Search Results (61)

Introduction: Decision-making regarding radiotherapy techniques for patients with nasopharyngeal cancer requires a comparison of photon and proton plans generated using planning software, which requires time and expertise. We developed a fully automated decision tool to select patients for proton therapy that predicts proton therapy (XT) and photon therapy (PT) dose distributions using only patient CT image data, predicts xerostomia and dysphagia probability using predicted critical organ mean doses, and makes decisions based on the Netherlands’ National Indication Protocol Proton therapy (NIPP) to select patients likely to benefit from proton therapy. Methods: This study used 48 nasopharyngeal patients treated at the Cancer Hospital of the Chinese Academy of Medical Sciences. We manually generated a photon plan and a proton plan for each patient. Based on this dose distribution, photon and proton dose prediction models were trained using deep learning (DL) models. We used the NIPP model to measure xerostomia levels 2 and 3, dysphagia levels 2 and 3, and decisions were made according to the thresholds given by this protocol. Results: The predicted doses for both photon and proton groups were comparable to those for manual plan (MP). The Mean Absolute Error (MAE) for each organ at risk in the photon and proton plans did not exceed 5% and showed a good performance of the dose prediction model. For proton, the normal tissue complication probability (NTCP) of xerostomia and dysphagia performed well, p > 0.05. There was no statistically significant difference. For photon, the NTCP of dysphagia performed well, p > 0.05. For xerostomia p < 0.05 but the absolute deviation was 0.85% and 0.75%, which would not have a great impact on the prediction result. Among the 48 patients’ decisions, 3 were wrong, and the correct rate was 93.8%. The area under curve (AUC) of operating characteristic curve (ROC) was 0.86, showing the good performance of the decision-making tool in this study. Conclusions: The decision tool based on DL and NTCP models can accurately select nasopharyngeal cancer patients who will benefit from proton therapy. The time spent generating comparison plans is reduced and the diagnostic efficiency of doctors is improved, and the tool can be shared with centers that do not have proton expertise. Trial registration: This study was a retrospective study, so it was exempt from registration. Full article

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

Cultural and religious diversity in Spain, driven by recent decades of migratory flows, has not been exempt from generating social tensions and, unfortunately, an increasing stigmatization of migrant children. This article examines how power dynamics and exclusion impact the identity construction of these young people, particularly within the child protection system. Through interviews and focus groups with young people and professionals in Barcelona and Melilla, this study highlights the resistance strategies these young individuals employ to counteract stigmatizing narratives. The findings indicate that, despite inclusion policies, imposed labels reinforce their vulnerability and limit their social and community participation. Although interfaith dialogue is proposed as a tool to mitigate these tensions, professionals working with these children emphasize the lack of institutional support and insufficient training in socio-cultural diversity, which hinders their efforts. The study underscores the importance of developing interfaith competencies that foster mutual respect and recognition, concluding with a critique of the current protection system. It advocates for a comprehensive approach to addressing these young people’s emotional, social, and spiritual needs beyond solely legal and educational aspects. Full article

Diabetes mellitus is one of the leading causes of morbidity and mortality worldwide. Type 2 diabetes mellitus is the most prevalent type of diabetes mellitus, and it is associated with both hereditary and lifestyle risk factors. South Africa is not exempt from this pandemic; hence, this paper aims to assess the prevalence and determinants of household self-reported diabetes mellitus in Gauteng, South Africa. Data were sourced from the Gauteng City-Region Observatory (GCRO) quality of life survey (2020/2021). Bivariate and multivariate logistic regressions were applied. The prevalence of household self-reported diabetes mellitus in Gauteng was 11.1%. The ‘other population’ group (which included Whites, Coloureds and Indians), as well as older respondents, higher household monthly food expenditure, poor self-perceived health status and household self-reported hypertension were factors that increased the odds of household self-reported diabetes mellitus. Only informal housing decreased the odds of household self-reported diabetes mellitus. Screening of diabetes mellitus among those with poor living conditions, no medical aid and lack of access to healthcare facilities such as Gauteng township and informal settlement residents should be intensified. This secondary disease prevention intervention is crucial, as it will enhance the appropriate referrals and timeous chronic treatment for those with diabetes mellitus. Full article

The stigma experienced by LGBTQIA+ youth in middle school and high school is commonly linked to poor mental health and academic success, but little is known about its potential long-term impact. It was hypothesized that stigma levels would differ based on geographical location, with rural youth experiencing higher stigma levels compared to urban youth. This IRB-approved exempt research design collected anonymous survey data from college students at a mid-south public university. The sample included a total of 94 respondents, with 63 from rural areas and 31 from urban areas. Experiences of internalized, enacted, and perceived stigma were assessed with rating scales. No statistically significant differences were found between rural and urban youth, with both groups reporting high levels of internalized, enacted, and perceived stigma. Rural youth reported experiencing more discrimination or attacks at school and fewer LGBTQIA+ school resources but slightly higher family support. Urban youth were more likely to be out to family members and felt safer at school. Comparatively, more rural youth reported experiencing anxiety, depression, and suicidal thoughts in the past 30 days than urban youth. A moderate correlation was found between perceived and internalized stigma. This study provides insight into the pervasive nature of LGBTQIA+ stigma, regardless of geographical location. Full article

Background: Health care is not exempt from harboring social inequalities, including in those countries with a universal public system. The objective was to ascertain whether the population’s assessment of primary care (PC) changed between 2006 and 2016, the decade that included the economic crisis of 2008, and also if it exhibited patterns of social inequality in Barcelona (Spain). Methods: This was a cross-sectional study using Barcelona Health Surveys 2006 and 2016. Samples (4027 and 3082 respectively) comprised residents in Barcelona, over 15 years old. Dependent variable: Primary Care (PC) index. Independent variables: age, social class, and birthplace. Analyses included means and percentiles of PC index, and Somers’ D test to compare the distribution of the groups. Results: Comparing 2016 with 2006, the distribution of the PC index remained in women (median of 73.3) and improved in men (from 70 to 73.3). By social class, the pattern of inequality observed in 2006 in men with perceived poor health status disappeared in 2016. Inequalities according to birthplace persisted in women, regardless of perceived health status, but disappeared in men. Conclusions: In the 10 years between which the global economic crisis occurred, the assessment of PC did not worsen, and it did improve for men, but the study points to the need for more focus on people born abroad. Full article

Traditionally, rental housing has been supplied by a large pool of individual investors who own a few units and invest their savings, with some leverage, to take advantage of the tax regime in Australia. The last five years have seen the emergence of build-to-rent (BTR) units, which are supplied by investors who own a large number of units. The state of Victoria in Australia has the largest share of these projects. In the current market and regulatory environment, the financial viability of BTR projects is low for investors and hinges on the ability of units to be leased at higher than market rents. This paper examines four groups of levers, including those already being pursued by the building industry, that can be used to improve the financial viability of BTRs. These include: (i) revenue maximization, (ii) cost reduction (iii) fiscal and (iv) planning incentives. An archetypical BTR project which mimics current practice is considered, assumed to be in Docklands, Victoria, where several BTR projects are planned. For the robustness check, a feasibility analysis is conducted for a site in North Melbourne, a neighbourhood in Victoria with several BTR projects. The results indicate that for revenue maximization, the mix of unit types in a BTR project should be location-specific, as market preferences (and the characteristics of renters) determine the rent for different types of units that can be achieved. In a conventional BTR project development, where land is bought upfront and the project is developed, the mixed-use BTR (residential in combination with commercial) does not provide significant financial benefits though including small retail (3–4% of the net lettable area) may provide complementary benefits. Incurring large capital costs upfront and having the revenue stream spread over long periods reduces financial viability. While construction costs are more difficult to reduce, ways to reduce land costs could be through zoning land for BTR use, through mechanisms such as joint ventures with landowners, and land leasing. Exemptions on income, land tax, and rates (like CHPs) can result in a higher return for investors. A full GST refund, an incentive that industry is lobbying for, results in a similar IRR as an exemption on income, land tax and rates would offer. These results will assist in determining priorities for policies that are aimed at BTR. Full article

Pulmonary vein isolation (PVI) with catheter ablation (CA) represents an effective therapy for atrial fibrillation (AF). Unfortunately, it is still not exempt from severe complications. The balance of risks and benefits should be assessed, and a patient-tailored approach is desirable. So far, several clinical and cardiac imaging parameters have been evaluated to investigate pre- and post-procedural features that could help clinicians in the selection of patients at high risk of a poor outcome after CA. This clinical and systematic review analyses the potential role of new LA parameters, such as LA reservoir strain, to predict AF recurrence after CA therapy. Notably, LA reservoir strain gains substantial clinical importance in patients with paroxysmal AF and when a low CHADS2-VASc score is retrieved. LA reservoir strain provides data concerning the risk of AF recurrence after PVI and, thus, in the management of long-term medical therapy in this patient’s group. Full article

SARS-CoV-2 virulence is known to increase with lowering of environmental temperature and solar ultraviolet radiation; therefore, we have focused our real-world nationwide study concerning with COVID-19 trend and dynamics on the coldest seasons of the year in Italy, the Western country hardest hit at the onset of the pandemic, comparing the autumn–winter of 2020 (before mass vaccination but when the emergency machinery was fully operative in terms of tracing and swabs) with the autumn–winter of 2021 (after mass vaccination), and analyzing the mortality burden by age groups and life stages in the years 2019 (pre-COVID-19), 2020 (before mass vaccination), and 2021 (after mass vaccination). Methods: During the state of national health emergency, the Civil Defense Department released the aggregate data coming from the Higher Institute of Health, the Ministry of Health, the Italian Regions, and the Independent Provinces, to inform the population about the pandemic situation, daily. Among these data, there were the number of contagions, performed swabs, hospitalizations in Intensive Care Units (ICU), non-ICU patients, and deaths. By means of a team effort, we have collected and elaborated all these data, comparing the COVID-19 pandemic in Italy during the autumn–winter of 2020 with the autumn–winter of 2021. Moreover, we have extracted from the database of the National Institute of Statistics the total number of annual deaths in Italy during the years 2019, 2020, and 2021, comparing them to each other in order to evaluate the mortality burden attributable to COVID-19. Results: From the autumn–winter of 2020 to the autumn–winter of 2021, the contagions increased by ≈285%, against a ≈290% increase in the performed swabs; therefore, the mean positivity rate passed from 8.74% before mass vaccination to 8.59% after mass vaccination. The unprecedent vaccination campaign allowed a ≈251% abatement in COVID-19 deaths, and a reduction of ≈224% and ≈228% in daily ICU and non-ICU hospitalizations due to COVID-19, respectively. Regarding COVID-19 deaths, in 2020, there was a mortality excess of ≈14.3% quantifiable in 105,900 more deaths compared to 2019, the pre-COVID-19 year; 103,183 out of 105,900 deaths occurred in older adults (≥60 years), which is equivalent to ≈97.4%, while in adults over 50, the segment of population just below older adults, in 2020, there were 2807 more deaths than in 2019. Surprisingly, from the analysis of our data, it is emerged that in people under the age of 40 in the years 2019, 2020, and 2021, there were 7103, 6808, and 7165 deaths, respectively. This means that in subjects under 40 during 2020, there were 295 fewer deaths than in 2019, while during 2021, there were 357 more deaths than in 2020, equivalent to ≈5.2% more. Conclusions: COVID-19 is a potential life-threatening disease mainly in older adults, as they are the most vulnerable due to inherent immunosenescence and inflammaging. Extensive vaccination in this segment of population with up-to-date vaccines is the means to reduce deaths, hospitalizations, and ICU pressure in the public interest. In the event of future threats, a new mass vaccination campaign should not be implemented without taking into account the individual age; it should primarily be aimed at people over 60 and at patients of any age with immune deficits, and secondly at people over 50. COVID-19 vaccination shows a favorable benefit–risk ratio in older adults, while the balance steps down under the age of 40; this younger segment of the population should be therefore exempt from any mandatory vaccination. Full article

Introduction: AFP and the RETREAT score are currently used to predict HCC recurrence after LT. However, superior discriminating models are needed for low AFP populations. The aim of this study is to investigate the predictive value of PIVKA-II on recurrence-free survival after LT in a low AFP population and microvascular invasion on explant. Methods: A retrospective cohort study including all consecutive patients transplanted for HCC between 1989 and 2019 in the Erasmus MC University Medical Center in Rotterdam, the Netherlands, was used. AFP and PIVKA-II levels were determined in serum samples collected at the time of transplantation. Data on tumor load and microvascular invasion were retrieved from patients’ records. Results: The study cohort consisted of 121 patients, with HCC recurrence in 15 patients (12.4%). The median AFP was 7.7 ng/mL (4.4–20.2), and the median PIVKA-II was 72.0 mAU/mL (41.0–213.5). Patients with low AFP (≤8 ng/mL) and PIVKA-II (≤90 mAU/mL) had a 5-year recurrence-free survival of 100% compared to 85.7% in patients with low AFP and high PIVKA-II (p = 0.026). Regardless of the AFP level, patients within the Milan criteria (based on explant pathology) with a low PIVKA-II level had a 5-year recurrence-free survival of 100% compared to patients with a high PIVKA-II level of 81.1% (p = 0.002). In patients with microvascular invasion, the AUC for PIVKA-II was slightly better than the AUC for AFP (0.775 vs. 0.687). Conclusions: The dual model of PIVKA-II ≤ 90 mAU/mL with either AFP ≤ 8 ng/mL or with patients within the Milan criteria identifies patient groups which can be exempted from HCC surveillance after LT in a low AFP population. PIVKA-II may be a better predictor for explant microvascular invasion than AFP and could play a role in future models identifying LT candidates with the highest risk for HCC recurrence. Full article

Single-use plastic (SUP) is an important product group in plastic pollution with various measures managing it within its lifecycle. Africa has the highest single-use plastic bag (SUPB) policy adoption by region globally, but the plastic problem persists, raising policy design concerns on effectiveness. This paper explores plastic policy design on plastic waste reduction in Africa. Using gap analysis and integrative propositional analysis, the status, scope, and variability of policies are assessed against a reference model. There are 48 active policies in 39 of the 55 countries in Africa. Of these, three countries have transitioned from plastic bag bans to SUP policies to manage more plastic products, and two countries have transitioned from SUPB charges to SUPB bans. There are 12 packaging policies, 29 bag policies, 2 bottle policies, 1 utensil and polystyrene boxes policy, and 1 straw policy. Themed SUP and packaging policies loosely cover plastic products. Four of the nine packaging policies analyzed are SUPB policies by design, as they explicitly mention the control of bags rather than primary packaging. Sixteen policies are designed for biodegradability restrictions, while ten policies are total bans on single-use plastic products. The lack of definitions and coherence and provision of exemptions in policies result in plastic waste traceable from exemptions, in-policy, undefined SUP, out-of-policy SUP, and non-SUP sources. The use of different policy mix instruments to manage plastic within its lifecycle was identified in African countries. The design of new policies should consider these shortcomings to enhance plastic waste management by explicitly identifying products and outlining management measures for excluded plastic products within the same plastic group for SUP or packaging policies in the absence of a global or regionally binding plastic policy. Full article

This study examined whether people who reside in different regions of South Korea exhibit different WTP for the mitigation of PM2.5 emissions from coal-fired power plants by restricting their operation during the winter and spring when air pollution becomes severe. The eastern portions of the country are relatively insulated from the harmful effects of PM2.5 emissions due to northwest winds which cause air pollutants generated from coal-fired power plants to be carried out to the East Sea (Sea of Japan). Consequently, our sample group was divided into central, western, eastern, and southern regions, and a contingent valuation method, combined with a double-bounded dichotomous choice, was used to derive people’s WTP for the mitigation of PM2.5 emissions. Our estimation results indicated that respondents who live in eastern regions showed a significantly lower WTP (about KRW 1280/month) than the mean WTP of other regions (above KRW 1337/month). Thus, we suggest that the current Seasonal Management System of PM2.5 emissions should be modified to consider regional differences. Statistical results from this study reinforce our suggestions—almost 78 percent of survey respondents support a revision of the current SMS policy and are in favor of a revised SMS policy—one that exempts eastern regions from a nationwide shutdown of coal-fired generation from December to March. Exempting coal-fired power plants in eastern regions from the Seasonal Management System might result in significant fiscal savings without a corresponding increase in nationwide PM2.5 concentrations. Full article

Waste segregation at the source is one of the most important strategies of urban waste management and the first environmental priority. This systematic review study was conducted to determine the effects of various interventions to promote household waste segregation behavior. Studies were searched in the Web of Science, Scopus, and PubMed databases using the keywords “waste segregation, intervention, randomized controlled trials, and clinical trials”. Through 2 January 2022, two researchers were independently involved in article screening and data abstraction. Inclusion criteria were as follows: experimental and quasi-experimental studies where primary outcomes of the studies included improvement in waste separation behavior, and secondary outcomes of the studies included increased knowledge and improvement in psychological factors. Articles that did not focus on households, studies that focused only on food or electronics separation, and studies that focused only on recycling and its methods were excluded. Of the original 5084 studies, only 26 met the inclusion criteria after reviewing the titles, abstracts, and full texts of the articles. The age of study participants ranged from 15 to 82 years. It seems that most of the studies that suggest higher efficacy consider older age groups for the intervention. Positive results of the interventions were reported in all studies with different ratios; in five studies, the improvement in results was more than 20%. Meta-analysis was not possible because of the diversity of study strategies and outcomes measured. In the studies that lasted longer than two months, people’s waste separation behavior was more permanent. Approaches such as engagement, feedback, and theory-based interventions have been effective in promoting waste separation behavior. Interventions that considered environmental, social, and organizational factors (such as segregation facilities, regular collection of segregated waste, tax exemption, and cooperation of related organizations) in addition to individual factors were more effective and sustainable. For the comparison of studies and meta-analysis of data, it is suggested to use standard criteria such as mean and standard deviation of waste separation behavior and influential structures such as attitude and norm in studies. The results show that it is necessary to use environmental research and ecological approaches and intermittent interventions over time to maintain and continue waste separation behavior. Based on the results of the current research, policy makers and researchers can develop efficient measures to improve waste sorting behavior by using appropriate patterns in society and knowing the effective factors. Full article

Background: The coexistence of lung cancer and tuberculosis is not rare. Rifamycin plays a pivotal role in anti-tuberculosis therapy. However, its potential impact on the liver metabolism of oncology drugs raises concerns. We performed this study to explore whether Rifamycin affects the survival of patients with tuberculosis and lung cancer. Methods: Drawing from the Taiwan National Health Insurance Research Database, we identified patients diagnosed with concurrent lung cancer and tuberculosis between 2000 and 2014. Patients were categorized based on whether they underwent rifamycin-inclusive or rifamycin-exempt anti-tuberculosis therapy. Subsequently, we paired them at a 1:1 ratio and evaluated the mortality risk over a two-year span. Results: Out of the study participants, 1558 (81.4%) received rifamycin-based anti-tuberculosis therapy, while 356 (18.6%) underwent a rifamycin-free regimen. Analysis revealed no marked variance in the biennial mortality rate between the groups (adjusted hazard ratio: 1.33, 95% confidence interval 0.93–1.90, p = 0.1238). When focusing on the matched sets comprising 127 individuals in each group, the data did not indicate a significant link between rifamycin and a heightened two-year mortality risk (adjusted hazard ratio: 1.00, 95% confidence interval 0.86–1.18, p = 0.9538). Conclusions: For individuals with concomitant lung cancer and tuberculosis, rifamycin’s administration did not adversely influence two-year survival. Thus, rifamycin-containing anti-TB regimens should be prescribed for the indicated patients. Full article

This article analyzes how and why a near-total abortion ban was recently secured by a populist ruling party with support from Catholic Church leaders and lay groups following earlier passage of one of the most restrictive abortion laws in Europe. The paper further examines the public health threats posed by these measures, which have long been under-researched. These policy shifts are situated within the deeply embedded context of Poland’s abortion conflict and a setting that has long been challenging for reproductive health. The 1993 ban led to the resurgence of clandestine abortions, a near-total privatization of abortion services, and more women seeking abortion services overseas. In late 2020, the exemption for severe fetal anomalies that made up 97% of all legal abortion cases in prior years was eliminated. Neither ban has significantly reduced the number of women obtaining abortions, nor have they increased birth rates as anticipated by proponents who championed traditional family values that they equated with Catholicism and Polish national identity. The new blanket ban on abortion constitutes a health risk and a punitive measure achieved via a judgement of the Constitutional Tribunal stacked with loyalists by the ruling party. It did not reflect popular will, although societal attitudes on abortion are markedly less permissive than in much of Europe. Although the populist and religious right have realized their long-held goal of further restricting, if not eliminating, women’s access to abortion services, compelling criticisms have been raised about how this move compromises women’s health and autonomy. Ironically, the realization of this goal, which many Poles view as unduly extreme, may also undermine long-term support for both the political right and the Church. The wisdom of their move was widely questioned, sparked the largest protests since the end of Communist rule, and drew international criticism. It proved a polarizing action that alienated many young adults and may have accentuated a secularizing shift. Women and their partners are finding new ways to navigate many public health threats by increasingly traveling beyond Poland for safe abortion care and resorting to newly available medication abortion methods. Full article