Search Results (90,706)

Background: Despite Rwanda’s achievement of the UNAIDS 95–95–95 targets, national evidence on virological failure (VF) and mortality after transition to second- or third-line antiretroviral therapy (ART) remains limited. We estimated the incidence of these outcomes and examined associated factors among people living with HIV (PLWH) transitioned to second- or third-line ART in Rwanda between 2019 and 2025. Methods: We conducted a retrospective cohort study using Rwanda’s national HIV case-based surveillance (CBS) system. PLWH aged ≥15 years who transitioned to second- or third-line ART between 1 January 2019 and 31 December 2025 were followed from transition until the first recorded outcome, last clinical contact, or administrative censoring. The primary operational VF endpoint was the first viral load >1000 copies/mL recorded ≥180 days after transition; a prespecified sensitivity analysis required two consecutive measurements >1000 copies/mL. We used Kaplan–Meier estimation and facility-clustered Cox regression for the composite outcome of VF or death, and Aalen–Johansen cumulative incidence functions and Fine–Gray regression for VF with death treated as a competing event. Results: Among 778 PLWH followed for 3564 person-years (median follow-up, 60.0 months), 81 (10.4%) met the primary operational VF endpoint, and 13 (1.7%) had death recorded as the first event. The composite incidence rate was 2.64 per 100 person-years (95% CI 2.10–3.17). In adjusted Cox regression, a PI-based regimen (adjusted hazard ratio [aHR] 2.14, 95% CI 1.37–3.36), WHO stage III (aHR 1.92, 95% CI 1.10–3.34), and WHO stage IV (aHR 3.59, 95% CI 1.61–8.02) were associated with the composite outcome. In Fine–Gray analysis, a PI-based regimen (subdistribution hazard ratio [sHR] 3.37, 95% CI 1.96–5.78) and WHO stage IV (sHR 4.44, 95% CI 1.91–10.4) were associated with VF. Conclusions: PI-based regimen use and advanced WHO clinical stage were associated with poorer outcomes after ART line transition. These findings support intensified viral load monitoring, adherence and resistance assessment, and individualized regimen review for patients receiving PI-based therapy, together with systematic implementation of the WHO advanced HIV disease package for patients with stage III or IV disease. Full article

Background: The increasing integration of Artificial Intelligence (AI) and Machine Learning (ML) into medical devices necessitates robust quality evaluation methods. However, existing approaches remain qualitative, sector-specific, or focused on isolated attributes, leaving a gap in quantifiable assessment for AI/ML-driven Software as a Medical Device (SaMD). Objective: This study introduces Q_AI/ML-SaMD, a novel hybrid metric that provides a comprehensive, quantifiable measure of AI/ML-SaMD quality by synthesizing health and information technology (IT) dimensions into a single composite, benchmark-ready score. Methods: The metric integrates key attributes from a systematic literature review, classified into Health and IT domains. Sub-metrics (Q_Health and Q_IT) use weighted sums, while the overall score employs a Weighted Geometric Mean with configurable parameters to penalize domain imbalances. Validation included (a) theoretical validation against four mathematical properties, (b) an illustrative example with sensitivity analysis, (c) expert-based validation with six specialists, and (d) an evidence-based case study on FDA-authorized IDx-DR using public regulatory and clinical documentation. Results: The illustrative example yielded a score of 29.7 (“Unsuitable”). Sensitivity analysis confirmed robustness across weight, score, and combined uncertainty perturbations, with classification unchanged. Expert validation showed 83.3% agreement. The IDx-DR case study produced a score of 82.3 (“Admissible”), correctly aligning with the device’s regulatory status and supporting external validity. Conclusions: The Q_AI/ML-SaMD metric provides a foundational, quantifiable framework for AI/ML-SaMD quality assessment, bridging qualitative regulatory principles and measurable outcomes. It offers a practical tool for developers, regulators, and clinicians to benchmark and track quality across the SaMD lifecycle. Full article

National evidence on cattle vaccination, disease-control practices, and producer-reported disease remains limited in Ecuador. This study assessed holding-level participation in preventive cattle-health activities and factors associated with self-reported disease, focusing on Manabí. We analysed anonymised public-use microdata from the 2025 Continuous Agricultural Production and Area Survey (ESPAC); all four outcomes were based on producer reports and were not independently verified against veterinary or administrative records. The principal design-adjusted analysis included 10,588 positive-weight holdings across continental Ecuador. Survey-weighted proportions and multivariable logistic regression models incorporated expansion weights, strata, and primary sampling units. Estimated participation in the official foot-and-mouth disease vaccination campaign, other cattle vaccination, and disease-control activities was 86.38%, 55.96%, and 64.74%, respectively; 11.22% of holdings reported a principal cattle disease. Larger herd size was positively associated with all four outcomes (all p < 0.001). Compared with the Coast, holdings in the Amazon and Highlands had lower adjusted odds of other vaccination and disease-control activities and higher odds of self-reported disease (all p ≤ 0.002). Manabí holdings had higher adjusted odds of all three preventive outcomes than holdings in the other Coast provinces (all p < 0.001), but not of self-reported disease (p = 0.493). Preventive engagement was strongest for the centrally organised foot-and-mouth disease campaign. These findings identify territorial and farm-level inequalities relevant to veterinary-service delivery and surveillance, without establishing animal-level coverage, confirmed prevalence, or causal effects. Full article

Background: The adoption of restrictive diets without medical indication is increasing, but the cognitive factors associated with this dietary behavior remain insufficiently understood. The aim of this study was to examine the proportion of participants following restrictive diets in a self-selected online sample of adults living in Romania and to analyze the associations of nutrition knowledge, beliefs regarding the relationship between diet and health, food vigilance, and social media use with the adoption of restrictive diets without medical indication. Methods: This cross-sectional observational study was conducted online in a self-selected sample of 766 adults living in Romania. Participants were classified into three groups: no restrictive diet, medically indicated restrictive diet, and restrictive diet without medical indication. Three composite scores were constructed: Restrictive Health Beliefs, Food Vigilance, and Nutrition Knowledge. Differences between groups were assessed using non-parametric tests and χ² tests, and factors associated with the adoption of restrictive diets were analyzed using multinomial logistic regression and multiple linear regression. Results: Among the participants, 30.9% reported following a restrictive diet, and 13.1% adopted one without medical indication. Participants who followed restrictive diets scored higher for Restrictive Health Beliefs and Food Vigilance but not Nutrition Knowledge. In the multivariate analysis, Restrictive Health Beliefs showed the strongest independent association with restrictive diets without medical indication. Food Vigilance was only associated with medically indicated restrictive diets (p < 0.001), suggesting an adaptive role in a therapeutic context. Nutrition knowledge and social media use were not independently associated with restrictive diets without medical indication, although social media use was associated with higher levels of Restrictive Health Beliefs. Conclusions: The results suggest that the adoption of restrictive diets without medical indication is more closely associated with beliefs regarding the relationship between diet and health than with the level of nutrition knowledge. These findings support the development of nutrition education interventions that, in addition to conveying evidence-based information, promote the development of critical thinking and the correction of insufficiently scientifically substantiated dietary beliefs. Full article

Background: Accurate diagnosis and cause of death ascertainment are essential for effective disease surveillance and epidemiological research. This study aimed to validate prostate cancer diagnostic accuracy (PCa) and the accuracy of cause of death information among veterans with type 2 diabetes mellitus (T2DM). Methods: We conducted a retrospective cohort study of veterans with T2DM diagnosed during the baseline period (2008–2009) and followed from 2010 to 2019 using data from the Veterans Health Administration (VHA) Corporate Data Warehouse (CDW). Diagnostic codes and cause of death data were obtained from the Prostate Cancer Data Core (PCDC) and the National Death Index (NDI), which served as the gold standards for validating PCa diagnosis and mortality information in the CDW. Concordance between data sources was assessed using Cohen’s Kappa statistic. Results: Among 763,424 veterans with T2DM, 37,048 (4.9%) were diagnosed with PCa in the CDW and 36,861 (4.8%) in the PCDC, with a concordance rate of 36,361 (98.6% of patients diagnosed in the PCDC). Mortality data from the NDI identified 2723 deaths with PCa listed as the underlying cause of death, of whom 75.4% had a corresponding PCa diagnosis recorded in the CDW. For all-cause mortality, 328,165 veterans were identified as deceased in the CDW Vital Status File (VSF), compared with 326,707 deaths recorded in the NDI. Of these, 324,567 deaths were concordant between the two sources, representing 99.3% of NDI-recorded deaths. Compared with the PCDC, the CDW demonstrated high accuracy for identifying incident PCa diagnosis, with a sensitivity of 98.6% and a specificity of 99.9%. Conclusions: The findings demonstrated a high level of concordance in key outcomes, including PCa diagnosis between the CDW and PCDC, and all-cause mortality between the CDW VSF and NDI. Full article

The concentrations of 18 chemical elements were determined in the upper soil horizons within the landscapes of river basins in the Eastern Caucasus, using the Ulluchay, Sulak, Sunzha, Samur, Shuraozen (Russia), Karachay, and Atachay (Azerbaijan) rivers as case studies. This research aims to provide an ecological and geochemical assessment of soil conditions in the mountain river basins of the Eastern Caucasus. The ecological status of the soils is largely governed by elevated concentrations of such elements as Zn, Ni, Cu, Mo, As, and Cr, which exhibit both accumulation tendencies and potential toxicity. Environmentally unfavorable areas were identified through an integrated scoring assessment that incorporates the values of four ecological and geochemical indices: the modified contamination factor (mCf), the Pollution Load Index (PLI), the Potential Ecological Risk Index (PERI), and the total contamination index (Zc). According to each index, more than half of the study area is classified as uncontaminated. Low PLI values were recorded for 54% of the sampling sites, and low mCf values for 63%. Based on PERI and Zc, 82% of the sampling sites are categorized as uncontaminated. The integral scoring assessment enabled the delineation of more than a dozen environmentally unfavorable areas, with the highest concentrations observed in the Atachay and Karachay basins, spatially extensive in the Sunzha basin. The formation of environmentally unfavorable zones in terms of soil contamination is primarily driven by natural factors, including lithological conditions, climatic features, complex topography, and the directions of waterborne and mechanical migration. Anthropogenic factors contribute to a lesser extent to the development of high-contamination zones and exert only localized influences near major settlements. The results can be applied to mitigate public health risks and to promote sustainable development of mountain river basins. Targeted measures are proposed for the sustainable management of contaminated areas, including restrictions on agricultural activities and the use of drinking water sources. Full article

Background: This study examined whether baseline subjective hyper-energy was associated with depressive symptom changes over three months in people with cancer. Methods: This secondary exploratory analysis used a historical oncology cohort of 263 participants. Subjective hyper-energy was defined using SF-12 (Short Form Health Survey 12-item) item 10, and depressive symptoms were assessed with the PHQ-9 (Patient Health Questionnaire, 9-item) at baseline and follow-up. Inverse-probability weighting (IPW) examined attrition bias. Results: Follow-up PHQ-9 data were available for 112 participants (42.6%). At baseline, PHQ-9 scores were lower with than without subjective hyper-energy (4.27 ± 3.42 vs. 7.48 ± 4.39; p < 0.001). At follow-up, the difference was smaller and nonsignificant (5.61 ± 3.85 vs. 7.04 ± 3.71; p = 0.068). Unweighted scores increased by 1.33 ± 4.28 points with subjective hyper-energy and decreased by 0.44 ± 3.33 points without it (p = 0.020). After IPW, the between-group difference in change was attenuated to 0.99 points (95% CI −0.73 to 2.76). Conclusions: Baseline subjective hyper-energy was associated with fewer concurrent depressive symptoms. Although its association with subsequent change was attenuated after IPW, subjective hyper-energy may represent a potentially informative characteristic deserving further investigation within the Dysregulation of Mood, Energy, and Social Rhythms (DYMERS) framework. Prospective studies with validated multidimensional measures are needed to clarify its relationship with depressive worsening and rhythm dysregulation. Full article

Background/Objectives: Occupational contact dermatitis (OCD) is the most common work-related skin disease, accounting for roughly 90–95% of occupational dermatoses and falling predominantly on the hands. It is rarely dangerous yet imposes a substantial burden through impaired quality of life, lost productivity, and premature exit from affected trades. The COVID-19 pandemic intensified this burden among healthcare workers, in whom the pooled one-year prevalence of self-reported hand eczema reaches around 27%; meta-analytic data link the increased risk principally to frequent handwashing and wet work rather than to alcohol-based hand rub. Methods: This narrative review, which follows a non-systematic, thematically organised search strategy rather than PRISMA methodology, integrates current evidence on the epidemiology, pathophysiology, diagnosis, prevention, and management of OCD, with particular emphasis on the self-reinforcing cycle linking skin barrier disruption, microbiome dysbiosis, and antimicrobial-peptide dysregulation to inflammation. Results: We critically appraise the prevention evidence, foregrounding the low certainty of the existing trial base and the tension between the randomised trials of primary and secondary prevention, which have been null, and the encouraging but uncontrolled results of structured tertiary-prevention programmes. We summarise recent therapeutic advances, including topical delgocitinib, and situate the field within the World Health Organisation’s 2025 recognition of skin diseases as a global public health priority. Established evidence and hypotheses are kept separate throughout: we additionally advance, explicitly as a conjecture rather than as a demonstrated mechanism, a conceptual trans-kingdom dialogue model in which protease-generated LL-37 fragments may modulate staphylococcal quorum sensing, and each step of that model is labelled according to whether the supporting evidence is direct, extrapolated, or as yet untested. Conclusions: We argue that the prevention failure is less one of biology than of trial design and measurement, and outline the research needed to close the gap. Full article

Background: Salmonellosis is a major global public health concern, commonly caused by serovars such as Salmonella enterica serovar Typhimurium and Salmonella enterica serovar Enteritidis. Rare serovars, however, may represent underrecognized links between environmental reservoirs and human infection. Salmonella enterica serovar Haifa is a sporadic serotype primarily associated with livestock and environmental sources and has previously been reported in Indian poultry but not in human clinical cases to date. Case Presentation: A 70-year-old male with a history of type 2 diabetes, presented with acute watery diarrhea and dehydration. One week prior to symptom onset, the patient reported direct contact with cattle and poultry in a rural setting. Laboratory investigations revealed leucopenia and elevated procalcitonin (3.73 ng/mL). Stool culture yielded non-lactose fermenting colonies on MacConkey agar and H₂S-producing colonies on Hektoen enteric agar. The isolate was identified via VITEK 2 and confirmed as Salmonella enterica serovar Haifa by the National Institute for Research in Bacterial Infections (NIRBI). Antimicrobial susceptibility testing (AST) revealed that the isolate showed resistance to ampicillin, ceftriaxone, and ciprofloxacin. The patient was successfully treated with a three-day course of intravenous Azithromycin (1 g) and achieved rapid clinical recovery. Conclusions: To the best of our knowledge, this case represents the first reported human infection caused by S. Haifa in India. The finding highlights the potential zoonotic risk of rare non-typhoidal Salmonella serovars and emphasizes the importance of surveillance, routine serotyping, and antimicrobial resistance monitoring within a One Health framework. Full article

Warsaw experiences significant urban heat island (UHI) effects driven by low-albedo surfaces and urban geometry, which pose ongoing challenges for public health and climate adaptation. This study evaluates daytime SUHI intensity at satellite acquisition time across the entire city to provide a comparison of two acquisition dates during heatwaves. Utilizing Landsat 7 and Landsat 9 satellite imagery from July 2015 and July 2022, the research compares six distinct SUHII calculation methods, including spectral indices, statistical normalizations, and area-based temperature differences, as minimum SUHII values differed significantly between the two observations (shifting from approximately −13.8 °C to −7.7 °C). This indicates that suburban areas can become thermally similar to the city due to rapid land conversion and decreased evaporative cooling of vegetation during severe heat. Average intensities calculated via the SUHII 4 method reached 5.80 °C in 2015 and 2.07 °C in 2022. Under the criteria considered in this case study—interpretability, explicit physical units, treatment of water bodies, data requirements, and spatial consistency—SUHII 4 was the most suitable of the six tested formulations for the Warsaw analysis. Conversely, dimensionless spectral indices and purely statistical approaches are not recommended due to interpretative limitations. Full article

Reducing alcohol consumption remains a global public health priority, with young adults representing an important target population for preventive strategies. This has increased interest in low- and non-alcoholic beers (LNABs) as alternatives to alcoholic beverages. However, relatively little is known about how sensory characteristics, emotional responses and consumption context jointly influence the acceptance of non-alcoholic beers among young consumers. This study investigated the sensory acceptance, consumption context, and emotional responses associated with LNABs among Romanian university students. A total of 673 participants (18–24 years) evaluated four commercially available LNAB products: one alcohol-free beer (0.0% ABV) and three flavored low-alcohol beers (1.9% ABV; grapefruit, lemon, and elderflower), using a 9-point hedonic scale, preference ranking, and a check-all-that-apply (CATA) emotional questionnaire. Flavored beers received significantly higher overall appreciation than the alcohol-free sample, with mean overall liking scores of 7.32 ± 1.54 for GLAB, 6.93 ± 1.61 for LLAB, and 6.89 ± 1.56 for ELAB, compared with 4.59 ± 2.00 for AFB (all p < 0.001). Aroma, fruity flavor, clarity, beer foam, and smell emerged as the principal drivers of consumer acceptance, whereas refreshing perception showed limited influence. Gender-related differences were generally small, although female participants assigned slightly higher ratings to sweetness, fruity flavor, clarity, and foam. Importantly, both genders expressed comparable acceptance of alcohol-free beer. Consumption was predominantly associated with social settings involving friends (66.7%) and family (34.8%). Emotional profiling revealed a predominance of positive emotions, particularly enjoyment (41.9%), happiness (35.1%), relaxation (34.0%), and achievement (21.2%). Preference data showed that 92.4% of respondents selected one of the flavored beers as their preferred sample, whereas only 5.2% preferred the alcohol-free beer. This study provides one of the first integrated evaluations combining sensory drivers, emotional profiling and consumption context to explain non-alcoholic beer acceptance among Romanian young adults. Full article

Environmental noise is a major environmental and public health concern in rapidly urbanizing cities, yet integrated studies combining field measurements, GIS-based spatial analysis, and predictive modelling remain limited in Central Asia. This study assessed the spatial distribution of urban noise pollution in Samarkand (Uzbekistan) and explored its statistical association with selected public health indicators, forecasting future trends. Measurements were conducted at 50 georeferenced sites covering more than 300 streets. The measured data were processed and mapped using ArcGIS 10.5 (Esri, Redlands, CA, USA) to produce the spatial distribution of environmental noise across the study area. Official data on registered vehicles, industrial enterprises, and disease incidence (2014–2024) were analysed using Pearson correlation, Autoregressive Integrated Moving Average (ARIMA), and its extension incorporating exogenous variables (ARIMAX) models. Results revealed pronounced spatial heterogeneity in noise levels, highest along transport corridors and industrial zones. Industrial enterprises showed the strongest correlations with disease incidence; vehicle registrations were excluded from final models owing to collinearity with industrial activity. ARIMA projected continued industrial growth through 2030, while ARIMAX models identified significant associations between industrial activity and diseases of the ear and mastoid process and of the nervous system (MAPE 28.55% and 19.78%). As an ecological, exploratory study using infrastructural proxies rather than measured noise exposure, findings should be interpreted as associations rather than causation. The framework offers a transferable approach for environmental risk assessment and sustainable urban planning. Full article

Background: Tinea capitis remains one of the most common superficial fungal infections in children worldwide and represents an important public health concern due to its high prevalence, potential complications, and changing epidemiology. This study aimed to characterize the epidemiological trends and etiological distribution of tinea capitis across the Americas through a systematic review of the available literature. Methods: A systematic search was conducted in MEDLINE (PubMed), Scopus, SCILIT, and SciELO following PRISMA guidelines. A total of 250 records were identified, of which 75 duplicates were removed. After title and abstract screening and eligibility assessment, 90 studies were included. Observational studies, prevalence studies, case series, and case reports reporting epidemiological or etiological data on tinea capitis in countries of the American continent were considered eligible. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. No formal certainty-of-evidence assessment or meta-analysis was performed due to the descriptive nature and heterogeneity of the included studies. This review was not prospectively registered. Results: The 90 included studies comprised 506,086 reported cases of tinea capitis. Marked regional differences were identified in the distribution of dermatophyte species. Trichophyton tonsurans predominated in North America and several Caribbean countries, whereas Microsporum canis was the most frequently reported etiological agent in much of South America and parts of Central America, suggesting an important role of zoonotic transmission in these regions. Variations in prevalence and species distribution were also associated with geographic, socioeconomic, and demographic factors. Overall, the included studies demonstrated low-to-moderate methodological risk of bias. Conclusions: These findings demonstrate substantial heterogeneity in the epidemiology of tinea capitis throughout the Americas and highlight the importance of continuous surveillance, accurate mycological diagnosis, and region-specific public health strategies to improve disease control and guide appropriate therapeutic interventions. Full article

Pectin oligosaccharides have emerged as promising prebiotics whose biological activities are closely tied to their structural features, particularly monosaccharide composition. However, systematic experimental evidence regarding how different monosaccharide compositions collectively influence gut microbiota modulation, SCFA production, and the metabolomic responses of mixed pectin oligosaccharides remains limited. To address this gap, Pool-I (27.92% galacturonic acid, rich in neutral sugars including galactose, glucose, and arabinose) and Pool-II (98.73% galacturonic acid) were evaluated by comparison with inulin, a reference prebiotic, using an in vitro human fecal fermentation model. Microbial community structure, SCFA production, and metabolomic profiles were assessed at 12 h and 24 h via 16S rRNA gene sequencing, gas chromatography, and untargeted metabolomics, respectively. Inulin exhibited superior enrichment of Actinobacteria (predominantly Bifidobacterium) and consistently higher total SCFA production (24.07 ± 0.25 mmol/L acetic acid at 24 h vs. 20.27 ± 0.28 and 20.53 ± 0.76 mmol/L for pectin oligosaccharides), particularly propionic and butyric acids. Although Pool-I and Pool-II yielded lower overall SCFA concentrations, they significantly enriched beneficial SCFA-producing genera (including Coprococcus_3, Butyricicoccus, and Parabacteroides) at 24 h. Metabolomic analysis revealed that Pool-I uniquely upregulated twenty-six differential metabolites (VIP > 1, p < 0.05), including taurine (VIP = 2.40, p < 0.001), L-proline (VIP = 1.72, p = 0.015), and pantothenate (VIP = 1.63, p < 0.001), while reducing uric acid (VIP = 1.05, p < 0.001), whereas only two differential metabolites were identified for Pool-II. We conclude that monosaccharide composition is a key determinant of the prebiotic efficacy of pectin oligosaccharides: Pool-II selectively promotes SCFA-producing taxa, whereas Pool-I elicits broader metabolic regulation. These effects provide a theoretical foundation for developing pectin oligosaccharides as potential prebiotic candidates. Full article

Background: This study aimed to investigate the effects of E. stephanianum-derived polyphenols on preventing the progression of collagen-induced arthritis (CIA) in mice and its associated metabolic alterations. Methods: The E. stephanianum plant was extracted, fractionated, and screened in vitro for anti-inflammatory, antibacterial, and antioxidant potential. Fraction 5 (identified as ellagic acid by nuclear magnetic resonance) exhibited the most potent activity and was selected for in vivo study. In the in vivo study, male DBA/1JGpt mice were randomized into five groups: control (CON), CIA (Model), low-dose extract (ES-L), high-dose extract (ES-H), and ellagic acid group. ES-L, ES-H, and ellagic acid were administered by daily oral gavage at 375, 750, and 250 mg/kg body weight, respectively, for 8 weeks. Arthritis severity was evaluated based on paw thickness, clinical score, ankle joint histopathology, and serum proinflammatory cytokine levels. To reveal the associated metabolic alterations, serum metabolites were characterized by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry. Results: Both the whole extract and ellagic acid revealed pronounced anti-inflammatory, antibacterial, and antioxidant properties. In vivo treatment with ES-L, ES-H, or ellagic acid similarly and significantly ameliorated CIA severity, showing smaller paw swelling, reduced clinical arthritis scores, milder joint histopathological injury, and lower serum tumor necrosis factor-α and interleukin-6 concentrations than the model group. Untargeted metabolomics identified 20 differential metabolites, mainly including triacylglycerols (containing n-3 fatty acids), pro-inflammatory phospholipids, and spermic acid 1. Moreover, the treatments significantly altered amino acid and purine metabolism. Conclusions:E. stephanianum derived polyphenols, like ellagic acid, significantly prevented the progress of CIA in mice. These effects were associated with the alteration of metabolic profiles. Full article