Search Results (2,830)

Veterinarians are routinely exposed to occupational infectious hazards at the human–animal interface, making vaccination an important preventive measure within a One Health framework. However, evidence on vaccination coverage and immunization practices in this professional group remains limited. This study assessed self-reported vaccination coverage, attitudes toward vaccination, perceived barriers, and training needs among registered veterinarians in Málaga, Spain. A cross-sectional anonymous survey was distributed to all actively practicing veterinarians registered with the Official Veterinary Association of Málaga. The questionnaire collected sociodemographic and professional information, self-reported vaccination status, attitudes toward vaccination, and perceived training needs. A total of 164 veterinarians participated (response rate: 15.2%). Given the voluntary nature of participation, findings should be interpreted as descriptive. Vaccination coverage was low for several vaccines relevant to occupational or adult immunization, including seasonal influenza (21.3%), rabies (23.2%), and tetanus–diphtheria–pertussis boosters (47.3%). Nearly half of respondents (49.1%) were uncertain about their hepatitis B vaccination status. In contrast, COVID-19 vaccination uptake was high (96.9% received at least one dose). Although most participants considered vaccination highly important, self-reported coverage remained limited for several recommended vaccines. Qualitative responses identified barriers related to access to vaccination, information, and the absence of structured occupational vaccination programmes. Among the surveyed veterinarians in Málaga, these findings support the need for clearer occupational vaccination recommendations, improved access to immunization services, and enhanced vaccinology training. Such measures could strengthen occupational health protection and support One Health prevention strategies at the human–animal interface. Full article

Objective: Varicella zoster virus (VZV), a member of the Herpesviridae family, is known as the causative agent of chickenpox (varicella). Following primary infection, VZV can remain latent for life and may reactivate over time to cause herpes zoster (shingles). Advanced age, immunodeficiency, and certain chronic illnesses are major risk factors for the development of herpes zoster. To prevent herpes zoster, a live zoster vaccine was licensed in 2006, followed by a recombinant zoster vaccine with higher efficacy in 2018. In Türkiye, the recombinant zoster vaccine was licensed in 2024. Raising awareness among healthcare workers is important both for their own health and the safety of vulnerable patients. This study aimed to evaluate healthcare workers’ knowledge and awareness of herpes zoster infection and zoster vaccines across the country, as well as to determine the prevalence of prior herpes zoster infection among them. Methods: After obtaining ethical approval, a nationwide multicenter survey was conducted. A questionnaire was distributed to healthcare workers via an online link. Participation was entirely voluntary. The survey collected demographic information (age, sex, profession, years of experience) and included questions on knowledge of herpes zoster, history of zoster infection, symptoms and severity (if applicable), awareness of the zoster vaccine, and vaccination attitudes. Results: A total of 5180 healthcare workers participated, of whom 3505 were female. The participants ranged in age from 18 to 79 years (mean age: 34.24 ± 11.52). Regarding professions: 47.9% were physicians, 21.3% were nurses or midwives, 0.8% were dentists or dental technicians, and 30% were from other healthcare professions. Among participants, 54.4% had ≤10 years of professional experience, 20% had comorbidities, and 10.5% were using immunosuppressive medications. It was found that 9.6% had previously had herpes zoster, 8.8% had no knowledge of the disease, 39.6% were aware of the vaccine, and 20.1% were unwilling to pay for vaccination. Multivariate binary logistic regression analysis revealed that being a physician significantly increased the likelihood of having correct knowledge by 1.961 times compared to other professions (p < 0.001, CI: 1.608–2.392). Similarly, those who had heard of herpes zoster were 3.191 times more likely to answer correctly than those who had not (p = 0.011, CI: 1.650–6.172). Male gender was significantly associated with a lower likelihood of having accurate knowledge compared to females (p = 0.001, OR = 0.720, CI: 0.594–0.874). Conclusions: This study revealed that healthcare workers’ knowledge and awareness regarding herpes zoster and its vaccines are generally insufficient. The recent licensing of the vaccine in Türkiye may explain this, but it is critical for healthcare professionals to be more informed about risk groups and vaccination indications in order to enhance the effectiveness of preventive healthcare services. Given the potential for serious complications of herpes zoster in elderly and immunocompromised individuals, the importance of vaccination should be emphasized more strongly to healthcare workers. Furthermore, the finding that 20.1% of those aware of the vaccine were deterred by its cost highlights the need to improve vaccine accessibility. Economic barriers preventing healthcare workers from being vaccinated emphasize the importance of making the vaccine widely available through public support to protect both healthcare workers and patient safety. Full article

Background: Influenza poses a serious threat to the health of older adults, and vaccination is a key strategy for prevention. As an economically developed city, Suzhou has a rapidly aging population, yet the influenza vaccination rate among older adults remains substantially lower than that in developed countries. There is an urgent need to understand the current vaccination status and its associated factors to inform future strategies for improving vaccination coverage. Objectives: To compare influenza- and vaccine-related knowledge, attitudes, practices, and information access channels between vaccinated and unvaccinated older adults (≥60 years) in Suzhou, and to identify factors associated with vaccination behavior in economically developed areas. Methods: A comparative cross-sectional survey was conducted from April to August 2024 across six districts or county-level cities randomly selected from Suzhou’s ten county-level administrative divisions. Participants were divided into vaccinated and unvaccinated groups based on their influenza vaccination status during the 2023–2024 influenza season. A two-stage sampling method was employed: the six districts were selected as primary sampling units; within each district, eligible older adults (aged ≥60 years) were randomly selected from two independent sampling frames—the vaccination information system for the vaccinated group and the basic public health service system for the unvaccinated group. Face-to-face structured interviews were conducted using a questionnaire consisting of four sections; data were entered using EpiData 13.1 and analyzed using SPSS 27.0. The χ² test, t-test, and multivariable logistic regression were used for statistical analysis. Results: Among 4622 valid older adults (vaccinated: n = 2007; unvaccinated: n = 2615), the vaccinated group scored significantly higher on influenza-related knowledge (4.06 ± 2.21 vs. 3.16 ± 2.33, p < 0.001), vaccine-related knowledge (2.10 ± 1.18 vs. 0.67 ± 1.07, p < 0.001), and perceived influenza risk scores (2.72 ± 1.42 vs. 2.26 ± 1.64, p < 0.001). Vaccine safety and efficacy endorsement were also markedly higher among the vaccinated group (70.3% vs. 22.0%; 49.7% vs. 9.3%). Regarding information sources, the vaccinated group relied more on healthcare institutions (54.56% vs. 46.92%), whereas the unvaccinated group relied more on television (60.34% vs. 51.17%). Multivariable logistic regression revealed that awareness of the influenza vaccine (aOR = 9.151, 95%CI: 6.32–13.25), having a planned vaccination site (aOR = 2.66, 95%CI: 2.01–3.54), and perceiving the vaccine as safe (aOR = 1.81, 95%CI: 1.31–2.49) were positively associated with vaccination, while rural household registration (aOR = 0.76, 95%CI: 0.63–0.93), full-time employment (aOR = 0.41, 95%CI: 0.28–0.60), and hypertension (aOR = 0.79, 95%CI: 0.65–0.94) were inversely associated. Conclusions: Compared with the unvaccinated group, the vaccinated group demonstrated significantly better influenza- and vaccine-related knowledge, risk perception, and recognition of vaccine safety and efficacy, and relied more on healthcare institutions for information. Multivariable regression analysis identified awareness of the influenza vaccine as the strongest associated factor. These findings suggest that vaccination coverage could be improved by strengthening vaccine knowledge promotion through healthcare professionals and increasing awareness of vaccination policies that integrate medical insurance reimbursement. Full article

Background/Objectives: Respiratory infections are a major cause of morbidity and mortality among older adults. However, vaccination coverage against respiratory pathogens remains suboptimal, particularly in rural and vulnerable populations. This study aimed to identify factors associated with respiratory vaccination uptake among older adults living in rural Amazonian communities in Peru. Methods: We conducted an observational, analytical, cross-sectional study using secondary data from the Amazon Frail Project. A total of 429 adults aged ≥60 years from rural and suburban communities in San Martín, Loreto, and Ucayali were included. Vaccination coverage for influenza, pneumococcal disease, pertussis, and COVID-19, as well as vaccine combinations, was assessed. Multiple linear and Poisson regression models with robust variance were used to identify associated factors. Results: Complete vaccination coverage was 42.89% for influenza, 23.08% for pneumococcal disease, 4.43% for pertussis, and 70.16% for COVID-19. Only 3.50% of participants had received all four respiratory vaccines. Higher educational attainment, multimorbidity, social frailty, greater muscle mass, better physical performance, and healthcare center attendance were associated with higher vaccination uptake. Depressive symptoms, cognitive impairment, functional dependency, physical frailty, dynapenia, and higher body mass index were associated with lower vaccination uptake. Conclusions: Respiratory vaccination coverage was suboptimal among older adults living in rural Amazonian communities. Educational, functional, physical, social, and healthcare access factors significantly influenced vaccine uptake, highlighting the need for targeted immunization strategies in vulnerable rural populations. Full article

Background: Neonates and young infants are susceptible to vaccine-preventable diseases because of immature immune responses and delayed acquisition of vaccine-induced protection. As household members and caregivers are a major source of exposure, international organizations recommend cocooning, i.e., vaccination of susceptible individuals who are in regular contact with infants, to provide complementary indirect neonatal protection. To evaluate cocooning implementation, we assessed influenza and pertussis vaccination uptake among mothers and close contacts of hospitalized neonates and identified factors associated with vaccine uptake. Methods: Mothers of neonates hospitalized in a Neonatal Intensive Care Unit (NICU) between 1 January 2022 and 31 December 2024 were invited to complete a structured questionnaire. Mothers reported their own vaccination status and that of the neonate’s close contacts. Associations between maternal characteristics and vaccine uptake were examined using logistic regression. Results: In total, 405 mothers participated. Influenza vaccination uptake was 47.6% among mothers, and at least one adult close contact was vaccinated in 53.6% of families. Pertussis vaccination uptake was 40.5% among mothers, and at least one adult close contact was vaccinated in 32.3% of families. The most frequently reported reason for non-vaccination was low perceived need among unvaccinated mothers (74.1% for influenza and 83.4% for pertussis) and among families with incompletely vaccinated adult close contacts (81.8% for influenza and 89.7% for pertussis). In multivariable analyses, higher maternal education was associated with increased uptake of both influenza (OR 2.36, 95% CI: 1.47–3.80, p < 0.001) and pertussis vaccination (OR 4.25, 95% CI 2.02–8.94, p < 0.001), whereas younger maternal age (≤25 years) was associated with lower influenza vaccine acceptance (OR 0.24, 95% Cl: 0.1–0.60, p = 0.002). Conclusions: Vaccination uptake among mothers and adult close contacts of NICU-admitted neonates was suboptimal for both influenza and pertussis vaccines. Targeted counseling before delivery, reinforced during maternity or NICU hospitalization as a catch-up opportunity, and system-level implementation measures aligned with the dominant barrier of low perceived need are needed to strengthen cocooning in this high-risk population. Full article

Background/Objectives: Needle-related procedures such as venipuncture are common in pediatric hospitals and are a major cause of pain, fear and distress for those affected. Despite the availability of a wide range of evidence-based support options, it is often the professionals who decide which interventions are offered. In this study, we adapted the CARD^TM (Comfort, Ask, Relax, Distract) system for needle-related procedures in hospitals. CARD^TM was originally developed to encourage children to actively participate in their vaccination process at school. It allows them to choose from numerous evidence-based interventions in the four different letter categories (C-A-R-D) to reduce pain, fear and related vaccination symptoms. Our aim was to examine perceptions of CARD^TM for needle-related procedures in a children’s hospital, including aspects of acceptability, feasibility, self-efficacy in managing fear and pain, and overall experiences. Methods: A qualitative descriptive design was used. The sample included nine children aged 10 to 15 undergoing needle-related procedures and seven nurses who performed these procedures. We conducted individual interviews and asked them about their experiences with CARD^TM. Data were evaluated using qualitative content analysis. Results: Four themes were identified: awareness of options and needs; relationship building; empowerment; and acceptability. CARD^TM helped children identify available options, prepare themselves, recognize their own needs and select strategies. CARD^TM offered a concrete framework for action that promoted participation and self-efficacy and strengthened the relationship between nurses and children. In practice, CARD^TM was perceived to be easy to implement and acceptable. Conclusions: The present findings suggest the applicability of CARD^TM for hospital needle-related procedures. Full article

Background: Men who have sex with men (MSM) experience a disproportionate burden of human papillomavirus (HPV)-related disease, yet vaccination uptake remains uneven. With MSM as the key population of interest, this review synthesized evidence on uptake, willingness, multilevel barriers and opportunities, and vaccine-oriented outcomes among MSM and related sexual and gender minority populations when MSM-relevant findings could be extracted. Methods: Six databases were searched for original English- or Chinese-language studies published from 1 January 2010 to 31 December 2025. Findings were synthesized narratively. Barriers and opportunities were mapped using a five-level socio-ecological model; study-level willingness–uptake patterns were explored using K-means clustering as an exploratory analysis among the nine studies reporting both outcomes; and genotype-specific and immunogenicity findings were summarized separately. Results: Fifty-three studies involving 169,241 participants were included; 87.2% of participants were MSM, and 79% of studies were cross-sectional. Barriers and opportunities occurred across individual, provider-related interpersonal, organizational/institutional, community, and policy/societal levels. Recurrent paired mechanisms involved knowledge and trust, provider recommendation and communication, service accessibility, community support, and eligibility and affordability. Nine studies contributed data to the exploratory clustering analysis; seven fell into low-uptake clusters, including three with high willingness but low uptake, which may indicate a possible study-level implementation gap. Two studies reporting genotype prevalence and antibody responses provided limited biological context supporting vaccination before exposure and suggesting potential benefit from catch-up vaccination. Discussion: Among MSM and related sexual and gender minority populations, HPV vaccination is shaped by interacting individual and structural conditions, with MSM remaining the principal focus of the evidence base. Improving uptake is likely to require complementary strategies: universal, gender-neutral routine vaccination in adolescence before their sexual debut, and targeted catch-up for MSM who missed routine vaccination, supported by trusted provider endorsement, convenient service delivery, community engagement, and inclusive, affordable policy. The thematic counts were study-level and unweighted, and the nine-study clustering analysis was exploratory rather than definitive. Full article

Heat shock proteins (HSPs), particularly HSP70 and HSP90, are highly conserved molecular chaperones that protect cells from a wide range of stressors and maintain proteome homeostasis. In cancer, tumor cells frequently overexpress and actively release HSPs into the extracellular space and circulation in response to metabolic alterations, hypoxia, oxidative stress, and therapeutic interventions. Consequently, circulating HSP levels are often elevated in patients with malignancies compared with healthy individuals. This review summarizes current evidence on the diagnostic, prognostic, and predictive value of circulating HSPs in both solid and hematological cancers. Clinical studies indicate that circulating HSP concentrations are associated with tumor type, disease stage, lymph node involvement, metastatic burden, treatment response, and risk of recurrence. Importantly, membrane-associated and extracellular vesicle-associated forms of HSP70 appear to exhibit greater tumor specificity than freely circulating proteins, highlighting the importance of selecting appropriate analytical approaches for biomarker assessment. Beyond their utility as biomarkers, extracellular HSPs actively participate in tumor biology and anti-tumor immunity. Depending on the cellular and immunological context, they can either support tumor progression or stimulate immune responses through activation of natural killer cells, antigen-presenting cells, and cross-presentation of tumor-derived antigens. These immunomodulatory properties have provided the foundation for the development of HSP-based vaccines and adoptive immunotherapeutic strategies, several of which have demonstrated encouraging results in clinical trials. We further discuss the relationship between extracellular chaperone biology and responses to major anticancer treatments, including radiotherapy, chemotherapy, HSP90-targeted therapies, and immune checkpoint blockade. In conclusion, the available evidence supports circulating extracellular HSPs as promising non-invasive biomarkers and potential pharmacodynamic indicators that may improve patient stratification, treatment monitoring, and prediction of therapeutic efficacy in clinical oncology. Full article

Alpha-enolase (ENO1) is a multifunctional protein frequently overexpressed in solid tumors, where elevated levels are associated with aggressive behavior and poor prognosis. Beyond its canonical glycolytic role, ENO1 participates in immunoregulatory processes through distinct subcellular pools. Intracellular ENO1 shapes tumor-associated metabolic programs, while surface-exposed ENO1 functions as a plasminogen receptor and can engage innate immune signaling pathways. Post-translational modifications—particularly citrullination and phosphorylation—generate structurally altered epitopes that expand ENO1 antigenicity and enable adaptive immune recognition, including coordinated humoral and T-cell responses in cancer patients. These determinants of ENO1 immunogenicity have downstream consequences within the tumor microenvironment: immune-accessible ENO1 modulates myeloid cell recruitment, dendritic cell maturation, and macrophage polarization, while ENO1-dependent metabolic and signaling programs contribute to immune suppression and escape through multiple interconnected axes. Together, these mechanisms position ENO1 at the interface between tumor metabolism and immune regulation. Preclinical evidence demonstrates that ENO1-directed strategies—including antibody-based targeting, DNA vaccination, and vaccines incorporating post-translationally modified ENO1 peptides—can generate productive antitumor immunity and synergize with checkpoint blockade, supporting the rationale for ENO1 as an immunotherapeutic target. This review synthesizes current evidence within an integrated framework linking ENO1 dysregulation to its immunological consequences in cancer and discusses translational implications for ENO1-centered immunotherapy and immunoprevention. Full article

Background: Vaccine hesitancy (VH) is a complex global public health threat requiring validated tools for its assessment globally. This study aimed to evaluate an extended adult Vaccine Hesitancy Scale (aVHS) among Greek-speaking adults. Methods: This study evaluated a newly developed extended version of a widely used aVHS, incorporating five additional items on long-term safety, risk–benefit evaluation, vaccine-related harm, scientific credibility, and perceived alternatives, on a cross-sectional sample of 491 adults in Greece and Cyprus. Cross-cultural adaptation of the extended aVHS involved translation, back-translation, and pilot testing. Structural validity was assessed using parallel analysis, exploratory factor analysis (EFA), and reliability using Cronbach’s α and McDonald’s ω. Criterion validity was assessed against focus-group classification using ROC analysis in 68 participants. Results: A one-factor EFA solution appeared the most parsimonious, showing strong loadings for the original and extended aVHS (0.67–0.86 and 0.65–0.87), with similar explained variance (60.31% and 60.06%). The one-factor solution was confirmed by parallel analysis for both scales. Internal consistency was excellent, and slightly higher for the extended than the original aVHS (α = 0.95; ω = 0.95 vs. α = 0.92; ω = 0.93). The five newly added items performed strongly, with item–rest correlations of 0.69–0.85 and loadings of 0.72–0.87. Criterion validity was excellent, with a slightly higher AUC (0.991 vs. 0.981) and numerically higher classification performance for the extended than the original aVHS. Conclusions: The extended aVHS is a psychometrically coherent tool that improves the performance of the original scale among Greek-speaking individuals. This scale may enhance VH surveillance, aiding targeted vaccination communication strategies. Full article

Background: Public acceptance of vaccines during emerging infectious disease outbreaks is influenced by perceptions of safety, accessibility, and cost. Understanding these determinants during the early phase of a pandemic is important for informing vaccination policy and communication strategies. This study examined the role of vaccine cost and safety perceptions in shaping COVID-19 vaccination intention among adults in Saudi Arabia prior to national vaccine rollout. Methods: A cross-sectional electronic survey was conducted among adults residing in Saudi Arabia between August and September 2020. Participants were recruited through online distribution using social media and electronic communication channels. The questionnaire assessed socio-demographic characteristics, knowledge and perceptions regarding COVID-19, and intention to receive COVID-19 vaccination under five hypothetical scenarios reflecting vaccine cost and the availability of scientific safety and efficacy evidence. Multivariable logistic regression analyses were performed to identify factors associated with vaccination intention. Results: A total of 1293 respondents completed the survey. When vaccination was offered free of charge, 57.5% of participants reported that they would likely receive the vaccine. Vaccination intention declined as the hypothetical vaccine price increased, reaching 38.7% when the cost exceeded 100 SAR. Intention was lowest when vaccination was presented under conditions in which safety and efficacy evidence had not yet been confirmed. Age, gender, educational attainment, and prior seasonal influenza vaccination were associated with COVID-19 vaccination intention across several scenarios. Conclusions: Perceived vaccine affordability and confidence in scientific safety and efficacy evidence were important factors associated with COVID-19 vaccination intention during the early phase of the pandemic in Saudi Arabia. Providing vaccination without direct cost to recipients and communicating safety and efficacy evidence transparently may support public confidence and vaccine acceptance during future large-scale immunization campaigns. These findings should be interpreted as an early-pandemic baseline and should not be extrapolated to current post-rollout attitudes. Full article

Background: In Turkey, meningococcal, rotavirus, and HPV vaccines are not included in the national schedule. We aimed to assess whether a face-to-face educational intervention could improve physicians’ knowledge about these vaccines and influence their subsequent counseling and recommendation practices. Methods: We used a two-phase intervention with pre/post assessment and a 4–6-week follow-up among family physicians. In Phase 1, participants received an in-person structured educational intervention on meningococcal, rotavirus, and HPV vaccines, and their knowledge was evaluated using identical true/false tests administered before and after the session. Phase 2, conducted 4–6 weeks later, measured changes in physicians’ self-reported frequency of providing recommendations about these vaccines, and whether they or their first-degree relatives had received any of the vaccines after the structured educational intervention. Differences in paired proportions were analyzed using McNemar’s test (p < 0.05). Results: Ninety-one physicians completed Phase-1; 70 from the same cohort completed Phase-2. Following the educational intervention, correct responses increased across multiple items: e.g., “Rotavirus vaccine is live” 89.0%→100% (p = 0.002); “Only humans are reservoir for meningococcal infection” 50.6%→96.7% (p < 0.001); “Meningococcal vaccine cannot be co-administered” (false) 70.3%→96.7% (p < 0.001). Phase-2 showed more proactive practice: for HPV, 52.9% reported recommending it “upon family request” and 27.1% “at every visit”; for rotavirus, these were 37.1% and 35.7%, respectively. Overall, 52.9% reported having administered one of the three vaccines to themselves or first-degree relatives after structured educational intervention; 62.2% rated the educational intervention’s influence on that decision as 10/10. Conclusions: A structured educational intervention improved family physicians’ knowledge and was associated with more proactive vaccine counseling and recommendation practices. Full article

Background/Objectives: Measles remains a significant public health concern in Romania, with recurrent ongoing nationwide outbreaks despite the availability of the measles–mumps–rubella (MMR) vaccine. This study investigates the epidemiological, clinical, and sociocultural dimensions of measles among Romanian adults, with a particular focus on a vulnerable group, the Roma population. Methods: We conducted a retrospective cohort study using clinical data from a tertiary hospital in Bucharest, Romania. The study included adult patients hospitalized with measles between July 2023 and April 2024. In a subsequent phase, we carried out a cross-sectional survey among hospitalized measles patients to assess their perception and understanding of measles and the MMR vaccine, with particular attention to responses from Roma participants. Results: A retrospective investigation of 100 hospitalized adult patients with laboratory-confirmed diagnoses of measles demonstrated frequent complications such as hepatic involvement (85/100), pneumonia (68/100), and respiratory failure (21/100). Only 6/100 of patients were fully vaccinated. Rhabdomyolysis was significantly more common in unvaccinated individuals and women. No deaths were recorded, and no ICU admissions occurred. Among the hospitalized patients, 49 adults responded to a vaccine centered questionnaire. We report a notable vaccine hesitancy, particularly among the Roma respondents. Socioeconomic factors such as low income, limited education, and lack of health insurance were significantly associated with negative perceptions of the MMR vaccine. A statistically significant association was observed between Roma ethnicity and the belief that the MMR vaccine causes autism. Conclusions: These findings highlight the urgent need for targeted public health interventions with culturally adapted education campaigns to improve vaccination coverage and thereby protect vulnerable adult populations in Romania. Full article

Background/Objectives: Healthcare systems increasingly operate through dense networks of clinicians, managers, public health authorities, institutions, and communities. Disagreement is no longer confined to bedside decisions; it also affects coordination, legitimacy, and implementation at system level. Bioethics, administrative governance, and consultation processes address important parts of this problem, but they do not by themselves provide a dedicated process for handling persistent disagreement, mistrust, and competing values across actors and institutions. This paper proposes medical–bioethical mediation as a potential governance innovation for sustainable, efficient, and resilient healthcare systems. Methods: This is a conceptual framework paper based on an integrative synthesis of selected literature in clinical bioethics mediation, medical mediation, public health ethics, deliberative and participatory governance, trust, inter-organizational coordination, health governance, and health system resilience. It does not report empirical research or a systematic review. Results: The proposed population-level framework is organized around seven linked components: conflict identification, stakeholder mapping, ethical issue clarification, mediation, negotiated solutions, implementation, and feedback and learning. These components form three broader moments: diagnosis, mediated deliberation, and implementation with learning. The framework identifies mechanisms through which mediation may affect health system governance, including conflict transformation, structured ethical deliberation, participation, trust-building, coordination, and adaptive learning. Illustrative scenarios include resource allocation, inter-organizational coordination, public health restrictions, vaccine mistrust, and system reform. The framework is proposed as a hypothesis-generating governance model rather than as a tested intervention. Conclusions: Medical–bioethical mediation should be considered beyond the bedside as a possible system-level governance approach. Its potential value lies in helping health systems manage recurring ethical and institutional conflict more constructively and may strengthen the conditions for legitimacy, coordination, implementation, and learning. Its potential contribution should be understood as plausible but unproven at population level and should be evaluated through pilot implementation, economic analysis, and comparative case research. Full article

The clinical relevance of concurrent vaccine-preventable anal HPV genotype infections, particularly for short-term repeated detection and cytologic outcomes in screened high-risk populations, remains uncertain. We performed a single-centre retrospective study of 145 adults with at least one 9-valent vaccine-preventable anal HPV genotype at baseline and repeat HPV DNA testing and cytology approximately 12 months later. Baseline infections were classified as single- or multiple-genotype infections. Outcomes included clearance of all baseline vaccine-preventable genotypes, genotype-specific repeated detection, detection of new vaccine-preventable genotypes, complete HPV negativity, and cytologic regression or progression. At baseline, 70 participants (48.3%) had single and 75 (51.7%) had multiple genotype infections; most were male (95.2%) and people living with HIV (88.3%), reflecting a highly selected anal HPV-screened cohort. Multiple infections were associated with more frequent abnormal baseline cytology (69.3% vs. 45.7%). At follow-up, clearance of all baseline vaccine-preventable genotypes was more common after single than multiple infections (34.3% vs. 12.0%). Complete HPV negativity was also more frequent after single infection (24.3% vs. 4.0%), although this stringent endpoint is intrinsically more difficult to achieve in individuals with multiple baseline infections. New vaccine-preventable genotype detection did not differ significantly between groups. Genotype-specific repeated detection was generally similar between groups, except for HPV58, a finding based on small subgroup numbers. Cytologic regression was more frequent after single infection, but not statistically significant. Multiple vaccine-preventable anal HPV genotype infections were associated with greater baseline cytologic abnormality and lower clearance of baseline vaccine-preventable genotypes at 12 months. Given the retrospective design, selected population, limited event counts, and residual confounding, these findings should be interpreted as hypothesis-generating and do not prove impaired biological clearance. Full article