Search Results (2,202)

Background: Undergraduate nursing students (UNSs) often enter clinical training just as they are still mastering the emotional labor of the profession. In Nepal, where teaching hierarchies discourage upward dialogue and hospitals routinely struggle with overcrowding, supply shortages, and outward nurse migration, these learners confront a distinct, under-documented burden of psychological distress. Objective: This study examines how UNSs interpret, negotiate, and cope with the mental health challenges that arise at the intersection of cultural deference, resource scarcity, and migration-fueled uncertainty. Methods: A qualitative design employing reflexive thematic analysis (RTA), guided by the Reflexive Thematic Analysis Reporting Guidelines (RTARG), was used. Fifteen second-, third-, and fourth-year Bachelor of Science in Nursing students at a major urban tertiary institution in Nepal were purposively recruited via on-campus digital flyers and brief in-class announcements that directed students (by QR code) to a secure sign-up form. Participants then completed semi-structured interviews; audio files were transcribed verbatim and iteratively analyzed through an inductive, reflexive coding process to ensure methodological rigor. Results: Four themes portray a continuum from silenced struggle to systemic constraint. First, Shrouded Voices, Quiet Connections captures how students confide only in trusted peers, fearing that formal disclosure could be perceived as weakness or incompetence. Second, Performing Resilience: Masking Authentic Struggles describes the institutional narratives of “strong nurses” that drive students to suppress anxiety, adopting scripted positivity to satisfy assessment expectations. Third, Power, Hierarchy, and the Weight of Tradition reveals that strict authority gradients inhibit questions in classrooms and clinical placements, leaving stress unvoiced and unaddressed. Finally, Overshadowed by Systemic Realities shows how chronic understaffing, equipment shortages, and patient poverty compel students to prioritize patients’ hardships, normalizing self-neglect. Conclusions: Psychological distress among Nepalese UNSs is not an individual failing but a product of structural silence and resource poverty. Educators and policymakers must move beyond resilience-only rhetoric toward concrete reforms that dismantle punitive hierarchies, create confidential support avenues, and embed collaborative pedagogy. Institutional accountability—through regulated workloads, faculty-endorsed wellbeing forums, and systematic mentoring—can shift mental health care from a private struggle to a shared professional responsibility. Multi-site studies across low- and middle-income countries are now essential for testing such system-level interventions and building a globally resilient, compassionate nursing workforce. Full article

This study aimed to map the literature on the clinical role of pharmacists in the care of incarcerated people at correctional facilities and to identify gaps in this field. A scoping review was conducted on 30 July 2024, using the PubMed, Scopus, and LILACS databases. Gray literature was searched via Google Scholar, and references of included studies were manually reviewed. Primary studies of any design reporting pharmacists’ clinical services and/or activities for incarcerated individuals were eligible. Study selection and data extraction were performed independently by two reviewers, with a third resolving disagreements. The search yielded 894 records, from which 27 studies were included. Most studies were conducted in the United States (n = 16; 59%) and France (n = 7; 26%). Eleven (41%) focused exclusively on male populations, and one (4%) on female inmates. Most studies addressed pharmacists’ clinical roles in mental health conditions and substance use disorders (n = 9; 33%), infectious diseases (n = 5; 19%), and diabetes (n = 4; 15%). Clinical services and/or activities related to direct patient care were the most frequently reported (n = 18; 67%). Process measures were reported in 18 studies (67%), and clinical outcomes were the most common type of outcome (n = 13; 48%). This review highlights the pharmacist’s clinical role in treating mental health conditions and substance abuse, infectious diseases, and diabetes in incarcerated care. It underscores the need for further research in low- and middle-income countries, on women’s health, and on other prevalent conditions. Full article

Background: Pulmonary tuberculosis (TB) is increasingly recognized as a risk factor for chronic obstructive pulmonary disease (COPD), but its impact on COPD onset and severity remains poorly characterized, particularly in low- and middle-income countries. This multicenter study aimed to assess the impact of prior pulmonary TB on COPD onset, severity, the timing of the first severe exacerbation, and progression among Romanian patients with and without a history of pulmonary TB. Methods: This retrospective multicenter study included adults hospitalized for their first severe COPD exacerbation at two tertiary care centers in Romania between April 2020 and April 2025. Patients were grouped based on smoking status and prior TB history. Propensity score matching was used to control for confounding factors. Clinical characteristics, spirometry, and radiological TB patterns were analyzed comparatively between patients with prior TB and TB-naïve patients. Results: Among 403 COPD patients, those with prior TB had significantly earlier COPD onset (mean age 48.67 ± 6.42 vs. 65.61 ± 5.14 years in smokers, p < 0.001) and shorter intervals to their first severe COPD exacerbation compared to patients without prior TB (6.35 ± 4.71 vs. 15.14 ± 6.93 years in smokers, p < 0.001). COPD prevalence was higher among TB survivors compared to those without TB history, especially in smokers (OR = 5.73; 95% CI, 3.30–9.94, p < 0.001), versus non-smokers (OR =2.23; 95% CI, 1.37–3.64, p = 0.001). Radiological severity of TB lesions significantly influenced COPD prevalence among smokers (OR = 10.79, p < 0.001). Conclusions: Prior pulmonary TB substantially accelerates COPD onset, exacerbation timing, and disease severity, particularly in smokers. This multicenter comparative study demonstrates that prior pulmonary TB significantly accelerates COPD onset, exacerbation timing, and disease severity, especially among smokers. Recognizing TB history as a significant COPD risk factor underscores the importance of targeted COPD screening and tailored management in populations with high TB prevalence. Full article

Antibiotics have dramatically reduced the burden of infectious diseases since their discovery, but the accelerating rise in antimicrobial resistance (AMR) now threatens these gains. AMR was responsible for nearly 5 million deaths in 2023 and continues to undermine the efficacy of existing treatments, particularly in low- and middle-income countries. While efforts to address AMR have focused heavily on antibiotic stewardship and new drug development, vaccines represent a powerful yet underutilized tool for prevention. By reducing the incidence of bacterial infections, vaccines lower antibiotic consumption, interrupt transmission of resistant strains, and minimize the selective pressures that drive resistance. Unlike antibiotics, vaccines offer long-lasting protection, rarely induce resistance, and confer indirect protection through herd immunity. This review examines the global burden and drivers of AMR, highlights the unique advantages of vaccines over antibiotics in mitigating AMR, and surveys the current development pipeline of vaccines targeting key multidrug-resistant bacterial pathogens. Full article

Background/Objectives: Burn injuries are a major public health concern. This study estimated global, regional, and national burn burdens by total body surface area from 1990 to 2021 and projected trends to 2050. Methods: Utilizing data from the Global Burden of Disease Study 2021, we examined the prevalence, mortality, and years lived with disability (YLDs) according to age, sex, and region. Future trends were predicted using Bayesian meta-regression models and Das Gupta decomposition analysis. Results: In 2021, global prevalence was 12.99 million for severe burns and 235.34 million for mild burns, with age-standardized rates of 158.75 and 2815.26 per 100,000. Severe burns were highest in Southern Latin America (7836.51 per 100,000) and mild burns in the Caribbean (626.94 per 100,000). The largest declines from 1990 to 2021 were in high-income North America for severe burns (−38.22%) and East Asia for mild burns (−73.03%). Females had higher severe burn prevalence at younger and older ages, while males had higher mild burn prevalence from early adulthood. Leading risk factors were fire, heat, and hot substances (38.22% of severe burn YLDs; 53.87% for mild burns). By 2050, severe burns are projected to rise by 233.4% and mild burns by 142.5%, with Eastern Europe showing the largest growth. Conclusions: Although age-standardized burn rates are declining, absolute cases are projected to rise due to population growth and aging, particularly in low- and middle-income countries, underscoring the need for stronger prevention and improved burn care infrastructure. Full article

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A total of 23 reports were included for review. The findings are presented according to the PRISMA guidelines. The studies mostly focused on fishery products, with arsenic and mercury being the most frequently studied hazards. The evidence of banned substances such as chloramphenicol and certain organochlorine pesticides (OCPs), including chlordane and Mirex, was reported in fish and meat. Additionally, mercury levels were measured in beef, pork, viscera, and eggs, but the average concentration remained significantly below the hazard index. The average concentration of polycyclic aromatic hydrocarbons (PAH) in smoked fish exceeded the EU limits, ranging from 0.034 to 17.2 mg/kg, with an average mean concentration of 1.92 mg/kg. The pooled geometric means of arsenic and mercury in fish were 0.40 mg/kg (95% CI: 0.25–0.66) and ~0.14 mg/kg (95% CI: 0.087 to 0.223), respectively. The health risk of mercury contamination in fishery products needs the attention of the risk managers. However, industrial contaminants such as polybrominated diphenyl ethers (PBDEs) and butyl tin in marine fishes were lower than those reported elsewhere, such as Japan. We discuss the implications of the findings for human health and national food control systems (NFCS), the capacity of different agencies to undertake chemical risk assessment, the utility of systematic literature reviews (SLRs) for risk assessment and communication in low- and middle-income countries (LMICs), and the need for further research. Full article

Helicobacter pylori (H. pylori) and intestinal helminthes are common in low- and middle-income countries, where co-infection is endemic due to similar modes of transmission and poor sanitation. Whereas H. pylori are recognized gastric pathogens that induce gastritis, ulcers, and gastric carcinoma, helminths possess systemic immunomodulatory functions. The immunological, epidemiological, and clinical features of H. pylori and helminth co-infections will be discussed in this review. Key findings include that helminths induce a Th2-biased and regulatory immune response, potentially counteracting the Th1/Th17 H. pylori-induced inflammation and therefore limiting gastric tissue damage and cancer risk. Certain human studies and animal models concluded that co-infection would be protective against extreme gastric pathology by modulating immunity, altering gut microbiota, and by helminth-secreted extracellular vesicles. Epidemiologic data show large regional heterogeneity in co-infection prevalence with higher rates in children and rural socioeconomically disadvantaged populations. Much of the research mechanisms, however, are limited to models in the lab, and few human studies exist. Lastly, helminth co-infection is also potentially immunoprotective against H. pylori-associated illnesses, but greater translational research and human clinical trials are necessary. Public health policy in endemic regions must consider the complex relationships between co-infecting parasites when developing control. Full article

Invasive fungal infections (IFIs) are one of the most significant public health challenges worldwide. Yet, research and communication thereof were left behind for a long time, until the WHO published a priority pathogens list to guide research, development, and public health action in October 2022. Indeed, due to the rising number of immunocompromised patients at risk and the high level of morbidity, mortality, and economic burden they entail, especially in low- and middle-income countries, IFIs are a serious public health threat. Fungal infections due to dimorphic fungi face additional challenges such as limited knowledge outside of endemic areas and restricted availability of antifungal molecules in areas affected by these infections. The number of related deaths per year is estimated at 2.5 million, but non-governmental organisations make a wider estimation, due to the difficulties in early in vitro diagnostic and troublesome collection and analysis of epidemiological data. Despite this fact, the therapeutic toolbox addressing these infections remains limited, with only four main families of molecules available so far. The antifungal therapeutic supply is composed of very toxic polyenes, the weakly selective and nearly unused 5-fluorocytosine, and azoles, some of which are becoming increasingly inefficient against IFIs. In the 2000–2020s, the fourth arising family consisted of safer semisynthetic echinocandins. Unfortunately, nowadays, more and more fungal isolates encountered in intensive care units exhibit a low susceptibility to echinocandins or are even multiresistant. In this review, we expose the current treatments available to fight against invasive fungal infections. We recall the discovery and physico-chemical aspects of these substances leading to structure/activity and structure/properties relationships. We particularly focus on the to-date resistances and their molecular mechanisms. We finally list some of the most relevant antifungal drug candidates, as they were freshly overviewed by the World Health Organization in April 2025, highlighting the importance of the molecular dimension of this pursuit toward the expansion of the antifungal therapeutic toolbox. Full article

Veterinary vaccines are essential tools for controlling infectious and zoonotic diseases, safeguarding animal welfare, and ensuring global food security. However, conventional vaccines are hindered by cold-chain dependence, thermal instability, and logistical challenges, particularly in low- and middle-income countries (LMICs). This review explores next-generation veterinary vaccines, emphasizing innovations in thermostability and delivery platforms to overcome these barriers. Recent advances in vaccine drying technologies, such as lyophilization and spray drying, have improved antigen stability and storage resilience, facilitating effective immunization in remote settings. Additionally, novel delivery systems, including nanoparticle-based formulations, microneedles, and mucosal routes (intranasal, aerosol, and oral), enhance vaccine efficacy, targeting immune responses at mucosal surfaces while minimizing invasiveness and cost. These approaches reduce reliance on cold-chain logistics, improve vaccine uptake, and enable large-scale deployment in field conditions. The integration of thermostable formulations with innovative delivery technologies offers scalable solutions to immunize livestock and aquatic species against major pathogens. Moreover, these strategies contribute significantly to One Health objectives by mitigating zoonotic spillovers, reducing antibiotic reliance, and supporting sustainable development through improved animal productivity. The emerging role of artificial intelligence (AI) in vaccine design—facilitating epitope prediction, formulation optimization, and rapid diagnostics—further accelerates vaccine innovation, particularly in resource-constrained environments. Collectively, the convergence of thermostability, advanced delivery systems, and AI-driven tools represents a transformative shift in veterinary vaccinology, with profound implications for public health, food systems, and global pandemic preparedness. Full article

Background and Objectives: Congenital abnormalities are a leading cause of neonatal morbidity and mortality and are frequently detectable through prenatal ultrasound. While widely implemented in high-income countries, such screening remains inconsistently applied in low- and middle-income regions. This study aimed to estimate the prevalence of congenital abnormalities identified via prenatal ultrasound in Lebanon and to explore associated maternal, obstetric, and psychosocial factors. Methods: A multicenter retrospective observational study, supplemented by follow-up interviews, was conducted in five Order of Malta medical centers. Pregnant women in their second trimester underwent an obstetric ultrasound, and data were collected through structured questionnaires and follow-up phone interviews. Variables included maternal demographics, obstetric history, anxiety levels (GAD-7 scores), and ultrasound findings. Results: A total of 426 pregnant women were enrolled (mean age: 28.8 ± 5.9 years). The overall prevalence of congenital abnormalities was 13.1%. Growth abnormalities were observed in 8.5% of fetuses and were significantly associated with obstetric complications and the presence of multiple abnormalities. Morphological malformations were found in 10.1% of cases and were more common among women of advanced maternal age, those with a history of anomalies, and those reporting elevated anxiety scores. Combined abnormalities, as well as growth and morphological malformations, were significantly associated with higher parity, prior anomalies, and current pregnancy complications. Conclusions: Prenatal ultrasound is essential for early detection of congenital abnormalities, facilitating timely intervention and improved neonatal outcomes. These findings emphasize the need to integrate systematic screening into prenatal care in Lebanon and for ongoing research to identify context-specific risk factors. Full article

There is increasing use of modern medicine globally to manage cardiovascular diseases (CVDs). However, many people, especially in low-to-middle-income countries, still rely on traditional medicinal plants for their daily health needs. However, limited studies have explored the use of these remedies. Therefore, this narrative review aimed to evaluate the potential of Sclerocarya birrea (S. birrea) in managing diabetes, dyslipidemia, inflammation, and hypertension, including its effects on oxidative stress. This study reviewed evidence from PubMed, Web of Science, and ResearchGate, published in these databases up to 30 April 2025. The evidence showed that S. birrea had the potential to preserve cardiometabolic health and reduce CVD-associated risk factors. Notably, S. birrea improved glucose metabolism, inflammation, hypertension, and oxidative stress. This plant exhibits antihyperglycemic effects by activating adenosine monophosphate-activated protein kinase (AMPK) and inhibiting gluconeogenesis and the activities of carbohydrase. It also ameliorates dyslipidemia by modulating the activities of peroxisome proliferator-activated receptor alpha (PPARα) and increasing fatty acid oxidation. The anti-inflammatory potential of S. birrea is modulated by the activation of PPARα, which inhibits nuclear factor kappa beta (NF-κβ) and decreases the production of inflammatory cytokines. Its antioxidant property is attributed to its ability to increase antioxidant enzymes like catalase (CAT), superoxide dismutase (SOD), and glutathione (GSH), which are known to counteract oxidative damage. However, it is important to note that different parts of the plant had varying impacts on CVD risk factors, depending on whether the study was conducted preclinically or clinically. Therefore, its extract should be explored as a potential remedy for the management of CVD risk factors, especially in areas where access to healthcare is limited. Full article

Background: Despite the huge burden of deaths associated with or attributable to antimicrobial resistance, studies on sequencing based antimicrobial resistance (AMR) monitoring in Africa are scarce, specifically in the animal sector. Objective and Methods: With a view to deploy rapid AMR monitoring through leveraging advanced technologies, in the current study, nanopore sequencing was performed with 10 E. coli strains isolated from rectal swabs of pigs and poultry layers in Nigeria. Two sequence analysis methods including command line, where bacterial genomes were assembled, and subsequently antimicrobial resistance genes (ARGs) were detected through online databases, and EPI2ME, an integrated cloud-based data analysis platform with MinION, was used to detect ARGs. Results: A total of 95 ARGs were identified and most of the genes are known to be expressed in the chromosome. Interestingly, few genes including qnrS1, qnrS15, qnrS10, kdpE, cmlA1, MIR-14, sul3 and dfrA12 were identified which were previously reported as transferred through Mobile Genetic Elements (MGEs). The antibiotic susceptibility assay determined that the E. coli isolates were resistant to Penicillin (100%), Ciprofloxacin (70%), tetracycline (50%) and Ampicillin (40%). The accuracies of the command line and EPI2ME methods have been found to be 57.14% and 32.14%, respectively, in predicting AMR. Moreover, the analysis methods showed 62.5% agreement in predicting AMR for the E. coli isolates. Conclusions: Considering the multiple advantages of nanopore sequencing, the application of this rapid and field-feasible sequencing technique holds promise for rapid AMR monitoring in low- and middle-income countries (LMICs), including Nigeria. However, the development of a robust sequence analysis pipeline and the optimization of the existing analysis tools are crucial to streamline the deployment of nanopore sequencing in LMICs for AMR monitoring both in animal and human sectors. Full article

The health technology assessment (HTA) is a multidisciplinary process utilized to determine the clinical, economic, social, and ethical value of new health technologies before they are incorporated into healthcare systems. In the case of rare diseases, such as Cystic Fibrosis (CF), challenges arise due to limited evidence and high treatment costs. Indeed, although CF transmembrane conductance regulator (CFTR) modulators are breakthrough therapies for CF, their incorporation into public health systems has been complex with considerable challenges, especially in low- and middle-income countries. This article presents a descriptive and exploratory case study of the regulatory and policy journey for CFTR modulators to be approved in Brazil. Based on a narrative review and document analysis, we highlight the importance of building lay society knowledge to shape policy decisions and promote equitable access to innovative therapies. In parallel, we critically reflect on the HTA process and highlight efforts in the training, education, and coordination required to enable meaningful public engagement and landmark achievements. Full article

Background: Congenital anomalies impact 52 million infants worldwide with an estimated 94% living in low- and middle-income countries (LMICs). Approximately 200,000 children are born with a neural tube defect (NTD) in LMICs annually. Zambia is an LMIC with a high burden of myelomeningocele (MMC; a severe form of NTD). This study sought to characterize the barriers influencing access to healthcare for children born with MMC in Zambia. Methods: Two cross-sectional surveys were administered to healthcare providers at referring public health facilities and mothers of infants born with MMC undergoing surgical closure. The survey among mothers was nested in a longitudinal study evaluating surgical closure in Lusaka, Zambia from 28 May 2024 to 21 January 2025. Results: Sixty-nine mother–MMC baby dyads and 123 providers from 21 facilities were enrolled in the study. The median age at presentation for MMC was 7.5 (range 0–244) days old. Most patients were referred from rural district hospitals (51%; n = 35) and travelled greater than 250 km to access care (80%; n = 55). Seventy-seven percent (n = 53) of mothers reported receiving at least one antenatal ultrasound, with 62% (n = 43) undergoing an ultrasound after 20 weeks estimated gestational age. Of these, only 3% (n = 2) received an MMC diagnosis prior to delivery. Referring patients with MMC for further care greater than six hours after birth was reported by 59% providers (n = 73). Hospitals further away from the tertiary center were more likely to report late referrals (p < 0.001). Conclusions: There is a delay in the diagnosis and referral of infants with MMC to specialized care in Zambia, which may be attributed to inadequate in utero diagnosis capabilities and distance from the tertiary facility. Improving the accuracy of prenatal diagnosis and strengthening referral pathways to facilitate access to care among infants with MMC in Zambia are important for improving incidence and outcomes. Full article

Background/Objectives: Preeclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries. Early-onset PE (EOP) and late-onset PE (LOP) are distinct clinical entities with differing pathophysiological mechanisms and prognoses. However, few studies have explored differential risk factors for EOP and LOP in Latin American populations. This study aimed to identify and assess clinical risk factors for predicting EOP and LOP in a cohort of pregnant women from Bogotá, Colombia, using traditional statistics and machine learning (ML). Methods: A cross-sectional observational study was conducted on 190 pregnant women diagnosed with PE (EOP = 80, LOP = 110) at a tertiary hospital in Bogotá between 2017 and 2018. Risk factors and perinatal outcomes were collected via structured interviews and clinical records. Traditional statistical analyses were performed to compare the study groups and identify associations between risk factors and outcomes. Eleven ML techniques were used to train and externally validate predictive models for PE subtype and secondary outcomes, incorporating permutation-based feature importance to enhance interpretability. Results: EOP was significantly associated with higher maternal education and history of hypertension, while LOP was linked to a higher prevalence of allergic history. The best-performing ML model for predicting PE subtype was linear discriminant analysis (recall = 0.71), with top predictors including education level, family history of perinatal death, number of sexual partners, primipaternity, and family history of hypertension. Conclusions: EOP and LOP exhibit distinct clinical profiles in this cohort. The combination of traditional statistics with ML may improve early risk stratification and support context-specific prenatal care strategies in similar settings. Full article