Search Results (10,681)

To clarify the effects of in situ tomato straw and green manure returning on soil quality and vegetable production in coastal saline–alkali greenhouse soils, this study employed a split-plot design to evaluate three green manure treatments (sweet corn, sorghum–sudangrass, and sesban) under two main treatments (tomato straw return or no straw return). The impacts on tomato and celery yield and quality, as well as soil physicochemical and biological properties, were assessed over a two-year rotation cycle. The results showed that: (1) compared to the control, green manure returning could significantly reduce soil bulk density, salinity, and fungal abundance; (2) different green manures specifically enriched functional microbes: Sesban enriched Nitrospira and Gemmatimonas; Sorghum–sudangrass enriched Streptomyces and Acidibacter; sweet corn enriched Pseudomonas; green manure reduced the relative abundance of Fusarium, whereas tomato straw showed the opposite trend; and (3) green manure, especially sorghum–sudangrass, significantly increased yields of both tomato and celery, while reducing celery cellulose content. Therefore, in situ sorghum–sudangrass returning is recommended as an effective strategy for maintaining soil health and achieving sustainable production in greenhouse systems within coastal saline–alkali regions. Full article

Aim: Self-stigma represents a major barrier to recovery among individuals with severe mental illness (SMI). This review aimed to identify and synthesize the available evidence on the effectiveness of non-pharmacological interventions for reducing self-stigma in adults with SMI, while also exploring physical appearance care as a potentially relevant but under-researched area. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and the Cochrane Handbook recommendations. The review protocol was registered in PROSPERO (CRD420251013333). Data Sources: A comprehensive search was conducted across multiple databases, including the Virtual Health Library, PubMed, Web of Science, the Cochrane Library, and EBSCOhost databases. A snowball search of reference lists was also performed. Studies published in English or Spanish within the past ten years were included. Review Methods: Two independent reviewers screened titles, abstracts, and full texts according to predefined criteria. Methodological quality was assessed using the Critical Appraisal Skills Programme España (CASPe). A qualitative synthesis was conducted for all included studies, and a random-effects meta-analysis was performed for studies providing sufficient quantitative data. Standardized mean differences and heterogeneity statistics were calculated. Results: Twenty-eight studies were included in the qualitative synthesis, and twelve were eligible for meta-analysis. Multicomponent interventions integrating psychoeducation, cognitive restructuring, narrative approaches, and social support showed the most consistent effects across the evaluated outcome domains. Meta-analytic findings indicated small-to-moderate reductions in self-stigma and improvements in hope, with low levels of statistical heterogeneity across outcomes. Effects on self-esteem, quality of life, self-efficacy, and psychiatric symptomatology were limited or inconsistent across studies. No studies specifically evaluated interventions focused on physical appearance care. Conclusions: Non-pharmacological interventions appear to produce modest but potentially meaningful reductions in self-stigma among individuals with SMI, particularly when delivered through multicomponent psychosocial approaches that integrate psychoeducation, cognitive restructuring, narrative techniques, and social support. Full article

Background/Objectives: Foods and beverages consumed during school lunch periods contribute substantially to children’s dietary intake; however, Canadian evidence of their nutritional contribution and quality remains limited. This study assessed nutrient content, nutrient density, and contributions to dietary recommendations among Saskatchewan elementary students. Methods: A descriptive quantitative study was conducted among 379 students aged 5–13. Dietary intake during school lunch periods was assessed using a photography-assisted plate waste method. Nutrient content was estimated using standard nutrient databases, nutrient density was evaluated using the Nutrient-Rich Food (NRF) 9.3 Index, and contributions to dietary recommendations were examined. Results: Median lunch energy was 411.4 kcal (IQR: 296.7), and the mean NRF 9.3 score was 292.6 (SD: 130.7). Compared with home-packed and mixed lunches, school-provided lunches contained less energy, carbohydrate, fat, and sugar, while protein was similar across lunch types. Overall, lunches contributed <25% of daily requirements for key nutrients, including fibre, vitamin D, calcium, and potassium. Older students had lower proportional nutrient contributions relative to their higher nutritional requirements. Nutrient density differed by lunch provenance, but not by age or reported gender, with school-provided lunches achieving the highest NRF 9.3 scores. Conclusions: Lunches contributed modestly to daily nutrient requirements, particularly among older students. In this sample, school-provided lunches were associated with higher nutrient density than home-packed lunches, although their absolute contributions to several nutrients remained limited. These findings provide baseline evidence on lunches consumed during school lunch periods among Saskatchewan elementary students and may inform future evaluations of school food systems and policies. Full article

Vermicomposting is an eco-friendly biotechnology for organic waste valorization. As the primary product of earthworm biotransformation, vermicompost is a high-value bio-organic fertilizer abundant in diverse biologically active components. To date, most studies have focused on quality variation during the earthworm transformation process, while research on quality variations in the resulting vermicompost fertilizer during long-term storage remains scarce. To explore the shelf-life of vermicompost fertilizer and its key influencing indicators, this study investigated the changes in quality indicators in sealed-packaged vermicompost over a 180-day period using two typical vermicompost, namely cattle manure vermicompost (CM) and straw-amended cattle manure vermicompost (CMS). The temporal dynamics of physicochemical properties, nutrient contents, humification indices, enzyme activities, and microbial communities were monitored. The vermicompost quality was evaluated, and core quality drivers were identified using an integrated principal component analysis-partial least squares (PCA-PLS) approach. The results indicated that moisture content (MC), total organic carbon (TOC), and total nitrogen (TN) declined progressively, whereas available phosphorus (AP) and available potassium (AK) peaked at day 150 and day 120, respectively, and the humification rate (HR) increased by 2.6–4.0-fold. Bacterial diversity and relative abundance slightly decreased, accompanied by taxonomic differentiation, whereas fungal communities maintained stable diversity. Most enzyme activities, including urease, phosphatase, catalase, and dehydrogenase, reached their maxima at day 120. Comprehensive quality scores peaked at day 150, with a marked decline observed by day 180. The recommended shelf-life of vermicompost fertilizer is 150 days. The key quality determinants include TN, electrical conductivity (EC), pH, actinomycete abundance, TOC, TP, bacterial abundance, AP, AK, and HR. These findings provide theoretical support and references for the storage management and quality control of commercial vermicompost products in practice. Full article

Background/Objectives: Pulses are nutrient-dense, low-glycaemic legumes rich in fibre and bioactive compounds that may modulate carcinogenesis through effects on diet quality, metabolism, and the gut microbiome. This scoping review mapped human evidence on pulses in relation to cancer risk reduction and related mechanistic and survivorship-relevant outcomes. Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) Population, Concept and Context (PCC) guidance, we searched CENTRAL, Scopus and PubMed (2014–31 December 2025), supplemented by backward and forward citation tracking, for English-language human studies in which pulses were a defined exposure or intervention and cancer-specific clinical outcomes or biomarkers were reported. Exposures are described using the original ‘legume’ terminology, with pulse-specific interpretation restricted to FAO-defined pulses or clearly dry pulse forms and to pulse-dominant legume intake where the constituent items were predominantly pulses but preparation was not specified. Results: After screening 1244 records, 15 studies met the inclusion criteria, comprising five case–control studies, five 4-week randomised controlled trials (RCTs), one 8-week randomised crossover trial, one controlled feeding study, two prospective cohort studies, and one other prospective study. Observational data from a single pooled case–control study suggest that higher pulse-dominant legume intake is compatible with modestly lower colorectal cancer risk, although the findings are mixed and often attenuate after adjustment for lifestyle and dietary confounders. Evidence for breast and oesophageal cancer and all-cancer mortality is limited, frequently subgroup-specific or highly sensitive to confounder control, and survivorship endpoints are represented mainly by short-term mechanistic and feasibility trials in colorectal cancer survivors rather than by long-term clinical outcomes. Notably, five of these navy bean interventions were conducted by a single research group using similar protocols, which constrains the independence of replication. Conclusions: Pulses can be considered practical components of cancer-protective dietary patterns, especially for colorectal cancer, but the heterogeneity of study designs, short-term interventions, limited sample sizes, and lack of preparation-specific exposure data preclude firm causal inferences; longer-term, rigorously designed trials and detailed observational work are needed to refine pulse-based recommendations for cancer risk reduction and to clarify any role in survivorship care. Full article

Background/Objectives: Standardised institutional patient satisfaction surveys are the primary quality-monitoring tool in Romanian public hospitals, but their ability to capture the full range of patient experiences remains uncertain. This study quantifies the discrepancy between institutional patient satisfaction scores and an independent, unmediated national feedback instrument, the Patient Feedback Mechanism (MFP), at Targoviste County Emergency Hospital (SJUT) over a six-year period (2019–2024), and examines item-level MFP results across eight dimensions of the patient experience, including dimensions not captured by the institutional indicators routinely reported by SMCSP. Methods: A sequential design combined six years of institutional satisfaction data (2019–2024) from SJUT (N = 32,176 questionnaires) with item-level MFP results for the same period, covering eight questions on medical services, cleanliness, out-of-pocket medication costs, staff involvement, communication, recommendation intent, self-reported health outcome, and willingness to report requests for money from staff. Hypotheses were tested using two-proportion z-tests with Wilson confidence intervals, Mann–Kendall trend analysis, and Cohen’s h for effect sizes. Results: Institutional satisfaction remained consistently high (96.88–97.45%), while MFP satisfaction with medical services ranged from 70.7% to 88.9% across the same years, yielding gaps of 7.9 to 26.7 percentage points, significant in every year (p < 0.001; Cohen’s h ranging from 0.32 to 0.82). The gap did not follow a monotonic trend (Mann–Kendall p = 0.469); instead, it widened to a peak in 2021 and narrowed progressively through 2024. A parallel comparison between the Quality and Patient Safety Management Service (SMCSP) overall impression item (exceeding 99%) and the MFP recommendation item (69.9–76.3%) showed even larger gaps, of 23.3 to 29.6 percentage points. The MFP item on willingness to report requests for money from staff, which is not part of SMCSP’s reported institutional indicators, remained in a narrow 4.0–5.5% range between 2019 and 2023 with no significant trend (Mann–Kendall p = 0.82); a higher 2024 value (6.9%) coincides with a national redesign of this item and is not directly comparable to earlier years. Conclusions: Institutional surveys and an independent national feedback instrument offer structurally distinct perspectives on hospital performance, reflecting differences in administration rather than equivalent estimates of patient satisfaction. The discrepancy between sources is significant and persistent, though not monotonic, widening sharply during 2021 before narrowing. One item with no institutional equivalent documents a measurable, non-trivial proportion of patients willing to report informal payment requests every year, although the available data do not establish whether this proportion is rising over time. Systematic use of existing MFP data, already collected nationally, can complement institutional surveys at minimal additional cost, provided the two instruments are interpreted as structurally different rather than as alternative estimates of the same quantity. Full article

Background: Sedentary behavior is a major modifiable risk factor for chronic metabolic disorders, particularly type 2 diabetes mellitus (T2DM). Despite recommendations promoting regular physical activity (PA), adherence remains low. DIA/01 is a multidisciplinary study designed to promote healthy lifestyles for the prevention and management of T2DM, supporting healthcare systems. Methods: A total of 123 adults with T2DM diagnosed will be enrolled at the Diabetes Center of the University Hospital of Perugia throughout 2025. Inclusion criteria are age 25–80 years, ability to walk independently, being inactive, and BMI 18.5–40 kg/m². Exclusion criteria include severe cardiovascular, central nervous system, or musculoskeletal diseases contraindicating PA. Participants will be randomized into three groups: (1) standard care (SC); (2) SC plus theoretical PA counseling (TCPA); and (3) SC plus TCPA plus a 3-month supervised mixed exercise program. The assessment, conducted at baseline and at 6 and 12 months, includes total weekly PA (WPA) time, using IPAQ-SF and actigraphy. Moreover, glycated hemoglobin, sedentary time (ST), functional capacity, body composition, cardiometabolic risk factors, dietary adherence, perceived barriers and willingness to initiate PA, readiness to change, health-related quality of life, and sleep quality will be studied. This study is registered in the Clinical Trials Registry on 13 May 2026, with the identifier NCT07583355. Conclusions: Participants in groups (2) and (3) are expected to show greater improvements in WPA, reductions in ST, and favorable changes in metabolic and functional outcomes compared with SC. This approach may support long-term engagement in regular PA and contribute to improving the clinical management of T2DM. Full article

To evaluate the effects of saline water on the yield and quality of tomatoes, a late fruit-setting stage irrigation experiment was conducted in a greenhouse using two cultivars: medium-fruited, tasty Strawberry tomato (fresh-eating) and large-fruited Maofen tomato (fresh/processing). For this, plants were grown in pots containing substrate, and five irrigation water electrical conductivity (EC) levels (1.0 as control, 2.6, 4.2, 5.8, and 7.4 dS m⁻¹) were applied for each cultivar, resulting in a 2 × 5 factorial design with 10 treatments in total. Then, tomato growth, fruit ion composition, and quality attributes were evaluated. The results showed that 1.0–7.4 dS m⁻¹ saline water had no significant impact on the plant height, stem diameter, single-fruit weight, or total yield of either cultivar. However, Strawberry tomato’s marketable yield decreased by 23.5% at 7.4 dS m⁻¹. The yield per plant of Maofen tomato was 2.7 times that of Strawberry tomato. Fruit Na⁺ content increased with EC for both cultivars; Maofen tomato had higher Na⁺ and a lower K⁺/Na⁺ ratio, with greater ion content responses to salinity. Regression analysis revealed distinctly nonlinear responses in key yield, ion, and quality parameters across the salinity gradient. The fruit comprehensive quality score (CQS) rose with EC, and Strawberry tomato’s average CQS increase (109%) was significantly higher than Maofen tomato’s. In conclusion, saline irrigation initiated when the fourth-cluster fruits attained 60% of the final harvested diameter, at EC ≤ 5.8 dS m⁻¹ for Strawberry tomato and ≤7.4 dS m⁻¹ for Maofen tomato, improved fruit quality without compromising yield. Strawberry tomato is recommended for quality-oriented production, whereas Maofen tomato is better suited for yield-oriented production, providing scientific support for saline water utilization in greenhouse soil-less cultivation. Full article

Background/Objectives: Artificial intelligence (AI) offers a promising approach for detecting and classifying symptom severity in patients with Parkinson’s disease (PD). The objective was to provide an overview of AI methods performance used for this classification through a systematic review and meta-analysis conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methods: The Google Scholar, IEEE Xplore, PubMed/MedLine, and ScienceDirect databases were searched for the period 2015–2025. The studies included were original, peer-reviewed studies written in English that addressed an AI method based on machine learning (ML) or deep learning (DL) for the classification of PD patients. The dataset used had to be “Gait in Parkinson’s Disease,” in which the severity of disease symptoms was assessed using the Hoehn and Yahr (H&Y) scale. Studies had to report at least one of the five performance metrics: accuracy, sensitivity, specificity, precision, and F1 score. Two reviewers independently selected articles, assessed the risk of bias using PROBAST (Prediction Model Study Risk of Bias Assessment Tool), and extracted data. The logit-transformed values were pooled separately by performance metrics and by severity level using a random-effects model. Cochran’s Q test, the I² statistic, and inter-study variability (τ²), computed using the generalized inverse variance method with the restricted maximum likelihood model, were used to assess heterogeneity. Forest plots with 95% confidence intervals were used to present the results. Possible causes of heterogeneity were explored using a subgroup analysis (ML vs. DL) and a sensitivity analysis. Finally, publication bias (Egger’s test) and the certainty of the evidence (using GRADE—Grading of Recommendations Assessment, Development, and Evaluation) were assessed to verify the generalizability of the results. Results: Among the 257 unique records, 12 studies were included. The methods demonstrated very high overall performance (>92%): accuracy (96.4%, 95% CI: 95.9–96.9%), specificity (97.7%, 95% CI: 97.3–98.1%), sensitivity (94.0%, 95% CI: 92.7–95.2%), precision (93.4%, 95% CI: 92.0–94.6%), F1 score (92.1%, 95% CI: 90.6–93.4%). Accuracy, specificity, and precision were high for all H&Y levels. However, the more advanced the symptoms, the lower the sensitivity (97.3% for H&Y0 vs. 92.1% for H&Y3). ML models achieved the best results for classifying healthy patients (H&Y0: 95.7% to 98.2%), while DL approaches performed better for classifying higher severity levels (>92%). Heterogeneity and inter-study variability were moderate (I²: 40–50% and τ²: 0.3–0.4) for precision and F1 score, and high (I² > 90% and τ² > 0.6) for accuracy, specificity, and sensitivity. The GRADE analysis revealed low-quality evidence for precision and F1 score and very-low quality for accuracy, specificity, and sensitivity. Conclusions: Thus, AI-based wearable gait assessment devices show great promise in terms of aiding clinical decision-making and treatment personalization. However, further research using a rigorous methodology (PROBAST) is needed to ensure the generalizability of the results and the clinical viability of the proposed solutions. Full article

Background: The convergence of machine learning (ML), gamification, and critical thinking assessment within adaptive educational platforms has accelerated since 2020, driven by large language models (LLMs) and graph neural networks (GNNs). No prior systematic review has jointly addressed all three dimensions, and Central Asian educational contexts remain underrepresented. Methods: Following PRISMA 2020 guidelines, we searched Scopus (n  =  4396) and OpenAlex (n  =  4152) for publications from 2016 to 2026. Quality assessment used the Mixed Methods Appraisal Tool (MMAT 2018; threshold ≥  2), yielding 82 papers. Five research questions addressed ML personalization (RQ1), gamification and engagement (RQ2), critical thinking assessment tools (RQ3), recommendation algorithms (RQ4), and regional applicability in Kazakhstan and Central Asia (RQ5). Results: Transformer-based and GNN models dominate the recent literature (52% of corpus from 2025), with an accuracy of 91–97% for dropout prediction and learning path recommendation under single-institution conditions. Gamification studies report up to 90% student satisfaction; LLM-based critical thinking assessment shows promise but faces validity concerns. Thirteen papers address Central Asian contexts. Conclusions: Significant gaps persist: no integrated gamification–critical thinking framework exists, recommendation systems lack explainability, and Kazakh-language datasets are severely underrepresented. Future research should prioritize multilingual adaptive systems, explainable algorithms, and privacy-preserving federated learning for low-resource contexts. Full article

Slaughterhouse wastewater introduces potentially toxic elements into aquatic ecosystems, yet bioaccumulation patterns in commercial fish species and associated human health risks remain underexplored in West Africa. This study quantified zinc (Zn), lead (Pb), iron (Fe), magnesium (Mg), chromium (Cr), and cadmium (Cd) in three ecologically distinct fish species—Oreochromis niloticus (Nile tilapia), Clarias gariepinus (African sharptooth catfish), and Mugil cephalus (Flathead grey mullet)—from two slaughterhouse-impacted rivers (Transamadi and Mgbuosimini) and a control site (Iwofe) in Rivers State, Nigeria. Metal concentrations were measured using atomic absorption spectrophotometry. Two-way ANOVA assessed species and location effects. Principal component analysis (PCA) was performed, with Mg used as a potential geogenic tracer, as its loading pattern was independent of Pb and Cd and consistent with the natural background. A Water Quality Index (WQI) classified Mgboshimini and Iwofe as having poor water quality (WQI > 75), while Transamadi had medium quality. Health risks were evaluated using estimated daily intake (EDI), target hazard quotients (THQ), and hazard indices (HI) following USEPA guidelines. Metal levels varied significantly by species and location (p < 0.001). Flathead grey mullet from Mgbuosimini had the highest Pb (1.50 ± 0.05 mg/kg) and Cd (0.41 ± 0.02 mg/kg), exceeding EU maximum levels for fish muscle (Pb 0.30 mg/kg, Cd 0.05 mg/kg) by 500% and 800%, respectively. PCA explained 77.5% of the variance, with Pb and Cd clustering as anthropogenic sources, while Mg loaded independently. THQ for Pb approached unity in Flathead grey mullet (0.88), and THQ for Cd reached 0.97. HI exceeded 1.0 in all species from Mgbuosimini, peaking at 2.07 in Flathead grey mullet. Uncertainty analysis (using ±SD) gave a HI range of 1.89–2.25 for this species, all above the safety threshold. Carcinogenic risk for Flathead grey mullet (3.97 × 10⁻⁴) approached the upper acceptable limit. Slaughterhouse effluent appears to elevate Pb and Cd burdens in fish, with detritivorous Flathead grey mullet posing the highest health risk. Exceedance of safety thresholds and HI > 1.0 indicate potential non-carcinogenic and carcinogenic risks. We recommend improved wastewater treatment and species-specific consumption advisories. Full article

Background: Patients with mild traumatic brain injury (mTBI) have a small but clinically relevant risk of intracranial injury (ICI), requiring timely detection. Computed tomography (CT) remains the diagnostic gold standard but is costly and exposes patients to ionising radiation. Combining blood-based biomarkers, glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), with clinical decision rules may allow safe exclusion of ICI without CT, reducing unnecessary imaging, radiation exposure, and resource use. Methods: A systematic review of clinical and economic studies in patients with mTBI was registered in PROSPERO (CRD420251051158). Searches were conducted in January 2025 and updated in May 2025 in MEDLINE, Embase, and the Cochrane Library. The aim was to assess the diagnostic accuracy and economic value of the combination of GFAP and UCH-L1 compared with CT scanning to rule out ICI in both adults and children with mTBI. Where available, studies directly comparing GFAP and UCH-L1 with S100β were also analysed descriptively. The quality of the clinical evidence was assessed with QUADAS-2 and GRADE. Meta-analyses used a bivariate random-effects model, with heterogeneity and sensitivity analyses explored. Results: Overall, 21 studies were considered in our review. Moderate- to high-quality evidence indicates that GFAP and UCH-L1, when used together with clinical assessment, have very high sensitivity and can reliably rule out ICI in adults with mTBI presenting within 12 h to the emergency department. Evidence for paediatric populations shows promise but remains very limited. Specificity is low, particularly in older adults, which limits the ability to reduce CT use in this high-risk group. Research on age-adjusted cut-offs is ongoing and may help to reduce the proportion of false positive tests without compromising sensitivity. Few studies directly compared GFAP and UCH-L1 with S100β, with slightly higher to equivalent sensitivity for GFAP and UCH-L1. Economic evaluations suggest possible cost savings and reduced CT utilisation, but these analyses rely on assumptions unsupported by robust data and are highly context-dependent. There is a lack of clarity in the included studies regarding whether existing clinical head rules were used to define the study populations (i.e., to determine which patients would be recommended for CT scanning) and, if so, which specific rules were applied. Conclusions: Evidence shows that GFAP and UCH-L1 can safely exclude ICI in adults with mTBI in whom a CT scan would otherwise be considered based on clinical assessment or decision rules. Nevertheless, real-world evidence and cost-effectiveness data are scarce. Further prospective studies, including paediatric and elderly populations, and integration with clinical decision rules will be informative to ensure optimal use in clinical practice. Full article

Autophagy-associated readouts in localized prostate cancer cannot be interpreted based on LC3, p62/SQSTM1, or LC3 puncta alone. In line with the concept of autophagy as a stress-response system, this review proposes a flux-aware, organelle-centered framework for assigning biological meaning to autophagy-related changes under disease-relevant stress. The framework integrates oxidative burden, lysosomal competence, selective autophagy, mitophagy, ferritinophagy, p62/SQSTM1-NRF2 signaling, ferroptosis-aware controls, and disease-stage context to distinguish four interpretive states: homeostatic quality control, adaptive tumor survival, blocked clearance, and stress-overload vulnerability. Flavonoid-associated responses are used as stress-test examples because they expose recurrent limitations in the field, including supraphysiologic exposures, limited metabolite realism, static-marker inflation, and insufficient assessment of lysosomal function. However, the framework is not restricted to dietary compounds; it applies to metabolic, pharmacological, inflammatory, androgen-related, radiation-associated, or therapy-induced perturbations in which autophagy-associated markers are altered without resolution of flux or organelle function. By linking autophagosome formation, cargo turnover, lysosomal acidification, redox buffering, and phenotype-level endpoints, this review defines a practical evidence hierarchy for interpreting autophagy in localized prostate cancer and for prioritizing translational vulnerabilities arising from organelle crosstalk. This contribution is primarily conceptual and is operationalized methodologically through flux-based evaluation criteria and translationally through disease-window-specific study-design recommendations. Full article

Background: Appropriateness of diagnostic test prescriptions represents a critical component of quality care in pediatric allergology, directly influencing diagnostic accuracy, therapeutic decisions, healthcare resource utilization, and patient outcomes. A multidisciplinary expert panel was convened to develop evidence-based clinical recommendations addressing the appropriate use of specialist consultations and diagnostic investigations in children with asthma, allergic rhinoconjunctivitis, and vernal keratoconjunctivitis (VKC). Methods: Clinical questions were formulated using the PICO framework and prioritized through structured expert consensus. Systematic literature reviews were conducted across major databases, and the certainty of evidence was assessed using the GRADE methodology. Results: Specialist evaluation emerged as a key determinant of improved diagnostic precision, optimization of treatment strategies, and reduction of inappropriate therapies. In asthma, spirometry, FeNO measurement, and allergy testing contributed to enhanced diagnostic accuracy and better control. In allergic rhinoconjunctivitis, allergological assessment supported diagnosis and the selection of immunotherapy, with demonstrated benefits on symptoms and quality of life. For VKC, multidisciplinary specialist involvement facilitated early diagnosis, personalized management, and prevention of complications. Conclusions: Although the overall certainty of evidence ranged from moderate to low, consistent clinical benefits supported consensus-based recommendations. Implementation of these recommendations may improve care quality, promote equitable access to diagnostic resources, and reduce unnecessary healthcare utilization. Full article

Background: Access to safe drinking water remains a critical public health concern in rural Ghana, particularly in climatically vulnerable and underserved settings. This study assessed the microbiological and chemical quality of drinking water and evaluated nitrate-related health risks in the North Gonja and North-East Gonja Districts of the Savannah Region. Methods: A cross-sectional study was conducted between January and March 2025. A total of 460 water samples were collected from groundwater sources and household storage containers. Microbial analyses targeted total coliforms and Escherichia coli. Physicochemical and chemical parameters included nitrate-nitrogen, pH, residual chlorine, major ions, and trace metals. Data was analyzed using descriptive statistics, chi-square tests, spatial interpolation, and non-carcinogenic health risk assessment based on the hazard quotient (HQ) approach. Results: Widespread microbial contamination was observed, with 91.5% of household water samples positive for total coliforms and 46.6% for E. coli. Contamination of source water was significantly higher in North Gonja than in North-East Gonja. Overall, 49.1% (n = 55) of groundwater sources exceeded the World Health Organization guideline value for nitrate-nitrogen, with exceedances predominantly occurring in North Gonja. Additionally, 67.0% (n = 75) of samples were outside the acceptable pH range (6.5–8.5), including 74 samples below 6.5 and one above 8.5. Residual chlorine was not detected in any of the samples. Health risk assessment indicated potential non-carcinogenic risks associated with nitrate exposure, particularly among infants and children. Conclusions: The study demonstrates significant microbial contamination and nitrate-related health risks in the study area, particularly in North Gonja. Interventions such as improved source protection, routine water quality monitoring, chlorination, household water treatment, and implementation of Water Safety Plans are recommended to enhance drinking water safety and reduce associated public health risks. Full article