Search Results (2,425)

Cervical cancer remains a significant global health burden, disproportionately affecting women in low- and middle-income countries despite being preventable. Since 2018, rapid advances in molecular profiling, immunotherapy, refinement of minimally invasive surgery, and targeted therapeutics have transformed diagnostic and therapeutic paradigms. This narrative review synthesizes clinical and translational progress across the continuum of care from 2018 to 2025. We summarize the evolving landscape of precision screening—including HPV genotyping, DNA methylation assays, liquid biopsy, and AI-assisted cytology—and discuss their implications for global elimination goals. Surgical management has shifted toward evidence-based de-escalation with data from SHAPE, ConCerv, and ongoing RACC informing fertility preservation and minimally invasive approaches. For locally advanced disease, KEYNOTE-A18 establishes pembrolizumab plus chemoradiation as a new curative standard, while INTERLACE underscores the benefit of induction chemotherapy. In the metastatic setting, survival outcomes have improved with the integration of checkpoint inhibitors (KEYNOTE-826, BEATcc, EMPOWER-Cervical 1), vascular-targeted therapies, and antibody–drug conjugates, including tisotumab vedotin and emerging HER2 and TROP-2–directed agents. We further highlight emerging biomarkers—PD-L1, TMB, MSI status, HPV integration patterns, APOBEC signatures, methylation classifiers, ctHPV-DNA—and their evolving role in treatment selection and surveillance. Future directions include neoadjuvant checkpoint inhibition, PARP-IO combinations, HER3-directed ADCs, DDR-targeted radiosensitizers, HPV-specific cellular therapies, and AI-integrated precision medicine. Collectively, these advances are reshaping cervical cancer care toward biologically individualized, globally implementable strategies capable of accelerating WHO elimination targets. Full article

Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) increasingly co-occur in low- and middle-income countries and aging populations. Prior pulmonary TB is a robust, smoking-independent determinant of COPD and is linked to persistent systemic inflammation, endothelial dysfunction, dyslipidemia, and hypercoagulability axes that also amplify cardiovascular disease (CVD) risk. We conducted a targeted narrative non-systematic review (2005–2025) of PubMed/MEDLINE, Embase, Scopus, and Web of Science, selecting studies for clinical relevance across epidemiology, clinical phenotypes, pathobiology, biomarkers, risk scores, sleep-disordered breathing, and management. No quantitative synthesis or formal risk-of-bias assessment was performed. Accordingly, findings should be interpreted as a qualitative synthesis rather than pooled estimates. Prior TB is associated with a distinctive COPD phenotype characterized by mixed obstructive–restrictive defects, reduced diffusing capacity (DLCO), radiographic sequelae, and higher exacerbation/hospitalization burden. Mechanistic insights: Convergent mechanisms chronic immune activation, endothelial injury, prothrombotic remodeling, molecular mimicry, and epigenetic reprogramming provide biologic plausibility for excess CVD, venous thromboembolism, and pulmonary hypertension. Multimarker panels spanning inflammation, endothelial injury, myocardial strain/fibrosis, and coagulation offer incremental prognostic value beyond clinical variables. While QRISK4 now includes COPD, it does not explicitly model prior TB or COPD-TB outcomes, but data specific to post-TB cohorts remain limited. Clinical implications: In resource-constrained settings, pragmatic screening, prioritized PAP access, guideline-concordant pharmacotherapy, and task-shifting are feasible adaptations. A history of TB is a clinically meaningful modifier of cardiopulmonary risk in COPD. An integrated, multimodal assessment history, targeted biomarkers, spirometry/lung volumes, DLCO, 6 min walk test, and focused imaging should guide individualized care while TB-aware prediction models and implementation studies are developed and validated in high-burden settings. Full article

Stroke is a leading cause of death and long-term disability worldwide, with ischemic stroke accounting for approximately 62.4% of all cases. This condition often results in persistent motor dysfunction, significantly reducing patients’ productivity. The effectiveness of rehabilitation therapy is crucial for post-stroke motor recovery. However, limited access to rehabilitation services particularly in low- and middle-income countries remains a major barrier due to a shortage of experienced professionals. This challenge also affects home-based rehabilitation, an alternative to conventional therapy, which primarily relies on standard evaluation methods that are heavily dependent on expert interpretation. Electromyography (EMG) offers an objective and alternative approach to assessing muscle activity during stroke therapy in home environments. Recent advancements in deep learning (DL) have opened new avenues for automating the classification of EMG data, enabling differentiation between post-stroke patients and healthy individuals. This study introduces a novel methodology for transforming EMG signals into time–frequency representation (TFR) spectrograms, which serve as input for a convolutional neural network (CNN) model. The proposed Tri-CCNN model achieved the highest classification accuracy of 93.33%, outperforming both the Shallow CNN and the classic LeNet-5 architecture. Furthermore, an in-depth analysis of spectrogram amplitude distributions revealed distinct patterns in stroke patients, demonstrating the method’s potential for objective stroke assessment. These findings suggest that the proposed approach could serve as an effective tool for enhancing stroke classification and rehabilitation procedures, with significant implications for automating rehabilitation monitoring in home-based rehabilitation (HBR) settings. Full article

Background: This study investigates the global burden of early-onset bladder cancer (EOBC) from 1990 to 2021, highlighting regional disparities and the growing role of metabolic risk factors. Early-onset bladder cancer (EOBC), diagnosed before age 50, is an emerging global health concern. While less common than kidney cancer, EOBC contributes substantially to mortality and disability-adjusted life years (DALYs), with marked sex disparities. Its global epidemiology remains unassessed systematically. Methods: Using GBD 1990–2021 data, we analyzed EOBC incidence, prevalence, mortality, and DALYs across 204 countries in individuals aged 15–49. Trends were examined via segmented regression, EAPC, and Bayesian age-period-cohort modeling. Inequality was quantified using SII and CI. Decomposition and SDI-efficiency frontier analyses were introduced. Results: From 1990 to 2021, EOBC incidence rose 62.2%, prevalence 73.1%, deaths 15.3%, and DALYs 15.8%. Middle-SDI regions bore the highest burden. Aging drove trends in high-SDI areas and population growth in low-SDI regions. Over 25% of high-SDI countries underperformed in incidence/prevalence control. Smoking remained the leading risk factor, with rising hyperglycemia burdens in high-income areas. Males carried over twice the female burden, peaking at age 45–49. Conclusions: EOBC shows sustained global growth with middle-aged concentration and significant regional disparities. Structural inefficiencies highlight the need for enhanced screening, early warning, and tailored resource allocation. Full article

Health equity and financial inclusion (FI) are at the core of the Sustainable Development Goals, yet their intersection remains critically under-studied. This bibliometric study maps this emergent and fragmented field by analyzing 24,140 publications from Scopus, PubMed, Web of Science, and Lens.org over five decades. Employing co-citation and co-word analysis via VOSviewer, chart research trends, governance frameworks, and policy linkages were systematically presented. The analysis reveals that less than 0.3% of the identified literature explicitly bridges financial inclusion with health outcomes, and direct investigations into health equity are virtually absent. Despite recent growth, fundamental gaps persist, including a lack of empirical studies on digital financial tools in low- and middle-income countries (LMIC) health contexts and insufficient focus on disadvantaged populations. As the first comprehensive empirical mapping of this nexus, this study underscores the urgency for scholarly and policy action to strategically leverage financial instruments for equitable healthcare access. The findings provide a foundational map and a structured agenda to consolidate this nascent field. Full article

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO–UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement. Full article

Background: Maternal health behaviors during pregnancy are crucial for maternal and fetal outcomes. While global research has explored that demographic, clinical, and psychosocial determinants significantly influence these behaviors, evidence from low- and middle-income countries (LMICs), including Albania, remains limited. This study aims to evaluate psychosocial perceptions and health behaviors related to lifestyle among pregnant women in a local Albanian community in order to identify which are higher risk subgroups that need targeted and tailored antenatal care interventions. Methods: This multicenter cross-sectional study included 200 pregnant women attending antenatal clinics from May to August 2024 in Vlora city, Albania. Participants were selected using consecutive sampling based on inclusion criteria. Data were collected through a validated questionnaire composed of five sections: demographic/obstetric data; maternal health behaviors; dietary diversity; physical activity, perceived stress; and social support. Clinical and anthropometric measurements were assessed by trained health professionals during antenatal visits. SPSS version 23.0 and binary logistic regression with p-value ≤ 0.05 statistically significant were used for data analysis. Results: Mean age was 28.3 ± 6.4 years, 71% employed and 83.5% urban residents. Key unhealthy behaviors included tobacco use (25.5%), alcohol consumption (10.5%), exposure to toxins (15%), and low dietary diversity (32%). We found significant correlations between low dietary diversity and rural residence (Adj OR = 2.48), hypertension (Adj OR = 6.88), and overweight/obesity (Adj OR = 2.33). Tobacco use was associated with unemployment and alcohol use with unemployment and hypertension variables. Low/moderate social support and high perceived stress were significantly related with multiple unhealthy behaviors, such as low dietary diversity, inadequate physical activity and antenatal care. Conclusions: Unhealthy nutritional behaviors, tobacco and alcohol use and low physical activity are more prevalent risk factors among pregnant women in Vlora city. Priority should be given to vulnerable groups, including rural residents, pregnant women with low social support, high perceived stress and those with hypertension and obesity. Interventions that integrate psychosocial support and health education into antenatal care services are urgently needed to enhance pregnancy outcomes in Albanian communities. Full article

Background/Objectives: Inclusive nutrition services and data on children with disabilities living in low- and middle-income countries remain limited. We estimated the prevalence of undernutrition and described feeding practices and difficulties among children with disabilities ages birth to 10 years at a rehabilitation hospital in Uganda and identified barriers and opportunities for inclusive nutrition. Methods: This cross-sectional study enrolled 428 children. Data included demographics, weight, height, mid–upper arm circumference (MUAC), hemoglobin levels, risk for feeding difficulties, caregiver-reported feeding practices, and functional difficulties complemented by 32 caregiver and stakeholder interviews. Undernutrition was defined using WHO z-scores, MUAC, and anemia cutoffs. Associations were examined using Pearson’s chi-squared tests and adjusted odds ratios from logistic regression. Results: Over half of participants were boys (56.1%) and 65.9% were <24 months old. Common conditions included cleft lip/palate (55.4%) and cerebral palsy (38.6%). Undernutrition was prevalent: 45.2% were underweight, 38.3% stunted, 16.1% wasted (by MUAC), and 39.5% anemic. Being at risk for feeding difficulties (67.2% of children) increased the odds of underweight [AOR = 2.28 (1.23–4.24)], stunting [2.46 (1.26–4.79)], and wasting [2.43 (1.10–5.35)] after adjusting for covariates. Bottle-feeding increased the odds of stunting [3.09 (1.24–7.70)] in infants with cleft lip/palate < 12 months old. Poor access to services, food insecurity, and feeding challenges were key barriers to optimal nutrition. Most caregivers reported using practices that support responsive feeding. Conclusions: Reported barriers to services and high levels of undernutrition, strongly linked to feeding difficulties, underscore the need for targeted feeding interventions and better access to inclusive nutrition services in Uganda. Full article

Leptospirosis remains a significant public health and economic burden in Southeast Asia, particularly in low- and middle-income countries where environmental, occupational, and socioeconomic factors contribute to its endemicity. Transmission is driven by close interactions between humans and infected animal reservoirs, alongside climatic conditions such as heavy rainfall and flooding. The region’s high but variable seroprevalence reflects inconsistencies in diagnostic methodologies and surveillance systems, complicating disease burden estimation. Major gaps persist in diagnostic capabilities, with current tools often unsuitable for resource-limited settings, leading to underdiagnosis and delayed treatment. Environmental modeling and spatial epidemiology are underutilized due to limited interdisciplinary data integration and predictive capacity. Addressing these challenges requires a One Health approach that integrates human, animal, and environmental health sectors. Key policy recommendations include harmonized surveillance, standardized and validated diagnostics, expanded vaccination programs, improved animal husbandry, and targeted public education. Urban infrastructure improvements and early warning systems are also critical, particularly in disaster-prone areas. Strengthened governance, cross-sectoral collaboration, and investment in research and innovation are essential for sustainable leptospirosis control. Implementing these measures will enhance preparedness, reduce disease transmission, and contribute to improved public health outcomes in all sectors across the region. Full article

Working equids support millions of people globally, especially in low-income, lower-middle-income, and upper-middle-income countries. However, they commonly suffer from poor welfare and are typically overlooked in policy and funding decisions. This scoping review aimed to collate evidence on two topics related to working equid use in low- and middle-income countries: their socioeconomic value to their owners and the impact of educational interventions for owners/handlers aiming to improve equid welfare. Original research published from 2014 onwards was eligible for inclusion. This scoping review followed the JBI methodology and PRISMA-ScR framework. One search strategy encompassing both topics was applied to five databases (CAB Abstracts, MEDLINE, Embase, Web of Science, and IBSS) on 24.04.24. Key characteristics and findings of eligible studies were charted. In total, 3514 sources were independently screened by two reviewers. In total, 61 socioeconomic value studies (47 journal articles, 2 reports, and 12 conference contributions) and 23 educational intervention studies (11 journal articles and 12 conference contributions) were included. Working equids supported their owners’ livelihoods in wide-ranging ways and contributed to the United Nations’ Sustainable Development Goals. Educational interventions employed varied approaches, and most reported success. Multilevel initiatives and those developed through participatory engagement may be more likely to directly improve equid welfare in the long term. These aspects should be prioritised during intervention development. The included studies used inconsistent terminology and were of variable quality. This review highlights the importance of including working equids within policy and funding strategies and provides recommendations to increase the discoverability, quality, and impact of working equid research. Full article

Amid increasing urbanization and escalating global mental health concerns, understanding the environmental determinants of mental illness has become a research priority. This study presents a bibliometric analysis of global research exploring the intersection of green spaces and mental illness. Drawing on 2136 peer-reviewed articles and review papers published between 1990 and 2024 from the Web of Science Core Collection and Scopus, this study examined publication trends, geographic and institutional contributions, research hotspots, and thematic evolution. Findings reveal a sharp increase in scholarly output since 2012, reflecting heightened interdisciplinary engagement and alignment with global frameworks, such as the United Nations Sustainable Development Goals. China, the United States, and the United Kingdom are leading contributors. Keyword co-occurrence analysis highlights major themes such as green spaces, mental health, physical activity, urban planning, and air pollution. Despite notable progress, the field faces methodological inconsistencies, limited integration of air quality data, and a lack of representation from low- and middle-income countries. This study offers a comprehensive overview of the research progress and gaps, supporting the development of nature-based strategies and sustainable urban planning to mitigate mental illness and promote psychological resilience. Full article

Background: Cancer-directed treatment near the end of life may represent low-value, high-intensity care and potential medical futility, but data from middle-income countries are limited. This study used digitally documented advanced care planning (ACP) in the electronic health record (EHR) and indicators of late oncologic interventions (LOI) within 15 and 30 days before death to examine end-of-life care in Brazil. Objective: To identify factors associated with LOI near death and to explore whether documented ACP is linked to lower treatment intensity. Design: Retrospective cohort study. Setting/Participants: Adults with metastatic solid tumors who died between January 2022 and December 2023 in two oncology referral hospitals in southern Brazil and had ≥6 months of premortem EHR data. Measurements: LOI were defined as systemic anticancer therapy, radiotherapy, or oncologic surgery within 30 days (LOI-30) or 15 days (LOI-15) before death. Independent predictors were estimated by Poisson regression with robust variance. Results: Among 79 patients, 21.5% received LOI-30 and 8.9% received LOI-15. Breast and lung cancers were the most common primary sites. LOI-30 was independently associated with age < 60 years (relative risk [RR] 3.76; 95% confidence interval [CI] 1.50–9.44), higher education (RR 2.07; 95% CI 1.07–3.99), and lower platelet count (RR 0.96 per 10,000/µL; 95% CI 0.92–0.99). ACP was documented for 19% of patients and was associated with absence of LOI-30. Conclusions: Digitally visible ACP in the EHR was associated with reduced aggressive end-of-life care. Using existing EHR infrastructure to prompt and standardize ACP documentation may help align care with patient values in middle-income countries. Full article

Background: Burns cause about 180,000 deaths annually and lead to substantial morbidity, especially in low- and middle-income countries. Clinical assessment of burn depth and TBSA relies on visual and bedside examination and remains subjective. Convolutional neural networks (CNNs) have been proposed to improve objectivity in image-based burn assessment, but clinical generalizability and acceptance remain uncertain. Aims: To map current evidence on CNN performance for burn TBSA, burn depth and treatment-related tasks and to explore whether a large language model (LLM) can organize extracted findings into a transparent, literature-derived orientation decision tree. Methods: We performed a scoping review following PRISMA-ScR. PubMed, Web of Science and Cochrane were searched on 5 April 2025. Eligible studies reported CNN analysis of 2D burn images and quantitative performance metrics. We summarized reported values descriptively. We then provided a structured summary of extracted findings to ChatGPT to draft a one-page orientation decision tree. Two consultant burn surgeons reviewed the figure for clarity and plausibility. Results: Of 659 records, 24 studies were included. Across studies, reported performance for TBSA and depth assessment was often high, but study designs, datasets, labels, imaging modalities and validation strategies varied substantially. High reported performance does not necessarily imply clinical robustness or real-world accuracy. A single study reported high test-set accuracy for graft versus non-graft using heavily expanded data. This value should not be generalized. Conclusions: CNNs show promise for image-based burn TBSA and depth assessment, but heterogeneity, dataset limitations and limited external validation restrict interpretation and clinical transfer. The LLM-derived decision tree is a literature-synthesis orientation figure, not a clinical decision-support tool. Full article

Cervical cancer remains the fourth most common malignancy among women worldwide. Despite well-developed prevention measures, incidence and mortality continue to rise, especially in low- and middle-income countries due to low screening coverage and unavailability of human papillomavirus (HPV) vaccination. The cervical cancer screening coverage could be improved by the implementation of a self-sampling modality for HPV testing. Multiple research pieces support the validity and reliability of a self-sampling modality as an alternative approach to clinician-collected samples for primary cervical cancer screening via HPV genotyping. Moreover, growing research evidence on the self-sampling modality reception shows high acceptance of the method among screened populations. Studies on the self-sampling approach economic efficiency also revealed a high cost-effectiveness of HPV testing through a self-sampling modality compared to other screening modalities for cervical cancer. It is specifically important for low-resource settings, which should use the self-sampling cost advantages to improve cervical cancer screening coverage by attracting underscreened populations. Overall, self-sampling modality has a higher participation rate and better patient satisfaction reported; thus, the method is highly recommended by the World Health Organization for cervical cancer screening. Full article

Group A rotaviruses (RVAs) remain the leading cause of acute gastroenteritis (AGE) in young children in low- and middle-income countries. In Brazil, the oral attenuated RVA vaccine (Rotarix^®), monovalent genotype G1P[8], is distributed by the national immunization program and has drastically reduced morbidity and mortality associated with RVA etiology. In this study, Rotarix^® G1P[8] was detected using specific qRT-PCR from the fecal shedding of children living in the Amazon region, and 18.3% (29/158) were positive and 75.8% (22/29) presented with AGE. The VP4 (VP8*) gene of these sheddings, submitted to Sanger nucleotide sequencing, showed an occurrence of mutations, including the silent mutation at 144C > G (one child) and the following missense mutations— 499T > C (F167L) (two children), 644G > C (C215S) (one child), and 787G > A (E263K) (one child). These mutations had no impact on the protein model structure in silico deduced from the VP4 (VP8*) mutants. The in silico protein model deduced from the VP4 (VP8*) nucleotide sequences, bound to type 1H sugar antigens (H1) and its precursor Lac-para-N-biose (LNB), had a stronger binding to the G1P[8] genotype, when compared to G3P[8]. Rotarix^® shedding was higher in HBGA secretors than in non-secretors (79.3%; 23/29). A total of 11.4% (18/158) of children with Rotarix^® G1P[8] shedding were unvaccinated, indicating the occurrence of indirect protection. Stability evidence of Rotarix^® VP4 (VP8*) spike protein from samples collected in vivo is presented. Full article