Search Results (53)

Background/Objectives: Neurodegenerative proteinopathies, such as Alzheimer’s disease (AD), Parkinson’s disease (PD), and dementia with Lewy bodies (DLB), are increasingly prevalent worldwide mainly due to population aging. These conditions are marked by complex etiologies, overlapping pathologies, and progressive clinical decline, with significant consequences for patients, caregivers, and healthcare systems. This review aims to synthesize evidence on the healthcare complexities of major neurodegenerative proteinopathies to highlight current knowledge gaps, and to inform future care models, policies, and research directions. Methods: We conducted a comprehensive literature search in PubMed/MEDLINE using combinations of MeSH terms and keywords related to neurodegenerative diseases, proteinopathies, diagnosis, sex, management, treatment, caregiver burden, and healthcare delivery. Studies were included if they addressed the clinical, pathophysiological, economic, or care-related complexities of aging-related neurodegenerative proteinopathies. Results: Key themes identified include the following: (1) multifactorial and unclear etiologies with frequent co-pathologies; (2) long prodromal phases with emerging biomarkers; (3) lack of effective disease-modifying therapies; (4) progressive nature requiring ongoing and individualized care; (5) high caregiver burden; (6) escalating healthcare and societal costs; and (7) the critical role of multidisciplinary and multi-domain care models involving specialists, primary care, and allied health professionals. Conclusions: The complexity and cost of neurodegenerative proteinopathies highlight the urgent need for prevention-focused strategies, innovative care models, early interventions, and integrated policies that support patients and caregivers. Prevention through the early identification of risk factors and prodromal signs is critical. Investing in research to develop effective disease-modifying therapies and improve early detection will be essential to reducing the long-term burden of these disorders. Full article

Acaricide usage has led to the growing problem of resistance in ticks. A heavy tick burden and the presence of ticks on animals throughout the year, despite the monthly application of acaricides, in farms in the United Arab Emirates formed the motivation for this study. The objectives of this research were as follows: (a) to assess the acaricide resistance status of the most prevalent tick Hyalomma spp. to widely used acaricides Cypermethrin and Deltamethrin; (b) to identify the association of farm management practices and farm-level risk factors with the failure of tick treatment (acaracide resistance). A total of 1600 ticks were collected from 20 farms located in three different regions of Abu Dhabi Emirate including Al Ain (n = 10), Al Dhafra (n = 5), and Abu Dhabi (n = 5). The ticks were subjected to an in vitro bioassay adult immersion test (AIT) modified with a discriminating dose (AIT-DD) against commercial preparations of Cypermethrin and Deltamethrin. A questionnaire was designed to collect metadata and information on farm management and the farm-level risk factors associated with routine farm practices relating to the treatment and control of tick and blood parasite infections in camels and small ruminant populations. Hyalomma anatolicum and Hyalomma dromedarii were identified among the collected ticks, with H. anatolicum being the most prevalent tick species (70%) in the present study. The test results of the in vitro bioassay revealed varied emerging resistance to both of the acaricides in the majority of the three regions; fully susceptible tick isolates with zero resistance to Deltamethrin were recorded in one farm at Al Ain and two farms in the Abu Dhabi region. A questionnaire analysis showed that the failure of tick treatment in farms varied with the presence or absence of vegetation areas, types of animal breeds, and management practices. This study reports the emergence of resistance in ticks to Cypermethrin and Deltamethrin across the Abu Dhabi Emirate, indicating a strict warning for the cautious use of acaricides. There is also a need to improve awareness about sound tick management and control practices among farm owners through a multidisciplinary approach adopting integrated pest management strategies that engage farmers, veterinarians, and policy makers. Full article

Background and Objectives: The COVID-19 pandemic disrupted cancer care, prompting adaptations to reduce patient exposure while preserving treatment efficacy. This retrospective observational study compared a weekly cisplatin and 5-fluorouracil (5-FU) regimen to the standard monthly regimen for neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma. Materials and Methods: This single-center retrospective study included 91 patients, divided into two cohorts: weekly chemotherapy (n = 30) and standard chemotherapy (n = 61). Treatment assignment was based on hospital policy changes during the pandemic, with weekly outpatient chemotherapy implemented after November 2022 to conserve inpatient resources. All patients received radiotherapy at 50 Gy in 25 fractions. The weekly regimen consisted of cisplatin 20 mg/m² and 5-FU 800 mg/m², administered over 1–2 h weekly, while the standard regimen administered the same doses over four consecutive days on weeks 1 and 5. Primary endpoints were pathologic complete response (pCR), progression-free survival (PFS), and overall survival (OS). Results: The response rates were similar between groups (weekly: 86.7% vs. standard: 90.2%; p = 0.724). The weekly regimen group showed a higher pCR (40.0% vs. 26.2%; p = 0.181) and significantly lower recurrence (26.7% vs. 52.5%; p = 0.020). Mortality was also reduced in the weekly group (6.7% vs. 34.4%; p = 0.004), though the follow-up duration was shorter (10.6 vs. 22.8 months; p < 0.001). Conclusions: In this retrospective observational study, weekly cisplatin and 5-FU demonstrated comparable efficacy to the standard regimen, with potential advantages in reducing recurrence and mortality. This modified approach may be a viable alternative for maintaining oncologic outcomes while minimizing the burden on healthcare systems during pandemic conditions, although prospective validation is needed. Full article

International waste policy promotes the reduction and re-use of waste materials, and in some cases, specifically calls for the use of recycled materials in pavements. In countries like Australia, most of the aircraft pavement network is constructed of flexible pavements. Consequently, understanding the opportunities for recycled materials in flexible aircraft pavements is paramount to increasing the technology uptake. This paper reviews opportunities for the incorporation of recycled materials in flexible airport pavement construction, specifically, their application to particle substitution in unbound and asphaltic layers, use in stabilization treatments, and use as a bitumen modifier. Additionally, environmental product declarations are reviewed to provide a range of typical environmental costs for each recycled material when considering material processing for incorporation into flexible pavements. These materials are compared to virgin material environmental costs to determine which recycled materials provide the highest environmental benefit potential. It was concluded that particle replacement in unbound layers with waste materials had a similar environmental cost to using virgin materials. However, the requirement to dispose of waste material to the landfill can be significantly reduced. For asphaltic layers, recycled asphalt pavement as an asphalt mixture replacement, fly ash as a hydrated lime replacement, and waste plastic and crumbed rubber as a virgin polymer replacement all are effective in reducing the environmental cost. To further increase the technology uptake, a risk-based approach for the implementation of waste materials in airport flexible pavements is recommended, which considers performance testing, the depth of the pavement layer, and the pavement functional area. Full article

The journey toward a viable malaria vaccine, initiated in 1965, reached a major milestone in 2021 with the WHO’s endorsement of RTS,S/AS01, a recombinant protein-based malaria vaccine. This progress continued with the 2023 approval of the R21/Matrix-M vaccine, which is more cost-effective, more potent due it is higher protein content, and easier to manufacture. Though these achievements signal hope, malaria’s intricate life cycle and its prevalence in underprivileged regions make vaccine development and equitable distribution challenging. This review explains the lifecycle of malaria and explores the evolution of various treatment strategies aimed at reducing malaria-related mortality. This scoping review aims to provide a comprehensive overview of malaria vaccines, examining their development, efficacy, safety, and implementation challenges. Using a structured literature search across PubMed, Web of Science, and Scopus, we identified key themes related to malaria vaccines trials, policy implications, and future research needs. Peer-reviewed publications on PubMed, Scopus, and Web of Science from 1970 to 2024 were searched without any limitations. Search and Boolean search terms were modified to include terms like “malaria vaccines”, “malaria vaccination”, “malaria immunisation”, “malaria immunisation AND malaria-endemic countries”, “malaria endemic low-income countries AND malaria control”, “malaria public health control”, “malaria chemoprophylaxis AND early diagnosis of malaria”, “screening for malaria”, and “laboratory diagnosis of malaria in endemic countries” in order to find pertinent studies. Preliminary insights suggest that although vaccines are crucial, comprehensive strategies involving health education, hygiene, and timely medical intervention remain essential to malaria control. Full article

Background: Obesity, commonly approximated by body mass index (BMI) ≥ 30 kg/m², is causally associated with at least 13 cancer types (obesity-related cancers) but it is unclear whether weight loss interventions among obese individuals result in risk reduction of cancer. Recently, several trials of short-term use of glucagon-like peptide-1 (GLP-1) receptor agonists, originally designed for use as anti-diabetes medications, have shown substantial weight loss outcomes compared with placebo. Notably, high-dose semaglutide is associated with approximately 15% weight loss in individuals with obesity without diabetes. With these impressive results, hypotheses are emerging that these drugs might have a role in the prevention of obesity-related cancers, mediated through weight loss. Objectives/methods: The aim of this opinion paper is to critically appraise the methodological challenges and pitfalls associated with studying the question ‘does weight loss through use of GLP-1 receptor agonists reduce cancer risk’ through observational studies, and exemplify this through critique of a recent study published in this journal. Results: We modified the ROBINS-E framework for assessing risk of bias, identifying seven methodological criteria specific to this research question, against which data should be interpreted. These include adequate adjustment for key parameters of body fatness; immortal time bias; treatment allocation bias; survival bias; cumulative drug dose effect; sufficient sojourn time between drug intervention and cancer presentation; and treatment effect specific to obesity-related cancers. We found that 6 out of 7 methodological criteria were at high risk of bias. Conclusions: Cancer prevention through GLP-1 receptor agonist use should be explored; however, there are several methodological challenges to overcome in understanding this link before it can inform clinical practice and policy. Full article

Type 2 diabetes (T2D) is a rapidly growing global health concern, projected to affect 1.3 billion people by 2050, necessitating a multidisciplinary approach. This review examines the epidemiological disparities in T2D, focusing on modifiable and nonmodifiable risk factors, socioeconomic determinants, and healthcare inequities. While genetic predisposition, age, and ethnicity contribute to T2D risk, socioeconomic status (SES) significantly mediates modifiable factors such as diet, physical activity, and access to healthcare. Lower SES is associated with poorer lifestyle choices, limited access to resources, and increased exposure to risk factors, exacerbating T2D prevalence among vulnerable populations. Geographic variations in T2D prevalence are evident, with racial and ethnic minorities and lower-income individuals being disproportionately affected in regions like the United States and Europe. The economic burden of T2D is substantial, with global healthcare expenditures reaching USD 966 billion in 2021 and projected to rise significantly, albeit with variations across different countries and health systems. Despite advancements in treatment, inequities in healthcare access persist, particularly in low- and middle-income countries, hindering optimal glycemic control and consequently contributing to preventable complications and poor health outcomes. This review highlights the critical need for targeted interventions and policy reforms to address the intersection of demographic, economic, and healthcare-related variables influencing T2D disparities. By bridging gaps in prevention, management, and treatment and accounting for the effect of SES on both modifiable and nonmodifiable risk factors, the global disease burden of T2D could be reduced and health equity could be improved. Full article

Background/Objectives: The indirect impact of the pandemic on the diagnosis and treatment of new primary melanoma has been carefully evaluated in recent years. The aim of the present study was to investigate if the indirect impact of the pandemic in Italy could be detectable also in the second year of the pandemic, as suggested by the characteristics of melanoma at diagnosis. Methods: Retrospective analysis of 1640 diagnoses of cutaneous melanoma in pre-pandemic period and 1292 diagnoses in the pandemic period from 10 centers (from 1 March 2019 to 28 February 2022). Results: Our findings confirmed an indirect impact of the pandemic on characteristics of incident melanoma, also in the second year of the pandemic in Italy (Breslow thickness p < 0.0001, tumor stage p = 0.002, ulceration p = 0.04, SNLB p = 0.03), without statistically significant differences between centers. A statistically significant reduction in the time interval from diagnosis to surgical treatment was observed, but only in centers that had to modify their case mix to address the needs of treating COVID-19 patients (p = 0.0002). Conclusions: Our study confirmed the indirect impact of the pandemic on melanoma characteristics at the diagnosis in the second year of the pandemic in Italy. We also found no differences in melanoma characteristics between hospitals with different organization. Diagnostic delays may be related to a delayed access of the patient to the entire diagnostic pathway, and therefore, especially in the case of a pandemic, policies to support early diagnosis are crucial. Full article

Background/Objective: Despite surgery being the primary curative treatment for cancer, patients with compromised preoperative physical, nutritional, and psychological status are often at a higher risk for complications. While various screening tools exist to assess physical, nutritional, and psychological status, there is currently no standardised self-reporting tool, or established cut-off points for comprehensive risk assessment. This study aims to develop, validate, and implement an online self-reporting preoperative screening tool that identifies modifiable risk factors in cancer surgery patients. Methods: This mixed-methods study consists of three distinct stages: (1) Development—(i) a scoping review to identify available physical, nutritional, and psychological screening tools; (ii) a Delphi study to gain consensus on the use of available screening tools; and (iii) a development of the online screening tool to determine patients at high risk of postoperative complications. (2) Testing—a prospective cohort study determining the correlation between at-risk patients and postoperative complications. (3) Implementation—the formulation of an implementation policy document considering feasibility. Conclusions: The timely identification of high-risk patients, based on their preoperative physical, nutritional, and psychological statuses, would enable referral to targeted interventions. The implementation of a preoperative online screening tool would streamline this identification process while minimising unwarranted variation in preoperative treatment optimisation. This systematic approach would not only support high-risk patients but also allow for more efficient provision of surgery to low-risk patients through effective risk stratification. Full article

Introduction: Spinal muscular atrophy is a rare genetic disease. Nusinersen and Risdiplam, recognized as disease-modifying therapies, were included in the National Reimbursement Drug List in 2022 and 2023, respectively, in China. Policies have been implemented to enhance a multi-level medical security system, particularly for rare diseases. This study explores the self-perceived burden and offers policy suggestions to improve China’s social security for rare diseases. Methods: In our mixed study, we conducted 37 semi-structured online interviews and a quantitative survey with 3 adult SMA patients and 34 family members (primary caregivers) in collaboration with the Meier Advocacy and Support Center. The interviews explored self-perceived burdens in psychology, domestic relations, medical care, rehabilitation, and economy, analyzing mainly through thematic analysis and multiple linear regression. Results: Respondents reported significant psychological burdens mainly stemming from limited treatment access. The instability within these families was linked to inconsistent therapeutic schedules, the lack of development opportunities, and misunderstandings. Choices between institutional and home rehabilitation were influenced by economic conditions and symptom severity. After the inclusion of medications, six patients (16.2%) still had not received pharmacological treatment, and many of those who underwent treatment were dissatisfied with the outcomes. The high costs of rehabilitation, family labor loss, and an incomplete medical security system resulted in significant economic burdens. Respondents called for more effective medications and better patient support. Conclusion: Although the inclusion of medications in National Reimbursement Drug List has improved availability and affordability, families still experienced significant burdens across multiple domains. A broader focus on social security is needed to enhance the comprehensive development of patients with rare diseases. Full article

The concentrations of estrogens and xenoestrogens in the environment are rising rapidly, posing significant and multifaceted risks to human health and ecosystems. It is imperative for governments to develop policies that leverage sustainable technologies to mitigate the presence of pharmaceutical estrogenic compounds in the environment. This review examines the global environmental and human health risks associated with indigenous estrogens and synthetic pharmaceutical xenoestrogens, while critically evaluating sustainable approaches to their management. A total of 28 studies, published between December 2013 and 18 January 2024, and sourced from PubMed and Scopus, were systematically reviewed. Most of these studies focused on estrogenic compounds in aquatic environments where they contribute to reproductive and developmental abnormalities in fish and may enter the human food chain, primarily through fish consumption. Sustainable methods for removing or neutralizing estrogenic compounds include adsorption, filtration, and enzymatic degradation. Additionally, technologies such as activated sludge processes and high-rate algal ponds demonstrate promise for large-scale applications; however, further research and standardized operational guidelines are needed to optimize their efficiency and sustainability. This review has concluded that ECs can have severe consequences on the environment, most notably, impairment of reproductive functions in fish and humans, underscoring the urgent need for governments to implement drug take-back programs, establish evidence-based guidelines for wastewater and pharmaceutical waste treatment, and set enforceable thresholds for estrogenic compounds in surface and drinking water. Existing regulations such as the UK’s Regulation on the registration, evaluation, authorization, and restriction of chemicals and the United States’ National Primary Drinking Water Regulations can be modified to include ECs as dangerous chemicals to aid in maintaining safe EC levels”. Such measures are critical for reducing the environmental concentrations of pharmaceutical estrogenic compounds and safeguarding both public health and ecological integrity. Full article

Background and aim: The coronavirus (COVID-19) pandemic led to significant changes in health service delivery. Despite the risk in high-exposure environments, frontline workers such as dental staff were expected to continue delivering essential services. This study specifically sought to explore the experiences of dental staff in New South Wales and determine their perceptions of dental care delivery during a pandemic. Methods: Purposive sampling was used to recruit twenty-four dental staff from two local health districts. A deductive framework, as described by Braun and Clark, was used to analyse the transcripts. Four major focus areas were identified: responding to protocol changes, adapting to the impact of changes in policy and protocol, modifying dental treatment planning and recommendations for training and implementation of policies. Results: Dental staff reported that management staff were doing all they could and were most supported working in a team. Reduced contact with patients and personal protective equipment helped staff feel safe when seeing patients. Mental health and remote dentistry services could be more supported. Conclusions: Unique challenges were experienced by dental staff and their management during the global COVID-19 pandemic. Future considerations include improved support for staff and further investigation into the effectiveness of options such as teledentistry. Full article

Heterogeneity of outcomes across different clinical trial study sites is often inevitable. Understanding how outcomes differ by site is important for planning future programs and studies. We examined the extent of heterogeneity of hepatitis C virus (HCV) treatment cascade outcomes among persons who inject drugs (PWIDs) across sixteen clinical sites utilized in the HERO Study—a pragmatic randomized trial of HCV treatment support. Treatment cascade outcomes included averages of overall treatment adherence and proportions of treatment initiation, treatment completion, sustained virologic response (SVR) test completion, and SVR achievement. The HERO study utilized 16 clinical sites across the United States (US): eight opioid treatment programs (OTPs) and eight community health centers (CHCs). Variability of the outcomes across the 16 clinical sites was assessed using ranges and intraclass correlation coefficients (ICC) estimated from mixed-effects linear or logistic regression models. Treatment initiation was analyzed in the intention-to-treat (ITT) sample (N = 755); treatment completion, adherence, and SVR test completion in the modified ITT (mITT) sample, which is the sample that initiated treatment (N = 623); and SVR achievement in the mITT and per-protocol (PP, N = 501) samples. Across the 16 clinical sites, the range observed in the averages of overall treatment adherence was from 68% to 81% [ICC = 0.026 (0.005, 0.054)], and the ranges of proportions observed were from 68% to 96% for treatment initiation [ICC (95% CI) = 0.086 (0.051, 0.155)], 60% to 100% for treatment completion [ICC = 0.049 (0.008, 0.215)], 54% to 95% for SVR test completion [ICC = 0.096 (0.006, 0.177)], 46% to 90% for SVR achievement in the mITT sample [ICC = 0.070 (0.014, 0.122)], and 76% to 100% for SVR achievement in the PP sample [ICC = 0.143 (0.021, 0.422)]. The variability of the outcomes across 16 US sites treating HCV among PWIDs appears to be substantial in view of the ranges and ICC values of the outcomes. It is imperative to develop tailored interventions to target the sources of variability and reduce barriers at the patient, provider, clinic, and state policy levels to facilitate more equitable access to HCV treatment and reduce heterogeneity in treatment outcomes. Full article

A carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak in an intensive care unit (ICU) was contained by an improved infection-control measure that included a disinfectant policy. In our retrospective cohort study, we describe the epidemiological investigations and infection-control measures during this outbreak. Descriptive analysis was used to summarize patient demographics, neurological diseases, surgical treatment, underlying diseases, infection, and outcomes. In December 2023, two CARB-positive patients were observed in the ICU, and four more patients became CRAB-positive in January. During this outbreak, there was an overlap of hospitalization periods among the CRAB-positive patients, and CRAB was isolated from the environment; the isolated CRAB strain was identical. Infection-control measures, including hand hygiene, contact precautions and isolation, surveillance, decolonization, environmental cleaning, and disinfection, were reviewed and modified. The aim of this study was to examine the molecular background of the effectiveness of the disinfectant shift used during successful outbreak control. Experiments were carried out to study the phenotypic sensitivity and genetic background of different disinfectant agents. A thorough analysis of the detected CRAB strain included whole-genome sequencing (WGS), investigation of the qacE and qacEΔ1 genes’ relative expression by qPCR after exposure to different disinfectant solutions, as well as an analysis of biofilm formation. WGS analysis of the CRAB strain identified that an ST2 high-risk clone was responsible for the outbreak, which produced OXA-83 and ADC-30 beta-lactamases; in addition, qacE and qacEΔ1 genes were also detected, which confer resistance to disinfectants containing quaternary ammonium compounds (QACs). A qPCR analysis demonstrated that after exposure to different disinfectants, the gene expression levels of qacE and qacEΔ1 increased and correlated with concentrations of QACs of disinfectants. During the outbreak, the standard-of-care QAC-based disinfectant was changed to a mainly alcohol-based agent in the ICU, which contributed to the successful control of this outbreak, and no additional patients were identified with CRAB. We conclude that continuous surveillance and hand hygiene training combined with fast identification and reaction to new cases, as well as an in-depth analysis of multidrug-resistant outbreak strains and investigation of their disinfectant tolerance/resistance during an outbreak, are essential to effectively control the spread of nosocomial pathogens. The smart policy of disinfectant agent selection played a crucial role in controlling the outbreak and ensuring patient safety in the ICU. Full article

Poor diet is the top modifiable mortality risk factor globally, accounting for 11 million deaths annually with half being from diet-linked atherosclerotic cardiovascular disease (ASCVD). Yet, most of the world cannot afford a healthy diet—as the hidden costs of the inadequate global food system total over USD 13 trillion annually—let alone the much more clinically, financially, and ecologically costly and resource-intensive medical interventions required to address the disease progression and acute complications of ASCVD. Yet, AI is increasingly understood as a force multiplying revolutionary technology which may catalyze multi-sector efforts in medicine and public health to better address these significant health challenges. This novel narrative review seeks to provide the first known overview of the state-of-the-art in clinical interventions and public health policies in healthy diets for ASCVD, accelerated by health equity-focused AI. It is written from the first-hand practitioner perspective to provide greater relevance and applicability for health professionals and data scientists. The review summarizes the emerging trends and leading use cases in population health risk stratification and precision public health, AI democratizing clinical diagnosis, digital twins in precision nutrition, and AI-enabled culinary medicine as medical education and treatment. This review may, therefore, help inform and advance the evidence-based foundation for more clinically effective, financially efficient, and societally equitable dietary and nutrition interventions for ASCVD. Full article