serving of sweets/desserts. The urinary BPA concentration was 3% higher per extra weekly serving of fruit juice (P=0.001). These results highlight the need for societal measures to reduce contaminant exposure through food.

Dementia care management in primary care practices: a descriptive study among nurse practitioners

BACKGROUND

More than 55 million people worldwide have dementia, and every year, 10 million new cases are diagnosed. In the United States (U.S.) alone, 6.9 million Americans ages 65 and older have dementia. Health systems are searching for innovative solutions to expand the primary care system's capacity to care for these patients. Advanced practice nurses such as nurse practitioners (NPs) are vital to increasing primary care capacity to meet the need, yet primary care NPs often face structural, organizational, and workforce challenges. More specifically, little is known about NPs who care for dementia patients in primary care settings. This study explored the practice structural capabilities, organizational context, and job outcomes (i.e., burnout, job dissatisfaction, and intent to leave the practice) among NPs providing care for patients with dementia in U.S. primary care practices.

METHODS

We conducted a national cross-sectional survey of NPs using modified Dillman methods. Between 2021 and 2023, NPs working in primary care practices who cared for patients with dementia received a mail and online survey. Additional survey mailings, emails, postcard reminders, and phone calls encouraged non-respondents to participate. In total, 968 NPs responded across 847 practices. We estimated a response rate of 16.4-36.4%.

RESULTS

NPs reported that the quality of dementia care in their practices is poorer than the overall care provided. About 45% of NPs indicated that dementia care in their practices is less than "very good," while only 17% reported that the overall care delivered falls below that standard. Additionally, NPs reported significant deficits in practice structural capabilities for dementia care and challenges with administration within their organization. The findings show that over a third of NPs report burnout.

CONCLUSIONS

Given the projected growth in the number of patients with dementia and the growing workforce of NPs worldwide, policy and practice efforts should be directed toward strengthening primary care practices to provide quality care for dementia patients. Bolstering NP workforce capacity and supporting NP roles in dementia care could improve organizational capacity to provide dementia care. However, widespread burnout among NPs found in our study could undermine their contribution to the dementia care workforce.

Strategies and challenges for maintaining the continuity of essential health services during a pandemic: a scoping review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on health systems worldwide, resulting in disruptions to essential health service delivery, such as routine immunizations, maternal and child health, and treatment for communicable and noncommunicable diseases. These services have been disrupted due to the diversion of resources towards the COVID-19 response. Therefore, the objective of this scoping review was to identify the strategies and challenges associated with maintaining the continuity of essential health services during a pandemic.

METHODS

This scoping review study was conducted in 2023 using the proposed Arksey and O'Malley framework. We conducted searches on PubMed, Scopus, ProQuest, and Web of Science using relevant keywords. Additionally, we searched Google Scholar, hand-searched reference lists of included studies, and reviewed organizational reports, websites, and other sources of information. Content analysis was employed to summarize the themes from the selected articles.

RESULTS

Our search of major databases yielded 3,732 results. After the screening process, 47 articles were included in the scoping review. The extracted interventions were classified into six groups based on the building blocks of the World Health Organization health system: leadership and governance, access to essential medicines, health systems financing, the health workforce, health service delivery, and health information systems.

CONCLUSIONS

The implementation of effective strategies and interventions can help ensure the provision of essential health services during a pandemic. These strategies include leveraging technology for remote care, ensuring the safety of healthcare workers and patients, strengthening supply chains, and establishing flexible and adaptive healthcare systems.

Do structured career counselling initiatives influence specialty preferences in medical students? A longitudinal observational survey study

OBJECTIVE

This longitudinal study aimed to document shifts in specialty preferences, career pathways and intended practice locations among medical students following the implementation of structured career initiatives during the 2023-2024 academic year.

DESIGN

A longitudinal observational survey study.

SETTING

A private, not-for-profit institution, VinUniversity in Hanoi, Vietnam during the 2023-2024 academic year.

PARTICIPANTS

All year 2, year 3 and year 4 medical students (n=144 eligible), of whom 105 (73%) completed both baseline and follow-up surveys.

INTERVENTIONS

Structured career counselling initiatives introduced at the start of the academic year, including academic mentoring, clinical mentoring, hands-on clinical exposure in year 4 and multiple career counselling activities.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was change in specialty preference over time, measured by students' self-reported first-choice specialty at baseline and follow-up. Secondary outcomes included shifts in factors influencing career decisions (eg, personal interest, income and family expectations), intended practice location (domestic or international) and preferred career pathways (residency, Specialist Level I, master's degree or direct workforce entry).

RESULTS

Personal interest remained the strongest influence on specialty choice from baseline to follow-up (mean scores 4.27 vs 4.36 on a 5-point scale). A notable decrease occurred in the importance of income (3.82 to 3.22; p<0.001). Students showed increased openness to both domestic and international practice, while the number of undecided students dropped (17.1% to 1.9%). Internal medicine nearly doubled in popularity (12.4% to 24.8%), and surgery maintained the highest stability in specialty preference over the 1-year period (66.7%). Students also shifted towards advanced training pathways, with more pursuing specialist qualifications or master's degrees instead of immediate workforce entry.

CONCLUSION

Noticeable shifts in specialty preferences and career pathways were observed after a series of career initiatives were implemented. Although these trends coincided with the new programmes, further qualitative research is needed to elucidate how and why these career initiatives may have influenced decision-making. Informed by these findings, medical educators can refine interventions to support students' evolving preferences and ultimately strengthen healthcare workforce distribution.

Understanding the psychological impact of flooding on older adults: A scoping review

Flooding is increasing in frequency and intensity as a function of climate change. Older populations are vulnerable to the physical and mental health impacts of flooding, having less ability to cope and fewer rescue possibilities compared to younger ages, with resulting mental health impacts. This scoping review, based on JBI Scoping Review Methodology, scoped and summarized the evidence for the psychological impacts of flooding on older adults. Electronic databases were searched for reports of direct or indirect experiences of flooding in older adults globally (mental health, well-being, emotional outcomes). Ten articles across four continents were included. Risk of bias analysis found that 80% of articles were of weak and 20% were of moderate quality. Most studies focused on depression (70%), posttraumatic stress (60%), and anxiety (20%) as outcomes. Over half considered additional impacts and protective factors. This small but growing literature base demonstrates that climate-related flooding affects the mental health of older adults, with associations between flooding, depression, and posttraumatic stress. Poor social support contributes to worse mental health outcomes, suggesting that helpful interventions might focus on enhancing resilience through building social networks. All studies reviewed were from high-income countries; more research is required with countries with lower income.

Exploring healthcare providers' perspectives of childbirth education classes for quality of care and positive childbirth experience: an interpretative phenomenological analysis study

BACKGROUND

Pregnancy is a significant transitional life experience that can be one of the most stressful experiences in life. Childbirth education is designed to improve health behaviors and offers information on psychological and physical changes that occur in pregnancy, signs that labor has begun, hospital routines and what to expect, how to manage pain through non-pharmacological strategies, the first hours of a newborn's life, and the benefits of breastfeeding. Healthcare providers play an essential role in this education. To discover how healthcare providers view childbirth education classes, we explored their perceptions in relation to the quality of care and positive childbirth experiences.

METHODS

An interpretative phenomenological qualitative approach was conducted in three government hospitals in the Eastern Province of Saudi Arabia. Data collection involved conducting semi-structured interviews with 15 participants. The sample consisted of physicians, nurses, and educators, ensuring a diverse range of perspectives.

RESULTS

An interpretative phenomenological analysis was conducted for data analysis. One core category (Road to a Pleasant and Safe Journey) with three themes (Mother's Experience, Obstacles, and Struggles of Healthcare Providers, and Solutions & Suggestions) emerged from the data analysis. The study findings indicate that childbirth education programs boost maternal health and facilitate a more positive delivery experience.

CONCLUSIONS

Receiving childbirth education about natural and instinctive childbirth was necessary for low-risk mothers to experience a positive childbirth experience. The education also enabled mothers to feel in control during pregnancy, birth, and postpartum. From the results of this research the following recommendations can be made: childbirth education should be mandatory for all hospitals and primary healthcare institutions in the Kingdom and its curriculum should be standardized by the ministry of health and all healthcare providers employed in maternity care should be required to attend the standardized childbirth education programs.

The relationship between early life course air pollution exposure and general health in adolescence in the United Kingdom

Air pollution is associated with health in childhood. However, there is limited evidence on sensitive periods during the first 18 years of life. Data were drawn from the Millennium Cohort Study, a large and nationally representative cohort born in 2000/2002. Self-reported general health was assessed at age 17; number of hospital records were derived from linked health data (Hospital Episode Statistics) for consented participants. Residential history was linked to 25 × 25 m grid resolution annual PM2.5, PM10 and NO2 maps between 2000 and 2019; year-specific air pollution exposure in 200-m buffers around postcode centroids were computed. After adjusting for individual and time-variant area-level confounders, children exposed to higher air pollution in early (2-4 y) (n = 9137; PM2.5: OR = 1.06, 95% CI: 1.01-1.11; PM10: OR = 1.05, 95% CI: 1.01-1.09; NO2: OR = 1.01, 95% CI: 1.00-1.02) and middle childhood (5-7) (n = 9171; PM2.5: OR = 1.04, 95% CI: 1.00-1.07; PM10: OR = 1.03, 95% CI: 1.01-1.06) reported worse general health at age 17. Higher PM2.5 and NO2 exposure in adolescence increased the number of hospital episodes in young adulthood. Individuals from non-White and disadvantaged backgrounds were exposed to higher levels of air pollution. Air pollution in early and middle childhood might contribute to worse general health, with ethnic minority and disadvantaged children being more exposed.

Assessment of consumer perspectives on the use of paper packaging in Trinidad

BACKGROUND

Paper packaging is increasingly being used to replace single use plastics to mitigate the negative effects of plastic pollution on the environment. While many developed countries have made considerable strides in this transition, developing countries, like Trinidad, have lagged behind, partly, due to no stringent legislation for types of packaging at commercial outlets.

OBJECTIVES

The objectives of this study were to investigate the demand for and assess public perceptions of sustainable paper packaging in Trinidad.

METHODOLOGY

Data were collected using a Knowledge, Attitudes, Practices (KAP) survey supplemented by interviews, packaging stress testing, and analysis via SPSS.

RESULTS

A majority of participants demonstrated awareness of recycling knowledge (79%) and deforestation awareness (84%); which aligns with the 71% of participants who considered themselves environmentally conscious. The attitudes and practices of participants did not correlate directly with their environmentally conscious behaviour such as willingness to purchase paper-based food containers (67%), finding paper packaging more aesthetically pleasing than plastic (73%) and willingness to pay more for paper packaging (53%). The interviews highlighted a demand for sustainable paper packaging while also identifying challenges such as waterlogging of packaging, sustainable raw materials sourcing, packaging strength, and the need for customer testing and feedback. The stress test showed good appearance and durability.

CONCLUSIONS

Overall, the sustainable paper packaging stress test received favourable feedback and there were varying levels of knowledge, attitudes and practices related to sustainable packaging. Future research can build on the current findings and the questionnaire can be replicated after the introduction of replacement of single use plastics with non-wood paper packaging.

A qualitative study on ICU nurses' perceptions of palliative care

INTRODUCTION

Providing palliative care is one of the most essential responsibilities of nurses toward patients and their families. To fulfill this role effectively, nurses require specific skills to understand patients better and gain their trust. Given the necessity of delivering palliative care and the limited studies available in Intensive Care Units (ICUs), this study aimed to explore the perceptions of nurses working in ICUs in Kermanshah Province.

METHODS

This qualitative study employed a descriptive phenomenological approach. Data were collected through purposive sampling via semi-structured interviews with 13 ICU nurses employed at hospitals affiliated with Kermanshah University of Medical Sciences. The interviews were recorded, transcribed verbatim, and analyzed using the Collaizi method, with data management conducted through MAXQDA-10 software.

RESULTS

Of the 13 participating nurses, 9 were female and 4 were male, with a mean age and work experience of 29.69, and 6.54 years, respectively. Four main themes and nine sub-themes emerged from the qualitative analysis. The primary themes included: "Understanding the meaning and concept of palliative care," "Nurses' perception of the types of palliative care," "Strengthening the foundations of palliative care for ICU nurses," and " Factors contributing to palliative care".

CONCLUSION

The findings highlighted several critical factors necessary for the effective provision of palliative care in ICUs, including nurses' understanding, patience, required knowledge, and a strong work ethic. These factors collectively enhance the quality of palliative care provided to patients. Given the pivotal role of palliative care in improving nursing care for critically ill patients, it is recommended that further qualitative studies be conducted to deepen nurses' understanding of palliative care in ICUs.

Exploring barriers and facilitators to integrating health equity into health and climate change policies in Nepal - a qualitative study among federal level stakeholders

BACKGROUND

Health is foundational for climate action, and integrating climate and health policies to achieve health equity is widely recognized. While there is a growing global momentum for collaborative health and climate initiatives, more effort is needed to incorporate health equity into national climate policies. Achieving this necessitates identifying both barriers and facilitators of integrated policymaking. This study examines the barriers and facilitators to integrating health equity into climate change-related policies at Nepal's federal level.

METHODS

We interviewed 14 key stakeholders from three major federal ministries, a high-level government entity, and a government partner institution in Nepal, all with diverse roles and responsibilities. To facilitate discussions, we developed an interview guide informed by two policy analysis frameworks: Health Equity Policy Process Analysis Framework and Schlossberg's Framework of Environmental Justice. Using both inductive and deductive approaches, we identified five key facilitators and four major barriers to integrating health equity in climate change-related policies in Nepal. We present these barriers in relation to WHO's climate-resilient health systems framework.

RESULTS

A wide array of facilitators was identified, broadly categorized as a) acknowledgement of the need to integrate health equity in climate change policies, b) political leadership, c) global influences, d) established mechanisms and structures in place for collaboration and e) the federal structure. Barriers identified were largely systemic and encompassed a) knowledge gaps, b) ownership and accountability, c) resource constraints: human resources and budget and d) data limitations. Among these, the issue of ownership and accountability emerged as an overarching theme, cutting across all barriers. Similarly, financing and knowledge gaps were identified as significant obstacles to progress.

CONCLUSIONS

The findings underscore the need for a more structured approach, with clearly delineated responsibilities to ensure all relevant sectors contribute to the goal of health equity in climate action. Developing well-defined guidelines outlining the roles and responsibilities of different sectors involved in climate action is crucial for fostering ownership and ensuring that health equity is effectively integrated into climate change policies, as well as aiding in resource allocation. We recommend future research to explore the potential role of policy champions within ministries in advocating for and advancing health equity within climate change-related policies.

Patterns and predictors of mental workload in intern nursing students: a latent profile analysis

BACKGROUND

Intern nursing students are facing considerable psychological burdens, which impact their mental well-being and career progression. Although numerous studies have explored the psychological status of intern nursing students and its influencing factors, the majority of these investigations have primarily focused on single-factor linear relationships. To date, there has been limited research analyzing the individual differences among intern nursing students.

OBJECTIVE

This study aimed to investigate the mental workload patterns of intern nursing students and identify the factors that predict these patterns.

METHODS

A total of 320 intern nursing students were recruited for this study via convenience sampling, 302 of whom completed the survey. A pattern of intern nursing students' mental workload was identified through a latent profile analysis of 6 items on the NASA-Task Load Index scale. The analysis of latent profiles was performed using Mplus 8.7 software, while χ2 test and logistic regression analysis were carried out using SPSS 27.0 software.

RESULTS

Three patterns of mental workload of intern nursing students were identified as "low MWL-high self-rated (n = 45, 14.9%)", "moderate MWL (n = 152, 50.33%)", and "high MWL-low self-rated (n = 105, 34.77%)". Age and monthly income of 3000-5000 RMB were the main predictors of low MWL-high self-rated pattern. In contrast, long internships, passive coping strategies, college degree and monthly income < 3000 RMB were predictors of moderate MWL pattern.

CONCLUSION

This study provided novel insights into the mental workload patterns among intern nursing students. The findings highlighted the heterogeneity of MWL and provide evidence-based guidance for nursing administrators to identify groups of intern nursing students with high mental workload and to develop targeted psychological interventions and management strategies.

CLINICAL TRIAL NUMBER

Not applicable.

Exploring the relationship between mental work load, work ability, and musculoskeletal disorders: A cross-sectional modeling study among health service workforces in Iran

INTRODUCTION

The health service workforces play a crucial role in shaping a nation's health system efficiency, making it vital to understand factors affecting their performance. This study examined the relationship between mental workload, work ability, and work-related musculoskeletal disorders (WMSDs) among employees at comprehensive health service centers in Saveh, Arak province, Iran.

MATERIALS & METHODS

The cross-sectional study involved 197 randomly selected personnel whose WMSDs prevalence was evaluated using the Nordic questionnaire. Work ability was assessed through the Work Ability Index (WAI), and mental workload was measured using the NASA Task Load Index (NASA-TLX). All data analysis was performed using SPSS v 24.0 software.

RESULTS

The average age and work experience of the participants were determined to be 35.74 ± 7.52 and 11.63 ± 8.59 years, respectively. The highest prevalence was reported in the lumbar region, with a lifetime prevalence of 63.5% and an annual prevalence of 60.9%. The average mental workload and work ability were calculated to be 63.24 ± 13.26 and 34.86 ± 7.61, respectively. The highest prevalence of WMSDs (89.5%) was observed in the lower back region among women aged 45-54 years. A significant relationship was identified between work experience and age with work ability and mental workload (P < 0/01). Furthermore, an increase of one point in work ability score leads to a decrease in WMSDs in the neck, wrists/hands, low back and hips/thighs regions by 13.5%, 8%, 11.5%, and 9%, respectively.

CONCLUSIONS

The study underscores the need to enhance the physical, psychological, and social environments of health service employees. Implementing targeted educational programs can improve task performance and mitigate high mental workload effects, ultimately reducing WMSDs and improving staff well-being.

Examining the relationship between occupational health and safety practices and productivity levels in private health facilities in the central region of Ghana

INTRODUCTION

Literature has established that offering protection for workers' health and safety is one method of preserving an organization's human resources and increase worker productivity. The purpose of this study was to examine occupational health and safety practices among selected private hospitals in the central region of Ghana and how it affects work productivity.

METHODS

This study was a descriptive cross-sectional quantitative study and structured questionnaires were used to collect data from 344 healthcare workers at sixteen (16) selected private health facilities in the Central Region of Ghana, through the convenience sampling technique. Data entry and analysis were conducted using Statistical Package for Social Sciences (SPSS).

RESULTS

A greater majority of the respondents exhibited positive perceptions and attitudes towards occupational health and safety protocols. The healthcare facilities of almost 6 out of every 10 sampled respondents had high compliance levels with occupational health and safety measures. Also, Pearson correlation analysis revealed a significant positive relationship between OHS implementation and overall productivity (r(344) = 0.255, p < 0.018). This relationship remained significant after controlling for demographic variables through partial correlation analysis (r(344) = 0.272, p = 0.015), indicating a stable and consistent association. The most mentioned potential areas for improvement to optimize employee well-being and productivity were safety training, safety satisfaction and feedback and management safety commitment while the least mentioned were safety reporting, safety involvement and working environment.

CONCLUSION

This study has demonstrated that the implementation of OHS measures has a positive and significant relationship with the overall productivity of healthcare workers in private health facilities in the Central Region of Ghana.

Towards a 'theory of change' for ocean plastics: a socio-oceanography approach to the global challenge of plastic pollution

Socio-oceanography is an emerging field which mobilises insights from natural and social sciences to explore the inter-connectedness of societal relationships with the ocean and to adopt a holistic approach to solving key oceanographic and societal challenges. It is within this specific context that we explore and reflect upon diverse communities in relation to engaging with plastic pollution in the ocean, one of the foremost socio-environmental challenges of our time. We establish definitions of 'community', arguing that communities are not 'out there' waiting to be engaged with but are dynamic and (re)constituted in four key contexts - geographical, practical, virtual, and circumstantial. We outline some 'rules of engagement' and draw upon several international case studies in the context of plastic pollution to evidence and emphasise the value of working with members of diverse communities to better address socio-oceanographic challenges. In the context of plastic pollution, communities have a vital role to play in terms of co-creating knowledge, lived experience, diverse expertise, and agency to bring about social change. Given the ubiquity of plastics in our day-to-day lives, and subsequently as an environmental pollutant, no community is unaffected by this issue. Relating to socio-oceanography, we argue that structural power imbalances in terms of how diverse communities and natural scientists are traditionally positioned within academic research mean that 'formal' scientific knowledge is frequently privileged, and members of communities risk being positioned as 'empty vessels'. Moving away from this 'deficit' model where knowledge is simply transferred or alternatively extracted from communities allows us to progress towards an inclusive 'socio-oceanography in society' approach, where members of communities are valued as vital in prioritising and addressing socio-oceanography issues which affect everyday life. Accessibility, openness, ethics and fairness in data are also essential in ensuring that research outcomes can be applied widely outside the academic community.

Graphical Abstract

Accuracy analysis of cervical cancer screening using urine and vaginal self-sampling versus clinician-collected samples: A systematic review and meta-analysis

OBJECTIVE

The aim of the present study was to explore the differences in diagnostic performance between vaginal self-sampling, urine self-sampling, and clinician sampling in cervical cancer screening.

METHODS

Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020, we searched PubMed, Cochrane Library, Web of Science, and Embase. Study quality was assessed with Cochrane Review Manager 5.3. Diagnostic performance was evaluated by pooling sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve using STATA 18.0.

RESULTS

The meta-analysis included 15 studies with 3665 participants, all with abnormal cervical cancer screening results. The pooled sensitivity for both self-sampling methods was 0.88 (95% confidence interval [CI]: 0.85, 0.91), the pooled specificity was 0.81 (95% CI: 0.68, 0.89), and the area under the curve (AUC) was 0.92 (95% CI: 0.89, 0.94). For high risk-human papillomavirus (HR-HPV), vaginal self-sampling showed a sensitivity of 0.92 (95% CI: 0.90, 0.94) and specificity of 0.80 (95% CI: 0.58, 0.92), and AUC was 0.93 (95% CI: 0.91, 95); urine self-sampling showed a sensitivity of 0.83 (95% CI: 0.77, 0.88) and specificity of 0.81 (95% CI: 0.65, 0.91), and AUC was 0.88 (95% CI: 0.85, 0.91). For >CIN2 lesions, vaginal self-sampling showed a sensitivity of 0.98 (95% CI: 0.96, 0.99) and specificity of 0.63 (95% CI: 0.48, 0.77), and AUC was 0.98 (95% CI: 0.96, 0.99); urine self-sampling showed a sensitivity of 0.95 (95% CI: 0.91, 0.97) and specificity of 0.62 (95% CI: 0.31, 0.86), and AUC was 0.95 (95% CI: 0.93, 0.97).

CONCLUSION

Vaginal and urine self-sampling for HPV testing show promising diagnostic potential, with vaginal sampling outperforming urine. Both methods have similar sensitivity for detecting lesions >CIN2.

Oral Cancer in the South and South-East Asia Region, 2022: Incidence and Mortality

INTRODUCTION

We present an epidemiological description of cancer of the lip, oral cavity, and oropharynx focused on South and South-East Asia by cancer site, sex, and population.

METHODS

The number of new cases and deaths from lip, oral cavity, and oropharynx cancers was extracted from GLOBOCAN 2022 and Cancer Incidence in Five Continents. We present age-standardized incidence and mortality rates (ASR) per 100,000 and temporal trends between 1992 and 2017 for four populations in the Region.

RESULTS

In 2022, there were 177,258 incident cases and 98,735 deaths from oral cancer in this region. ASR for lip and oral cancer in South and South-East Asia was highest in India (14.67), Sri Lanka (14.04), Bangladesh (13.61) and Pakistan (12.07) in males. The highest age-standardized mortality rates for lip and oral cancer were observed in India (8.17), Bangladesh (8.07) and Pakistan (7.74) for males.

CONCLUSION

Incidence and mortality rates of oral cancer in South and South-East Asia are among the highest globally. 52% of total global deaths from oral cancer are reported from this region. Data suggest a persisting trend and an increase in the incidence of oral cavity cancer among Indian and Bangladeshi males.

Understanding the barriers and facilitators to delivering peer support effectively in England: a qualitative interview study

BACKGROUND

Peer support roles within mental health services are rapidly increasing in number and scope in the UK and internationally. This paper explores the facilitators and barriers to delivering peer support effectively, as experienced by Peer Support Workers (PSWs) in a range of services and settings.

METHODS

We conducted semi-structured qualitative interviews with paid mental health PSWs working across a range of settings in England. We took a collaborative, participatory approach. Interviews were carried out by researchers with experience of living with and/or supporting others with mental health conditions, and for some having experience delivering peer support themselves, and data were analysed using methods guided by general principles of thematic analysis.

RESULTS

We interviewed 35 PSWs with a range of roles that spanned a range of mental health areas, and regions. Overarching facilitators and barriers were identified including the need for roles to have flexibility with some structure and boundaries; the need for support, supervision and training to ensure PSWs are skilled in delivering the unique elements of their job; the importance of working with a strong team and leaders who support and value PSW; the complexity of working where there are tensions between the flexibility of PSW and the structures of existing healthcare systems, as well as the systemic factors such as funding, pay and progression can have an effect both on the personal experience of PSWs and on the value placed on PSWs in the wider organisation.

CONCLUSION

Our findings highlight the complexity of peer support work and PSW roles, with a variety both of facilitators allowing them to carry out roles effectively and the barriers to doing so. As PSWs numbers and the scope of their roles increase, awareness of barriers and facilitators needs to inform PSW job roles, support systems and integration into teams and systems.

The history of occupational health on the African continent

BACKGROUND

The history of occupational health on the African continent is important but under-studied.

METHODS

We surveyed key resources related to medical history from the Ancient Egypt through the Ottoman Empire period. For the colonial era, we examined archival records, official reports, and historiographical studies, focusing on key cases from French North Africa, Belgian Congo, Italian East Africa, and British South Africa. To explore occupational health in Africa during the post-colonial period, we supplemented biomedical publications with data from governmental reports and policy documents.

RESULTS

The history of occupational health on the African continent has been characterized by poor working conditions, especially in mineral extraction. Colonial exploitation frequently worsened these underlying problems. The post-colonial record suggests that many past deficiencies continue.

DISCUSSION

An integrated approach to the history of occupational health on the African continent provides context for better understanding current problems and for anticipating future trends.