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Abstract Background The Tpeak‐end(Tp‐e) has not been compared in all 12 ECG leads in healthy adults to determine if the Tp‐e varies across leads. If there is variation, it remains uncertain, which lead(s) are preferred for recording in order to capture the maximal Tp‐e value. Objective The purpose of the current study was to determine the optimal leads, if any, to capture the maximal Tp‐e interval in healthy young adults. Methods In 88 healthy adults (ages 21–38 years), including derivation (n = 21), validation (n = 20), and smoker/vaper (n = 47) cohorts, the Tp‐e was measured using commercial computer software (LabChart Pro 8 with ECG module, ADInstruments) in all 12 leads at rest and following a provocative maneuver, abrupt standing. Tp‐e was compared to determine which lead(s) most frequently captured the maximal Tp‐e interval. Results In the rest and abrupt standing positions, the Tp‐e was not uniform among the 12 leads; the maximal Tp‐e was most frequently captured in the precordial leads. At rest, grouping leads V2–V4 resulted in detection of the maximum Tp‐e in 85.7% of participants (CI 70.7, 99.9%) versus all other leads (p

Abstract Vector‐borne diseases constitute a major global health burden and are increasing in geographic range and prevalence. Mounting evidence has demonstrated that the vector microbiome can impact pathogen dynamics, making the microbiome a focal point in vector‐borne disease ecology. However, efforts to generalize preliminary findings across studies and systems and translate these findings into disease control strategies are hindered by a lack of fundamental understanding of the processes shaping the vector microbiome and the interactions therein. Here, we use 16S rRNA sequencing and apply a community ecology framework to analyze microbiome community assembly and interactions in Ixodes pacificus, the Lyme disease vector in the western United States. We find that vertical transmission routes drive population‐level patterns in I. pacificus microbial diversity and composition, but that microbial function and overall abundance do not vary over time or between clutches. Further, we find that the I. pacificus microbiome is not strongly structured based on competition but assembles nonrandomly, potentially due to vector‐specific filtering processes which largely eliminate all but the dominant endosymbiont, Rickettsia. At the scale of the individual I. pacificus, we find support for a highly limited internal microbial community, and hypothesize that the tick endosymbiont may be the most important component of the vector microbiome in influencing pathogen dynamics.

OBJETIVO: Estudar a variação das taxas de mortalidade neonatal precoce, natimortalidade e de um conjunto de indicadores da rede de hospitais que prestaram atenção obstétrica ao Sistema Único de Saúde, visando o monitoramento das unidades hospitalares a partir do Sistema de Informações Hospitalares (SIH/SUS) e do Sistema de Nascidos Vivos (SINASC). MÉTODOS: Em 1997, 135 hospitais do Estado do Rio de Janeiro foram estudados por meio da análise estatística fatorial, pelo método de componentes principais. Estabeleceu-se a distribuição dos escores dos estabelecimentos nos dois primeiros componentes, o que permitiu classificar os hospitais segundo o perfil de risco materno das internações e os resultados da assistência. RESULTADOS: Observou-se que a rede obstétrica do Sistema Único de Saúde no Estado, responsável por cerca de 77,8% dos partos, possui 23% dos hospitais que realizam menos de 100 partos/ano. Entre os hospitais com perfil de internação de extremo risco materno e baixo desempenho encontram-se unidades consideradas referência para gestação de alto risco. Observou-se que 5% dos hospitais possuidores de estruturas de baixa complexidade apresentaram um perfil de risco materno alto e resultados da assistência questionáveis. CONCLUSÕES: O SIH/SUS mostrou ser uma importante fonte de dados para monitorar a natimortalidade e a mortalidade neonatal precoce hospitalares e para o planejamento das ações de vigilância das unidades hospitalares obstétricas e neonatais.OBJECTIVE: To analyze variations in early neonatal mortality, stillbirth rates, and a set of indicators collected from obstetric hospitals affiliated to the Brazilian National Unified Health System (SUS) for their monitoring through the Hospital Data System (SIH/SUS) and Live Births Data System (SINASC). METHODS: One-hundred and thirty five hospitals in the state of Rio de Janeiro were assessed in 1997. Factor analysis was conducted using principal components. Score distribution for the first two components were established, which allowed to classify hospitals according to maternal risk profile and care outcomes. RESULTS: Hospitals affiliated to SUS were responsible for 77.8% of all deliveries in the state of Rio de Janeiro and 23% of them performed fewer than 100 deliveries a year. Among hospitals of extreme high maternal risk and low performance, there were several units considered as referral centers for high-risk pregnancy. It was also observed that 5% of hospital units with low complexity infrastructures showed a profile of high maternal risk and questionable care outcomes. CONCLUSIONS: The Hospital Information Data System affiliated to the National Unified Health System has proven to be an important information source for monitoring hospital stillbirth and early neonatal mortality rates as well as for planning surveillance actions for health services providing obstetric and/or neonatal care.

OBJETIVO: Estudar a variação das taxas de mortalidade neonatal precoce, natimortalidade e de um conjunto de indicadores da rede de hospitais que prestaram atenção obstétrica ao Sistema Único de Saúde, visando o monitoramento das unidades hospitalares a partir do Sistema de Informações Hospitalares (SIH/SUS) e do Sistema de Nascidos Vivos (SINASC). MÉTODOS: Em 1997, 135 hospitais do Estado do Rio de Janeiro foram estudados por meio da análise estatística fatorial, pelo método de componentes principais. Estabeleceu-se a distribuição dos escores dos estabelecimentos nos dois primeiros componentes, o que permitiu classificar os hospitais segundo o perfil de risco materno das internações e os resultados da assistência. RESULTADOS: Observou-se que a rede obstétrica do Sistema Único de Saúde no Estado, responsável por cerca de 77,8% dos partos, possui 23% dos hospitais que realizam menos de 100 partos/ano. Entre os hospitais com perfil de internação de extremo risco materno e baixo desempenho encontram-se unidades consideradas referência para gestação de alto risco. Observou-se que 5% dos hospitais possuidores de estruturas de baixa complexidade apresentaram um perfil de risco materno alto e resultados da assistência questionáveis. CONCLUSÕES: O SIH/SUS mostrou ser uma importante fonte de dados para monitorar a natimortalidade e a mortalidade neonatal precoce hospitalares e para o planejamento das ações de vigilância das unidades hospitalares obstétricas e neonatais.

OBJETIVO: Apesar da reconhecida importância em acompanhar a evolução temporal da mortalidade infantil precoce, a deficiência das estatísticas vitais no Brasil ainda permanece na agenda atual dos problemas que impedem o seu acompanhamento espaço-temporal. Realizou-se estudo com o objetivo de investigar o Sistema de Informações Hospitalares (SIH/SUS) como fonte de informações, para estimar a natimortalidade e a mortalidade neonatal. MÉTODOS: Propõe-se um método para estimar a natimortalidade e a mortalidade neonatal, o qual foi aplicado para todos os Estados das regiões Nordeste, Sul e Sudeste e para o Pará, no ano de 1995. Para fins comparativos, o Sistema de Informações sobre Mortalidade (SIM/MS) foi utilizado para estimar as taxas sob estudo, após a correção do número de nascidos vivos por um método demográfico. RESULTADOS: O SIH/SUS forneceu mais óbitos fetais e neonatais precoces do que o SIM/MS em grande parte das unidades federadas da região Nordeste. Adicionalmente para os Estados localizados nas regiões Sul e Sudeste, que apresentam, em geral, boa cobertura do registro de óbitos, as taxas calculadas pelos dois sistemas de informação tiveram valores semelhantes. CONCLUSÕES: Considerando a cobertura incompleta das estatísticas vitais no Brasil e a agilidade do SIH/SUS em disponibilizar as informações em meio magnético, conclui-se que o uso do SIH/SUS poderá trazer inúmeras contribuições para análise do comportamento espaço-temporal do componente neonatal da mortalidade infantil no território brasileiro, em anos recentes.

OBJETIVO: Apesar da reconhecida importância em acompanhar a evolução temporal da mortalidade infantil precoce, a deficiência das estatísticas vitais no Brasil ainda permanece na agenda atual dos problemas que impedem o seu acompanhamento espaço-temporal. Realizou-se estudo com o objetivo de investigar o Sistema de Informações Hospitalares (SIH/SUS) como fonte de informações, para estimar a natimortalidade e a mortalidade neonatal. MÉTODOS: Propõe-se um método para estimar a natimortalidade e a mortalidade neonatal, o qual foi aplicado para todos os Estados das regiões Nordeste, Sul e Sudeste e para o Pará, no ano de 1995. Para fins comparativos, o Sistema de Informações sobre Mortalidade (SIM/MS) foi utilizado para estimar as taxas sob estudo, após a correção do número de nascidos vivos por um método demográfico. RESULTADOS: O SIH/SUS forneceu mais óbitos fetais e neonatais precoces do que o SIM/MS em grande parte das unidades federadas da região Nordeste. Adicionalmente para os Estados localizados nas regiões Sul e Sudeste, que apresentam, em geral, boa cobertura do registro de óbitos, as taxas calculadas pelos dois sistemas de informação tiveram valores semelhantes. CONCLUSÕES: Considerando a cobertura incompleta das estatísticas vitais no Brasil e a agilidade do SIH/SUS em disponibilizar as informações em meio magnético, conclui-se que o uso do SIH/SUS poderá trazer inúmeras contribuições para análise do comportamento espaço-temporal do componente neonatal da mortalidade infantil no território brasileiro, em anos recentes.OBJECTIVE: Studies on the evolution of infant mortality rate are very relevant. Nevertheless, lack of vital statistics in Brazil limits the temporal and spatial analysis of this indicator. This study aims to investigate the possible use of the Brazilian Hospital Information System as an alternative information source for stillbirth and neonatal mortality rates by age group. METHODS: A new method to estimate the stillbirth and neonatal mortality rates is proposed. It was applied in a set of selected Brazilian states in the year of 1995. For comparative purposes, the Brazilian Death Information System was assessed to estimate the mortality rates under study, after adjusting the registered number of live births by using a demographic tool. RESULTS: By assessing the Hospital Information System a larger number of fetal and early neonatal deaths were observed when compared to data given by the death information system of the Northeastern states. Besides, in the Southern and Southeastern states, where death records are more thorough, the mortality rates calculated using both information sources were very similar. CONCLUSIONS: The results suggest that the proposed methodology could greatly contribute to the analysis of the spatial-time evolution of stillbirth and neonatal death rates in recent years in Brazil, as data on death registration in the majority of the Brazilian states are less thorough than those from the hospital information system.

This study attempts to explore the anorexia nervosa (AN) patient's subjective experience in family therapy by employing a qualitative inquiry. The data collection process required the participant to review videotapes of her family sessions and then to write down her thoughts in response to a core research question: "What was your experience of the family therapy sessions?" We tried our best to minimize any possible influence from the research setting. Unexpectedly, a core idea about the anorexic body emerged from the patient's writings. This core idea was divided into four themes: (1) the development of the anorexic body; (2) the anorexic body and body weight; (3) the anorexic body and clothing; (4) maintaining the anorexic body. This study suggests that a qualitative client-driven approach can reveal the AN patient's perceptions of her body. Most importantly, this paper ends by providing recommendations for qualitative researchers: adopting a not-knowing position and being open to learn that knowledge can be found accidentally. URN: urn:nbn:de:0114-fqs030117

OBJETIVO: Estudar a variação das taxas de mortalidade neonatal precoce, natimortalidade e de um conjunto de indicadores da rede de hospitais que prestaram atenção obstétrica ao Sistema Único de Saúde, visando o monitoramento das unidades hospitalares a partir do Sistema de Informações Hospitalares (SIH/SUS) e do Sistema de Nascidos Vivos (SINASC). MÉTODOS: Em 1997, 135 hospitais do Estado do Rio de Janeiro foram estudados por meio da análise estatística fatorial, pelo método de componentes principais. Estabeleceu-se a distribuição dos escores dos estabelecimentos nos dois primeiros componentes, o que permitiu classificar os hospitais segundo o perfil de risco materno das internações e os resultados da assistência. RESULTADOS: Observou-se que a rede obstétrica do Sistema Único de Saúde no Estado, responsável por cerca de 77,8% dos partos, possui 23% dos hospitais que realizam menos de 100 partos/ano. Entre os hospitais com perfil de internação de extremo risco materno e baixo desempenho encontram-se unidades consideradas referência para gestação de alto risco. Observou-se que 5% dos hospitais possuidores de estruturas de baixa complexidade apresentaram um perfil de risco materno alto e resultados da assistência questionáveis. CONCLUSÕES: O SIH/SUS mostrou ser uma importante fonte de dados para monitorar a natimortalidade e a mortalidade neonatal precoce hospitalares e para o planejamento das ações de vigilância das unidades hospitalares obstétricas e neonatais.

Abstract Background Evidence is needed to understand factors that influence child development and caregiving experiences, especially in marginalized contexts, to inform the development and implementation of early childhood development (ECD) interventions. This study explores caregiving practices for young children in an urban informal settlement with Kenyans and embedded refugees, and identifies factors shaping these caregiving experiences, to inform the design and development of potentially appropriate ECD interventions. Methods A qualitative formative study, which included 14 focus group discussions (n = 125 participants), and 13 key informant interviews was conducted between August and October 2018. Purposive sampling approaches were used to select a diverse range of respondents including caregivers of children below three years of age and stakeholders of Kenyan nationality and refugees. Data were analysed using a thematic approach and the Nurturing Care Framework was used as an interpretative lens. Results There was a fusion of traditional, religious and modern practices in the care for young children, influenced by the caregivers’ culture, and financial disposition. There were mixed views/practices on nutrition for young children. For example, while there was recognition of the value for breastfeeding, working mothers, especially in the informal economy, found it a difficult practice. Stimulation through play was common, especially for older children, but gaps were identified in aspects such as reading, and storytelling in the home environment. Some barriers identified included the limited availability of a caregiver, insecurity, and confined space in the informal settlement, all of which made it difficult for children to engage in play activities. Physical and psychological forms of discipline were commonly mentioned, although few caregivers practiced and recognized the need for using non-violent approaches. Some overarching challenges for caregivers were unemployment or unstable sources of income, and, particularly for refugee caregivers, their legal status. Conclusion These findings point to the interplay of various factors affecting optimal caregiving for young children in an urban informal settlement with Kenyans and refugees. Integrated ECD interventions are needed for such a mixed population, especially those that strive to anchor along caregivers’ social support system, co-designed together with community stakeholders, that ideally focus on parent skills training promoting nurturing care and economic empowerment.

Abstract Background Severe and Enduring Eating Disorders (SEED), in particular SEED-Anorexia Nervosa (SE-AN), may represent the most difficult disorder to treat in psychiatry. Furthermore, the lack of empirical research in this patient group, and, consequently the lack of guidelines, call for an urgent increase in research and discussion within this field. Meanwhile experts concur that effective care should be structured in a collaborative manner. Objective To identify the challenges in providing care to patients with SE-AN in the Dutch healthcare context, and propose a collaborative care treatment model to address these issues. Methods A pragmatic mixed-method approach was used, structured as follows: (1) Identifying perceived barriers and treatment needs from the viewpoint of both patients and eating disorder healthcare professionals through an evaluation questionnaire; (2) Investigating current treatment practices for SEED/SE-AN via benchmarking; (3) Gaining insight into the optimal structure and content of care by interviewing network partners and experts-by-experience. Based on these findings, and drawing from literature on severe and enduring disorders, a treatment model for SE-AN was proposed and implemented. Results The key challenges identified included a lack of knowledge about eating disorders among network partners, treatment ambivalence among patients and poor collaboration between professionals. The proposed model enhances self-management and collaborative relationships with healthcare providers, offers user-friendly and practical guidance, and aims at stabilization, reducing relapses, deterioration, and readmissions, thereby being cost-effective. Importantly, the model operates across levels of care (primary, secondary, tertiary). Conclusion This study, describing a collaborative care program for SE-AN, developed and implemented in a highly specialized treatment center for eating disorders, sets the stage for further explanatory/efficacy research to build on the findings in this study, with the following aims: addressing the critical gap in care for SEED/SE-AN, improving better healthcare organization, reducing relapse rates, and lowering costs for this often overlooked patient group.

Objetivo: Relatar intervenção de promoção da saúde realizada a uma pessoa com Transtorno Afetivo Bipolar, à luz da Teoria Human Becoming e das competências de promoção da saúde do Consenso de Galway. Método: Estudo descritivo, do tipo relato de experiência, desenvolvido em janeiro de 2021, por acadêmicos de enfermagem da Universidade Estadual Vale do Acaraú junto a uma pessoa com Transtorno Afetivo Bipolar. A intervenção foi desenvolvida em quatro etapas conforme os domínios de competência de promoção da saúde do Consenso de Galway e os princípios da Teoria Human Becoming. Resultados: Na intervenção, foi possível identificar os significados, as repercussões biopsicossociais e as das principais necessidades de saúde do sujeito no enfrentamento ao transtorno bipolar. Por meio disso, desenvolveu-se quatro ações educativas, que objetivaram auxiliar o paciente a lidar com as dificuldades vivenciadas, a modificar seus hábitos de vida e a identificar medidas de cuidado para favorecer a melhora da saúde mental e do controle dos sintomas do transtorno. Conclusão: A intervenção reforça a importância de referenciais teóricos e competências de promoção da saúde no cuidado a pessoa com transtorno bipolar, haja vista que promovem uma abordagem inovadora, holística e humanizada para favorecer a reabilitação e o autocuidado do sujeito.

The COVID-19 pandemic and the ongoing Russia-Ukraine war had severe implications for global food security and nutrition. It was feared that food systems would be impacted negatively, especially food, seed, fertilizer, and fuel quantities required for agricultural production. The study aimed to ascertain the extent to which calls to action by AU policy organs, as well as recommendations by experts, to mitigate possible effects of the COVID-19 pandemic, were implemented at the national level across three of the five regional economic communities and whether they yielded any tangible impacts. The study conducted a desk review of literature and key informant interviews in 18 African countries. We found a wide range of varia­tions in terms of country responses to the pan­demic. Countries in the East African Community focused more on expanding targeted social protec­tion programs, Economic Community of West African States countries focused more on support­ing smallholder farmers and digital agriculture, and the Southern African Development Community focused on budgetary stimulus packages. We found a lack of coherence in responding to the crisis within each region to improve the supply and dis­tribution of food, seed, fertilizer, and fuel; thus, necessitating an immediate and aggressive imple­mentation of strategies aligned with continental and regional policy resolutions and recommenda­tions.

Este estudo objetiva descrever uma intervenção educativa sobre o uso problemático da internet junto a adolescentes escolares, desenvolvida por integrantes de um projeto de extensão universitária denominado Liga Interdisciplinar de Promoção à Saúde do Adolescente - LIPSA. Trata-se de um estudo descritivo do tipo relato de experiência de ações de extensão universitária desenvolvido por estudantes de enfermagem junto a adolescentes escolares, no período de setembro a novembro de 2022. Foram realizados quatro encontros quinzenais com 70 alunos do 1º e 2º ano do Ensino Médio de uma Escola Estadual de Ensino Médio Regular do Município de Sobral-CE. As ações de extensão universitárias tinham o intuito de prevenir e/ou amenizar o uso problemático da Internet dos adolescentes escolares, mediante o uso de tecnologias educativas que facilitaram o diálogo e reflexão entre os sujeitos. A participação ativa dos adolescentes, que demonstraram grande interesse pela temática, foi um fator central para o sucesso da intervenção. A prática da extensão universitária contribuiu para o processo formativo, pedagógico e cidadão dos integrantes da Liga de extensão universitária. Palavras-chave: Estudantes; Enfermagem; Extensão Comunitária; Internet All that glitters is not gold - Outreach action on problematic internet use among adolescents Abstract: The study aims to describe an educational intervention on problematic Internet use among school adolescents, developed by members of a university extension project called the Interdisciplinary League for the Promotion of Adolescent Health. This article is a descriptive study of the experience report type of university extension actions developed by nursing students with school adolescents, from September to November 2022. Four biweekly meetings were held with 70 students from the 1st and 2nd year of High School at a State School of Regular High School in the Municipality of Sobral, Ceará State, Brazil. The university extension actions were intended to prevent and ease adolescent students' problematic Internet use through educational technologies that facilitated dialogue and reflection between the subjects. The active participation of the adolescents, who showed a keen interest in the theme, was a critical factor in the success of the intervention. The practice of university extension contributed to the formative, pedagogical and citizen process of the members of the University Extension League. Keywords: Nursing Students; Community Outreach; Internet

Background Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding. Objectives To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS. Design Evidence syntheses with stakeholder engagement. Review methods Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents’ panels, 15 women in the focus groups and 87 stakeholders who attended the workshops. Results We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence. Limitations There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics. Conclusions ‘Breastfeeding only’ support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for ‘breastfeeding plus’ interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4–6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women’s and supporters’ needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK. Future work Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies. Study registration This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen’s University Belfast Research Portal (https://pure.qub.ac.uk/). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information. Plain language summary What was the question? We know that breastfeeding is good for the health of mothers and babies, yet many mothers experience difficulties and stop breastfeeding before they want to. This is noticeable among women living in disadvantaged areas where there are low rates of breastfeeding. Good support may help women overcome difficulties so that they can continue to breastfeed. Women with chronic illnesses such as diabetes and depression face additional challenges in breastfeeding. We wanted to understand how to improve breastfeeding support for UK women. What did we do? We brought together previous scientific studies to learn about what works. We also spoke with parents and service providers. We combined all our findings into a toolkit to help the NHS improve breastfeeding support for women. What did we find? We found that, for healthy women, some forms of breastfeeding support can probably help reduce the number of women stopping breastfeeding and help them breastfeed exclusively. For women with chronic illnesses, we found that the types of support used in the studies probably did not help women to breastfeed. Most of the evidence did not come from the UK. We identified barriers to providing breastfeeding support for all women, especially those who are disadvantaged. We identified strategies that could help the NHS overcome these barriers. There was a lack of evidence on how cost-effective these interventions are compared with usual care, but parents and providers saw the value of paying for breastfeeding support. What does this mean? Giving women targeted breastfeeding support will help them to breastfeed; however, we need to test if this support works in the NHS. We also need to develop additional services for women with chronic illnesses. The NHS could use our findings to improve support for all breastfeeding women by identifying specific barriers and using evidence-based strategies to overcome them. Scientific summary Background Breastfeeding impacts positively on multiple health outcomes across the lifespan. Global and UK infant recommendations are that infants should receive breastmilk exclusively for 6 months and as part of a mixed diet until 2 years. However, fewer than half of UK women are breastfeeding at 6–8 weeks, with a marked social gradient. Objectives This study aimed to synthesise global and UK evidence in order to co-create with stakeholders a framework to guide the implementation and evaluation of cost-effective breastfeeding support interventions in the NHS: Update the Cochrane review ‘Support for healthy breastfeeding mothers with healthy term babies’ (McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017;2:CD001141). Synthesise process evaluations of breastfeeding support interventions. Conduct an economic evaluation of interventions to enable women to breastfeed. Conduct a systematic review of breastfeeding support interventions for women with long-term conditions (LTCs). Synthesise evidence of barriers to and facilitators of breastfeeding support for women with LTCs. Conduct a systematic review of economic evaluations of breastfeeding support interventions. Co-create a NHS-tailored implementation and evaluation strategy framework to increase breastfeeding rates in the UK. Contribute to methodological development on involving stakeholders in systematic reviews. Design The study comprised two meta-analyses of breastfeeding support interventions, two mixed-methods evidence syntheses and two economic evaluations with embedded stakeholder engagement, including parents’ panels, stakeholder working groups, focus groups and workshops. Stakeholders interpreted and adapted the international evidence to ensure its relevance to UK settings and co-produced the toolkit. Review methods Review 1: update of Cochrane review ‘Support for healthy breastfeeding mothers with healthy term babies’ The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched in May 2021. Healthy women and babies were those who did not require additional medical care. Interventions could be delivered as standalone breastfeeding support interventions (‘breastfeeding only’) or as part of a wider maternal and newborn health intervention (‘breastfeeding plus’) where additional services (e.g. vaccination, intrapartum care) are provided. Primary outcomes were stopping any or exclusive breastfeeding at 6 months and 4–6 weeks postpartum. We used standard Cochrane methods for data extraction, risk-of-bias assessment and statistical analysis. We used meta-regression to investigate statistical heterogeneity. Review 2: mixed-methods review of process evaluations linked to effective breastfeeding support interventions Six electronic databases were searched in March 2022. Eligible studies reported the views and experiences of delivering or receiving effective breastfeeding support interventions. Qualitative and quantitative findings were synthesised separately and then integrated into a theoretically informed cross-study synthesis. Review 3: economic evaluation review This review, with searches conducted in February 2021, considered value for money by appraising and synthesising the evidence of incremental costs and cost-effectiveness in comparison with a control. The eligibility criteria were the same as those of review 1, with the addition of relevant economic outcomes such as incremental cost-effectiveness ratios (ICERs). Quality assessment followed National Institute for Health and Care Excellence (NICE) guidance. Consistency between studies in evidence of cost-effectiveness was reviewed. Review 4: effectiveness of breastfeeding support for women with long-term conditions Searches were conducted in August 2022. Included studies involved women with a long-term physical or mental health condition. Primary outcomes were stopping any or exclusive breastfeeding at 4–8 weeks and 6 months. We used standard Cochrane methods for data extraction, risk-of-bias assessment and statistical analysis. Review 5: mixed-methods review of experiences of breastfeeding support for women with long-term conditions Searches were conducted in October 2022. Included studies reported primary research on the views and experiences of breastfeeding women with LTCs and/or support providers. Qualitative and quantitative findings were synthesised separately and then integrated into a theoretically informed cross-study synthesis. Review 6: review of economic evidence for breastfeeding support for women with long-term conditions The search strategy for review 3 was used for this review, with modification of the inclusion criteria for women with LTCs. Searches were conducted in August 2022. Quality assessment followed the NICE guidance. Stakeholder engagement Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, face-to-face focus groups and four workshops. Participants were 23 stakeholders (health service providers and representatives of third-sector organisations), 16 parents in the parents’ panels and 15 women from a deprived and diverse locality in the focus group discussions. Results We found considerably more interventions designed for healthy women (review 1) than aimed at women with LTCs (review 2). ‘Breastfeeding only’ interventions probably have a small effect in reducing the number of healthy women stopping breastfeeding. However, ‘breastfeeding plus’ and interventions for women with LTCs probably have little or no effect on breastfeeding outcomes. In both reviews, approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and it is possible that the impact of support is different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed participants’ suggestions of potential strategies to improve breastfeeding support, the most widely reported being the need to involve wider sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) in supporting women with LTCs to breastfeed. In reviews 3 and 6, there was uncertainty in the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence. More specific findings from each review are presented below. Review 1 This updated review includes 125 interventions reported in 116 trials with more than 98,816 mother–infant pairs. Ninety-one interventions were ‘breastfeeding only’ and 34 were ‘breastfeeding plus’. The overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions, and, as studies used self‐report breastfeeding data, there is also a risk of bias in outcome assessment. Moderate‐certainty evidence indicated that ‘breastfeeding only’ support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at 6 months [relative risk (RR) 0.93, 95% confidence interval (CI) 0.89 to 0.97]; stopping exclusive breastfeeding at 6 months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4–6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4–6 weeks (RR 0.83, 95% CI 0.76 to 0.90). The evidence for ‘breastfeeding plus’ was less consistent. Interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4–6 weeks (RR 0.73, 95% CI 0.57 to 0.95, very uncertain evidence) and 6 months (RR 0.79, 95% CI 0.70 to 0.90, moderate-certainty evidence). However, ‘breastfeeding plus’ support probably results in little to no difference in other breastfeeding outcomes. We conducted meta‐regression to explore substantial heterogeneity for the primary outcomes. Minimal differential effects were found except for a schedule of four to eight visits possibly associated with more beneficial effects. There was a lack of evidence for UK effective interventions. Review 2 We included 16 studies linked to 10 effective interventions. The quality of the included studies was mixed, but all studies’ findings were judged to be at least fairly well supported by data. The synthesis identified 18 factors affecting implementation of interventions and data-driven analytical themes. Mapping to the Consolidated Framework for Implementation Research resulted in three overarching themes: (1) assessing the needs of those delivering and receiving breastfeeding support interventions, (2) assessing the context and optimising delivery and engagement with breastfeeding support interventions and (3) reflecting and evaluating the success of implementing and providing breastfeeding support. Included studies identified implementation challenges relating to the needs, preferences and priorities of intervention providers and recipients. Overall, breastfeeding women perceived support as positive, important and needed. Breastfeeding supporter training enabled implementation teams to address breastfeeding supporters’ needs. Studies reported contextual factors (e.g. alignment with local policies) affecting the implementation and delivery of breastfeeding support interventions as well as tailoring strategies (e.g. community involvement, use of lay language, responsive support content/information) to address contextual factors. Reports about implementation success focused on key implementation outcomes such as satisfaction, fidelity or usefulness. Review 3 We included 39 economic evaluations, nine of which were deemed directly or partially applicable to the UK system. For ‘breastfeeding only’ support, evidence from one study suggested that the intervention was unlikely to be cost-effective [£56,074.98 per quality-adjusted life-year gained at 2022 Great British pounds (GBP) prices]. There was evidence for the incremental cost per additional woman breastfeeding (any or exclusive), with ICERs ranging from £67 to £112 from 2 weeks up to 8 weeks postpartum, and from £2446 to £4226 up to 6 months postpartum. Without willingness-to-pay thresholds, value for money is unclear. Evidence for ‘breastfeeding plus’ support suggests that this is not cost-effective; however, there was a lack of good-quality evaluations, with inconsistency in results. Where evidence of sensitivity analysis was reported for handling uncertainty, ICERs were upheld. Scenario analyses from the base case did show changes in costing the intervention, which suggested that costs were sensitive. Eight studies were deemed to have potentially very serious limitations due to short time horizons and a lack of extrapolation beyond within-trial data. These limitations affect conclusions about cost-effectiveness. Review 4 Twenty-two studies of 23 interventions were included. The meta-analyses included 5048 mother–infant pairs. The most common condition, in nine studies, was overweight and obesity. A further three studies were of women with gestational diabetes mellitus. Five studies included women with human immunodeficiency virus (HIV). Two studies were of women with substance misuse problems, and one was of women with anxiety and depression. Interventions varied in whether they provided breastfeeding support only or if they also provided support for the LTC. The overall risk of bias of trials was generally high. Blinding of participants and personnel is not feasible in such interventions. About half of the studies were rated as being at high or unclear risk of allocation concealment and incomplete outcome data. All studies were rated as being at high or unclear risk of selective outcome reporting. There was little to no difference between intervention and control for any of the primary outcomes. We judged these outcomes to be of low and moderate certainty. Review 5 We included 24 studies. The health conditions covered were HIV, obesity and overweight, substance use, diabetes in pregnancy, disabilities and a rare genetic disorder. The overall quality of included studies was mixed. Four key themes were identified: (1) additional breastfeeding support needs for women with LTCs; (2) variable or insufficient availability of breastfeeding support for mothers with LTCs; (3) experiences of breastfeeding support of mothers with LTCs suggesting complex breastfeeding journeys; and (4) suggestions from participants of potential strategies to improve breastfeeding support. Review 6 We included five economic evaluations. The conditions assessed were HIV, obesity, prenatal opioid use and medically high risk (maternal hypertension and diabetes prior to birth). Each intervention assessed in full economic evaluations was deemed cost-effective for the base case. However, each study failed to meet one or more applicability criteria, which is likely to change the conclusions about cost-effectiveness. Embedded stakeholder engagement and patient and public involvement Two stakeholder working groups with 23 members and two parents’ panels with 16 members met virtually several times throughout. The main study stakeholder group and parents’ panel discussed the realities of breastfeeding, ranked intervention transferability criteria, highlighted barriers to accessing and providing breastfeeding support and prioritised implementation strategies to overcome barriers. Six focus group discussions involving 23 participants from an area of high socioeconomic disadvantage represented the perspectives of communities who are less likely to breastfeed. The other stakeholder working group and parents’ panel provided first-hand accounts of breastfeeding, and of providing breastfeeding support for women with multimorbidities. They discussed adapting interventions identified in the main study to meet the needs of women with LTCs. The views and suggestions of all stakeholders and parents guided all stages of the project and directly influenced the co-production workshops. Four workshops across the UK were attended by 87 participants representing parents and third-sector organisations, healthcare practitioners, service managers and commissioners, policy-makers and academics. The workshop output was a toolkit for implementing breastfeeding support interventions in the UK. The toolkit comprises evidence-based recommendations for breastfeeding support services, prioritised criteria for adapting the evidence-based recommendations to local services, and guidance on implementing new breastfeeding support services, planning the implementation strategy and evaluating the breastfeeding support services. A discrete choice experiment showed that participants valued additional breastfeeding support and were willing to pay £89.91 per woman to achieve a 1% reduction in the number of women stopping any breastfeeding at 6 weeks, and £105.04 for a 1% reduction in stopping exclusive breastfeeding. Conclusions ‘Breastfeeding only’ support can increase the duration and exclusivity of breastfeeding in healthy women. For ‘breastfeeding plus’ and interventions for women with LTCs the evidence is less certain and there is probably little effect on breastfeeding outcomes. As the mixed-methods synthesis and stakeholder work identified that women with LTCs face additional challenges when breastfeeding, more research is needed to develop effective and cost-effective support. Evidence for the effectiveness and cost-effectiveness of breastfeeding support interventions in the UK is lacking. Implications for health care Decision-makers and frontline practitioners can use the toolkit to inform implementation efforts, to overcome barriers specific to their settings and to tailor evidence-based interventions to their populations. Key to success will be addressing health system barriers and enhancing the skills, knowledge and confidence of practitioners. Regarding women with LTCs, stakeholder engagement suggested health services could integrate infant-feeding specialists with the multidisciplinary team to give infant feeding a higher profile in obstetric and medical care. Recommendations for research (numbered in priority order) Development and evaluation of breastfeeding support interventions for women with LTCs and multimorbidities, particularly mental health conditions, overweight/obesity and gestational diabetes. Focus on understanding the components of breastfeeding support interventions that make them effective, including which components would be more effective in populations at risk of poorer breastfeeding outcomes (e.g. areas of high socioeconomic deprivation), and understanding why ‘breastfeeding plus’ interventions are less effective. Implementing and evaluating effective breastfeeding support in the UK for all women. This could evaluate the prototype intervention proposed in this report tailored to local contexts via implementation and effectiveness and cost-effectiveness studies or using quality improvement methodology. Study registration This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen’s University Belfast Research Portal (https://pure.qub.ac.uk/). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.

Abstract Introduction Food security and nutrition have been severely impacted during the COVID-19 pandemic, particularly in low- and middle-income countries (LMICs). We aimed to quantify the impacts of the pandemic on food security and diet diversity within Chilanga District in Zambia and identify target areas for high-impact social protection and safety net programs. Methods We conducted a cross-sectional study in Chilanga district immediately after the Omicron variant surge in February 2022. Diet quality and food security were assessed based on a household diet questionnaire and a Minimum Dietary Diversity-Women (MDD-W) score was calculated. A paired t-test was used to determine whether there was a statistically significant change in the MDD-W score and McNemar test was used to investigate the change in food security between the pre- and peri-COVID-19 period. Results Compared to the pre-COVID-19 period, there were increases in food prices across the board in the peri-COVID-19 period and decreased consumption of key food categories including legumes, dairy and vitamin A rich foods. Despite high rates of food insecurity, only 6.6% of surveyed households received any cash or in-kind assistance from a government agency, non-profit, or other organization in the post-COVID-19 period. Conclusion The COVID-19 pandemic had significant impacts on food security and dietary diversity in Chilanga district. This is particularly relevant in the low-income communities that we surveyed, which had pre-existing challenges with food security. Additional resources must be invested in Chilanga District and similarly affected areas to address this gap in access to food and promote national equity. Trial Registration N/A.

Abstract Background Several studies have reported that climate change elevates heat exposure in pregnant women and high temperatures during pregnancy are associated with preterm births (PTBs). Although the association might be disproportionate, related evidence remains sparse. We evaluated the disproportionate risk of PTB associated with ambient temperature during pregnancy by individual and regional characteristics in South Korea. Methods We collected data on birth certificates and daily mean temperatures during the period from 2011 to 2019. A time-stratified case-crossover design was used to investigate the association between temperature and PTB and stratified analyses were conducted to examine the effect modification of individual and regional characteristics. Results A total of 160,067 singleton PTBs were recorded in Korea from 2011 to 2019. A 5℃ increase in the mean temperature during the last four weeks before delivery was associated with an increased risk of PTB with an odds ratio (OR) of 1.03 (95% confidence interval [CI]: 1.02, 1.05), and the association was more evident in mothers aged ≥35 years (OR: 1.06 [95% CI: 1.03, 1.10]) and with low education levels (OR: 1.04 [95% CI: 1.02, 1.05]). Additionally, the estimated risk was evident in districts with lower medical resources and more prominent disparities were shown by individual and regional characteristics in rural areas than in urban areas. Conclusions This study provides evidence that the risk of PTB related to ambient temperature is disproportionate by individual and regional characteristics and suggests the need for public health policies to alleviate the disparities, especially in rural areas.

Introduction: Female fecundity decreases significantly after the age of 32, and rapidly so after age 37. There is no treatment to prevent this decline. Furthermore, globally, women are getting married later and the age at which they have their first child is increasing. As of July 2023, elective egg freezing (EEF) or oocyte cryopreservation (OC) for age-related fertility decline, commenced in Singapore. With medical advancements in OC, EEF is no longer considered experimental. The aim of this review is to examine the existing literature around EEF with regard to reproductive outcomes and its safety, to better guide clinicians in counselling young single women. Method: Published studies were examined to increase understanding on optimal age for EEF, ideal number of oocytes for a live birth, recommended OC protocols, cryopreservation techniques affecting thaw survival or fertilisation, oocyte storage and pregnancy risks. Results: Models predict that EEF should be performed at age

Objetivou-se relatar a experiência extensionista no campo da promoção da saúde mental de adolescentes da comunidade, com foco na prevenção contra o suicídio na adolescência. O estudo descreve ações de educação em saúde, realizadas em duas Estações Juventude de um município do interior do Ceará, ocorridas em setembro de 2022. As práticas foram realizadas por acadêmicos de enfermagem e educação física, integrantes da Liga Interdisciplinar de Promoção à Saúde do Adolescente, da Universidade Estadual Vale do Acaraú, em Sobral-CE, Brasil. Os resultados obtidos relevaram, no decorrer das atividades de extensão com adolescentes, contribuição no senso crítico dos participantes, fazendo com que conseguissem expor opiniões, experiências vivenciadas e esclarecimentos de dúvidas relacionadas com as temáticas abordadas. Conclui-se que as ações educacionais realizadas por universitários são de suma importância tanto para os participantes quanto para os acadêmicos, e, por abordar questões corriqueiras relacionadas com o público adolescente, ocorreu grande interação entre ambos, gerando troca valiosa de saberes. Além disso, contribuiu para que os acadêmicos se inserissem na comunidade visualizando novas realidades. Palavras-chave: Educação em Saúde; Ensino Superior; Ciências da Saúde; Saúde do Adolescente Promoting mental health and suicide prevention among adolescents in the community Abstract: The goal of this study is to relate an extension experience in the mental health field among adolescents in a community, with focus on preventing suicide in adolescence. The study describes health educational activities, conducted in two Youth Stations in the town in the countryside of Ceará, which took place in September 2022. The activities were realized by nursing and physical education students, who were members of the Liga Interdiscplinar de Pormoção à Saúde do Adolescente [Interdisciplinary League for Adolescent Health Promotion] at Universidade Estadual Vale do Acaraú [Vale do Acaraú State University] in Sobral-CE, Brazil. The obtained results revealed that the extension activities with adolescents contributed to the participants’ critical thinking skills, enabling them to express their opinions, share personal experiences, and clarify doubts related to the topics discussed. It is concluded that the educational actions carried out by university students are of paramount importance both for the participants and for the students themselves, as they address common issues related to the adolescent population, fostering a valuable exchange of knowledge. Additionally, these actions helped the students become integrated into the community and gain a new perspective on different realities. Keywords: Health Education; Higher Education; Health Sciences; Adolescent Health

Several studies have compared the transcriptome across various brain regions in Huntington’s disease (HD) gene-positive and neurologically normal individuals to identify potential differentially expressed genes (DEGs) that could be pharmaceutical or prognostic targets for HD. Despite adhering to technical recommendations for optimal RNA-Seq analysis, none of the genes identified as upregulated in these studies have yet demonstrated success as prognostic or therapeutic targets for HD. Earlier studies included samples from neurologically normal individuals older than the HD gene-positive group. Considering the gradual transcriptional changes induced by aging in the brain, we posited that utilizing samples from older controls could result in the misidentification of DEGs. To validate our hypothesis, we reanalyzed 146 samples from this study, accessible on the SRA database, and employed Propensity Score Matching (PSM) to create a “virtual” control group with a statistically comparable age distribution to the HD gene-positive group. Our study underscores the adverse impact of using neurologically normal individuals over 75 as controls in gene differential expression analysis, resulting in false positives and negatives. We conclusively demonstrate that using such old controls leads to the misidentification of DEGs, detrimentally affecting the discovery of potential pharmaceutical and prognostic markers. This underscores the pivotal role of considering the age of control samples in RNA-Seq analysis and emphasizes its inclusion in evaluating best practices for such investigations. Although our primary focus is HD, our findings suggest that judiciously selecting age-appropriate control samples can significantly improve best practices in differential expression analysis.

Abstract Premise Reintroductions or translocations are an increasingly important activity to recover and conserve at‐risk plant species. Yet because many are not published in the scientific literature, learning from previous attempts may often require considerable time and effort. The Center for Plant Conservation Reintroduction Database (CPCRD; https://saveplants.org/reintroduction-database/), a new centralized and standardized repository of U.S.‐based plant reintroductions, aims to improve the efficiency and effectiveness of accessing data on rare plant reintroductions. Methods The CPCRD is the product of multiple efforts to assemble information on rare plant reintroductions in the United States. The database comprises a wealth of standardized data on the key stages of a reintroduction, from the planning and implementation phases, to monitoring and management techniques. Results The CPCRD is a dynamic resource, allowing data contributors to continually update their entries as projects progress. While contributions are ongoing, the CPCRD currently includes 460 projects involving 201 plant taxa, spanning diverse growth forms, ecosystems, and regions. Discussion The CPCRD and its well‐documented and monitored projects provide a valuable practical resource for conservation practitioners, and have supported multiple scientific studies and contributed to the internationally recognized Center for Plant Conservation Best Practices Guidelines.

Summary: Background: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable.

Objetivo: Analisar a prevalência e os fatores associados ao uso de álcool, tabaco e maconha entre alunos de Escolas Públicas de Ensino Médio da Cidade de Sobral-CE. Métodos: estudo desenvolvido com 546 alunos de sete escolas do Ensino Médio da sede do Município de Sobral-CE, através de um questionário online com informações sociodemográficas e do Drug Use Screening Inventory. Os resultados foram analisados utilizando os testes do Qui-quadrado e razão de verossimilhança. Resultados: o álcool apresentou maior prevalência (16,8%) seguido da maconha (7,3%) e do tabaco (3,5%). Estudar em escola em território de maior desigualdade social e cursar o 2º ou 3º ano, foram estaticamente significantes para o uso dessas três substâncias. Não ter religião também esteve associado ao uso de álcool e tabaco. Conclusões: há necessidade de uma atuação mais efetiva do poder público, com ações intersetoriais, envolvendo a comunidade escolar e equipes de saúde multiprofissionais.

Objectives: Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail. Methods: We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy. Results: The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. Conclusion: These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts.

Tuberculosis (TB) remains an impactful infectious disease, leading to millions of deaths every year. Mycobacterium tuberculosis causes the formation of granulomas, which will determine, through the host–pathogen relationship, if the infection will remain latent or evolve into active disease. Early TB diagnosis is life-saving, especially among immunocompromised individuals, and leads to proper treatment, preventing transmission. This review addresses different approaches to diagnosing TB, from traditional methods such as sputum smear microscopy to more advanced molecular techniques. Integrating these techniques, such as polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP), has significantly improved the sensitivity and specificity of M. tuberculosis identification. Additionally, exploring novel biomarkers and applying artificial intelligence in radiological imaging contribute to more accurate and rapid diagnosis. Furthermore, we discuss the challenges of existing diagnostic methods, including limitations in resource-limited settings and the emergence of drug-resistant strains. While the primary focus of this review is on TB diagnosis, we also briefly explore the challenges and strategies for diagnosing non-tuberculous mycobacteria (NTM). In conclusion, this review provides an overview of the current landscape of TB diagnostics, emphasizing the need for ongoing research and innovation. As the field evolves, it is crucial to ensure that these advancements are accessible and applicable in diverse healthcare settings to effectively combat tuberculosis worldwide.

Candida tropicalis is regarded as an opportunistic pathogen, causing diseases ranging from superficial infections to life-threatening disseminated infections. The ability of this yeast to form biofilms and develop resistance to antifungals represents a significant therapeutic challenge. Herein, the effect of geraniol (GER), alone and combined with fluconazole (FLZ), was evaluated in the planktonic and sessile cells of azole-resistant C. tropicalis. GER showed a time-dependent fungicidal effect on the planktonic cells, impairing the cell membrane integrity. Additionally, GER inhibited the rhodamine 6G efflux, and the molecular docking analyzes supported the binding affinity of GER to the C. tropicalis Cdr1 protein. GER exhibited a synergism with FLZ against the planktonic and sessile cells, inhibiting the adhesion of the yeast cells and the viability of the 48-h biofilms formed on abiotic surfaces. C. tropicalis biofilms treated with GER, alone or combined with FLZ, displayed morphological and ultrastructural alterations, including a decrease in the stacking layers and the presence of wilted cells. Moreover, neither GER alone nor combined with FLZ caused toxicity, and both treatments prolonged the survival of the Galleria mellonella larvae infected with azole-resistant C. tropicalis. These findings indicate that the combination of GER and FLZ may be a promising strategy to control azole-resistant C. tropicalis infections.

A abordagem Nexus foca na avaliação integrada das opções de desenvolvimento e gestão visando às seguranças hídrica, alimentar e energética (SHAE). Este artigo visa apresentar uma estratégia metodológica para avaliação da influência de políticas públicas (PP) nas SHAE, sendo aplicada na região hidrográfica Guandu (RH-II), com ênfase no município de Rio Claro, RJ. A estratégia metodológica é composta de quatro etapas: levantamento e sistematização de PP nos diferentes níveis em base de dados, identificação de critérios e classificação das PP, seleção das PP estruturantes e integradoras e a avaliação das mesmas. Para o caso da RH-II, cerca de 43% das PP atendem a mais de uma segurança. Cinco PP foram selecionadas como estruturantes e integradoras e avaliadas em relação ao potencial impacto nas SHAE da área de estudo. A área de estudo foi bastante promissora para a aplicação da abordagem Nexus para avaliação do potencial impacto das PP nas SHAE, pois possui um elevado percentual de remanescentes florestais e elevada demanda por água e energia. Esses fatores a tornam alvo de PP de restauração e conservação florestal, do solo e da água e de mecanismos de compensação. A presente estratégia metodológica pode ser aplicada em outras regiões ou bacias hidrográficas do país, visando subsidiar a gestão integrada das SHAE nas mesmas.

ObjectiveTo evaluate the effectiveness of pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function and quality of life (QoL) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP).MethodsThis study will be a randomized, controlled, parallel, and blinded clinical trial. The final sample will consist of 32 women diagnosed with SUI and cystocele (stage I and II). All volunteers will be assessed and reassessed using the same protocol: assessment form, gynecological examination, functional evaluation of PFM, and questionnaires to assess quality of life, urinary function, and sexual function. All volunteers will be evaluated for satisfaction levels post-treatment. The intervention will be PFMT, totaling 16 sessions to be conducted twice a week. Reevaluation will take place at the end of treatment and 1 month after completion of PFMT. Descriptive analysis and repeated measures ANOVA will be used for result analysis. A significance level of pEthics and disseminationThis study has been submitted to the Ethics in Research Committee of the Federal University of Rio Grande do Norte and approved under protocol number 5.826.563. It has been registered with the Brazilian Clinical Trials Registry ReBec (RBR-49p6g3t). It is expected that these studies will provide a deeper understanding of the efficacy of PFMT in women with SUI and cystocele. Additionally, it aims to provide more insights into the efficacy of PFMT prior to surgery.

The fungus Phyllosticta citricarpa is a quarantine phytopathogen responsible for causing citrus black spot (CBS) disease. To export fruits to CBS-free countries, they must undergo a sanitation process to ensure disease control. In this study, neem essential oil (NEO) was tested against P. citricarpa for the first time as an alternative sanitizer. In vitro experiments were conducted to determine the inhibition concentration of NEO for P. citricarpa, and the mode of action of the essential oil was evaluated. In vivo assays were performed to simulate the sanitization process used in packinghouses. NEO was characterized by GC-MS/MS. The results revealed that NEO at 100 μL·mL−1 exhibited a similar inhibitory effect as copper oxychloride, suppressing 89.68 ± 1.14% of fungal mycelium growth. Fluorescence microscopy experiments demonstrated that NEO functions by disrupting the cytoplasmic membrane of fungal hyphae, leading to their death within 30 minutes of contact with NEO. GC-MS/MS characterization revealed a high presence of phenolic compounds, which serve as the primary antifungal agents responsible for the action against fungal hyphae. In vivo assays showed that NEO at 100 μL·mL−1 also reduced microorganisms (CFU mL−1) by 93.00 ± 3.88% compared to the negative control. Overall, the results demonstrate that NEO can effectively serve as an alternative sanitizer against P. citricarpa in citrus packinghouses. Our findings allow future studies to explore the use of NEO for sanitizing other fruits and combating different phytopathogens to broaden its potential application in fruit sanitation for export.

Background & Aims: Hepatocellular carcinoma (HCC) is a heterogeneous cancer with varying levels of liver tumor initiating or cancer stem cells in the tumors. We aimed to investigate the expression of different liver cancer stem cell (LCSC) markers in human HCCs and identify their regulatory mechanisms in stemness-related cells. Methods: We used an unbiased, single-marker sorting approach by flow cytometry, fluorescence-activated cell sorting, and transcriptomic analyses on HCC patients’ resected specimens. Knockdown approach was used, and relevant functional assays were conducted on the identified targets of interest. Results: Flow cytometry on a total of 60 HCC resected specimens showed significant heterogeneity in the expression of LCSC markers, with CD24, CD13, and EpCAM mainly contributing to this heterogeneity. Concomitant expression of CD24, CD13, and EpCAM was detected in 32 HCC samples, and this was associated with advanced tumor stages. Transcriptomic sequencing on the HCC cells sorted for these individual markers identified epidermal growth factor receptor kinase substrate 8-like protein 3 (EPS8L3) as a common gene associated with the 3 markers and was functionally validated in HCC cells. Knocking down EPS8L3 suppressed the expression of all 3 markers. To search for the upstream regulation of EPS8L3, we found SP1 bound to EPS8L3 promoter to drive EPS8L3 expression. Furthermore, using Akt inhibitor MK2206, we showed that Akt signaling–driven SP1 drove the expression of the 3 LCSC markers. Conclusions: Our findings suggest that Akt signaling–driven SP1 promotes EPS8L3 expression, which is critical in maintaining the downstream expression of CD24, CD13, and EpCAM. The findings provide insight into potential LCSC-targeting therapeutic strategies.

Nos últimos anos tem se notado um considerável desenvolvimento na cidade de Ribeirão Pires, São Paulo, desenvolvimento esse que afetou diversos setores tanto econômicos quanto sociais, e causou grande impacto na qualidade de vida da população da cidade e possibilidade de investimentos empresariais na mesma. É notório que a evolução econômica e social de uma cidade pode gerar ótimas oportunidades de investimento, abertura de negócios, empresas e mudanças de vida. O artigo propôs analisar os agentes causadores do desenvolvimento ocorrido na cidade, assim como seus efeitos positivos e negativos, e criação de oportunidades de investimentos. Para isso, utilizou-se de pesquisas descritivas, técnicas documentais, levantamentos estatísticos e entrevistas com moradores da cidade, para levantar dados sobre a evolução da cidade e seus efeitos. A análise dos agentes desenvolvedores e seus efeitos têm ênfase nos setores econômicos, sociais e de geração de oportunidades de investimentos logísticos na cidade. O artigo buscou encontrar oportunidades de investimento logístico na cidade, baseado nas informações do que já foi desenvolvido na mesma e que pode ser ainda mais explorado.

Abstract Background Dissonance-based eating disorder programs have successfully targeted body dissatisfaction by challenging the thin beauty ideal in the preventive context and in groups of patients with a subthreshold and full threshold DSM-5 eating disorder. As there is a need for interventions specifically targeting thin-ideal internalization in (highly) specialized treatment centres, the present study adapted Stice’s et al.’s Body Project for its use as an add-on treatment for severe eating disorders with the aims to identify whether it was feasible and acceptable in this treatment context, to determine any necessary modifications with regard to the treatment and study procedures, and to test preliminary effectiveness. Methods The study was a randomized controlled pilot/feasibility trial. Thirty patients started in the Body Project group and 25 in the Psycho-education group. Measurements took place pre- and post-intervention, and at three and six months follow-up. Patients and staff evaluated treatment and study procedures, and patients completed questionnaires on thin-ideal internalization, body dissatisfaction, self-objectification, negative affect and eating disorder pathology. Results The Body Project group and Psycho-education group both proved highly feasible and acceptable, as well as preliminarily effective, based on quantitative scores and qualitative feedback. Preliminary analyses showed that treatment effects did not differ between treatment groups. As both groups were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. Qualitative feedback for the Body Project group included several recommendations for future implementation: increasing the number of treatment sessions, creating homogeneous therapy groups, and optimizing timing of the treatment. Conclusions Future research should examine further modifications to the Body Project group for severe eating disorders, as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group. Plain English summary We tested the feasibility and acceptability of a group intervention targeting the thin beauty ideal (Body Project group) in patients with severe eating disorders and compared this intervention to a group intervention focusing on psycho-education about eating disorders (Psycho-education group). Both interventions were added to standard treatment. We adapted the protocol for patients with severe eating disorders. Both the Body Project group and the Psycho-education group were evaluated by patients as well as staff as highly feasible and acceptable, and effects were positive. Treatment effects did not differ between treatment groups. As both treatments were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. The study suggested further modifications to the Body Project group. Future research should examine these modifications as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group.

The endocannabinoid system has been linked to various physiological and pathological processes, because it plays a neuromodulator role in the central nervous system. In this sense, cannabinoids have been used off-label for neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHA), as well as in Alzheimer’s disease (AD), a more prevalent neurodegenerative disease. Thus, this study aims, through a comprehensive literature review, to arrive at a better understanding of the impact of cannabinoids in the therapeutic treatment of patients with ASD, ADHD, and Alzheimer’s disease (AD). Overall, cannabis products rich in CBD displayed a higher therapeutic potential for ASD children, while cannabis products rich in THC have been tested more for AD therapy. For ADHD, the clinical studies are incipient and inconclusive, but promising. In general, the main limitations of the clinical studies are the lack of standardization of the cannabis-based products consumed by the participants, a lack of scientific rigor, and the small number of participants.

Worldwide, oak species are threatened with extinction due to habitat loss, pathogens, and changing fire regimes. Ex situ conservation through tissue culture may protect the remaining genetic diversity of Quercus dumosa, or the coastal sage scrub oak, from further loss. We designed three basal salt formulations based on the mineral composition of shoot tips and first leaves from mature Q. dumosa and explored carbohydrate source, stress-mitigating compounds, and plant growth regulator concentrations to develop a method of cultivating many Q. dumosa culture lines in vitro. All three novel basal salt formulations led to decreased necrosis compared with commercial basal salt formulas WPM, MS, and DKW. Substitution of 30 g L−1 sucrose with glucose and adding 250 mg L−1 ascorbic acid, 5.2 mg L−1 SNP sodium nitroprusside, and 103 mg L−1 y-aminobutyric acid improved culture health overall. In an experiment involving 115 culture lines, 0.66 mg L−1 6-benzylaminopurine produced the highest average shoots per explant, but 0.33 mg L−1 produced the greatest proportion of shoots 2 cm or greater. Incubation for 24 h in 20 mg L−1 indole-3-butyric acid led to the most rooting. These methods show promise for the ex situ conservation of many genotypes of endangered Q. dumosa.

Integrated early childhood development (ECD) programs boost child health and developmental outcomes. However, the factors contributing to the successful implementation of such programs in informal urban settlements are not well researched. We conducted 14 focus group discussions and 13 key informant interviews with 125 caregivers of children under the age of 5 years and stakeholders, exploring their views on enablers and barriers to implementing an integrated ECD program in an informal settlement in Kenya. Strategic engagement, capacity building, transparency, fair compensation of ECD workforce, communication skills, and the need to tailor ECD programs to local realities were discussed. An equity-focused implementation approach for integrated ECD programs is timely.

ABSTRACT Purpose: to present a scoping review protocol to identify and analyze free applications available for Android and iOS operating systems to assist nursing mothers in terms of breastfeeding. Methods: the methodological structure of this scoping review has nine stages: developing the research question; defining descriptors; establishing application inclusion and exclusion criteria; locating applications; listing applications; selecting them by title and icon analysis; collecting application data; selecting them by application data analysis and quality assessment. The research question was developed based on the participants-concept-context strategy. Breastfeeding mobile applications assistance will be searched in Google Play and Apple Store. Two independent raters will select applications, collect data, and assess their quality. Quality assessment will use the Mobile App Rating Scale, which will be correlated with user ratings. Final Considerations: this research presented a nine-stage scoping review protocol aimed at identifying and analyzing free applications available for Android and iOS operating systems to help nursing mothers in terms of breastfeeding. The protocol is ready to be implemented.

Objetivos: identificar as estratégias de adaptação no domicílio, utilizadas pelos pacientes para início do tratamento da diálise peritoneal; descrever as principais facilidades e dificuldades encontradas pelos pacientes na realização da diálise peritoneal no domicílio; identificar o entendimento e a aceitação do paciente sobre o método de diálise peritoneal. Método: estudo descritivo, com abordagem qualitativa. Os dados foram coletados através de entrevistas semi-estruturadas, organizadas e analisadas conforme a técnica de análise de conteúdo de Bardin. Resultados: da análise das unidades de significação emergiram três categorias temáticas, sendo elas representações da DP; vivências e sentimentos frente à doença e na escolha do método; (re) conhecendo aspectos facilitadores e dificultadores diante a diálise peritoneal em casa; identificando as estratégias para adequação do cotidiano à diálise peritoneal. Conclusão: após o reconhecimento da necessidade da utilização da diálise peritoneal para manutenção da vida, o paciente desenvolve uma série de adaptações para viabilizar o tratamento diário em domicílio. Descritores: Diálise Peritoneal. Adaptação psicológica. Assistência domiciliar

Introdução: As infecções relacionadas à assistência à saúde (IRAS) constituem uma preocupação crescente que exige atenção dos profissionais da saúde, especialmente quando se trata de microrganismos resistentes a múltiplos antimicrobianos (MDR). Pseudomonas aeruginosa, um bacilo Gram-negativo não fermentador, é frequentemente associado a IRAS de alta morbimortalidade e apresenta comumente um perfil MDR. Nesse contexto, a fagoterapia tem emergido como uma alternativa promissora ao uso de antimicrobianos, consistindo no uso de bacteriófagos altamente específicos para o combate às infecções bacterianas. Objetivos: Estabelecer um protocolo de isolamento de bacteriófago de P. aeruginosa isolada de amostra de secreção traqueal. Metodologia: Foram utilizadas amostras de secreção traqueal provenientes do Laboratório de Análises Clínicas da Universidade do Oeste Paulista (UNOESTE), destinadas ao descarte. As amostras clínicas foram diluídas em tampão específico e submetidas à centrifugação. O sobrenadante resultante foi reservado e tratado com clorofórmio para reduzir a presença de células bacterianas, obtendo-se assim um lisado bacteriano que foi mantido a 7°C em geladeira. Os isolados bacterianos, previamente identificados como P. aeruginosa, foram utilizados para cultura do lisado, em meio Luria-Bertani para realização de streak e spot testes. Os plaques formados foram imersos em tampão e armazenados em geladeira para análises moleculares posteriores. Resultados: foi isolado um bacteriófago específico para P. aeruginosa a partir de um total de 10 isolados clínicos testados durante a fase inicial do estudo. Além disso, construiu-se um banco de lisados e isolados a partir de 147 amostras clínicas para análise futura. Conclusão: Esses achados preliminares indicam que a metodologia empregada neste estudo possui um promissor potencial para o isolamento de bacteriófagos específicos para P. aeruginosa. A busca por terapias alternativas ao uso de antimicrobianos é de suma importância para o controle adequado das IRAS e das infecções comunitárias causadas por microrganismos de difícil tratamento. Os resultados obtidos contribuem significativamente para o avanço do conhecimento científico nessa área e podem ter implicações relevantes no desenvolvimento de novas estratégias terapêuticas para o controle das infecções relacionadas à assistência à saúde.

Abstract Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

ABSTRACT In Brazil, the Steppe Savanna and associated vegetation types, typical of the Chaco, are in the Pantanal biome. Land use in this region has caused the suppression of natural vegetation and the emission of greenhouse gases. The knowledge of the phytophysiognomies of the Chaco and its importance for the mitigation and adaptation to climate change can contribute to conservation and protection policies in this region, including specific public policies to support the sustainable use of biodiversity and carbon stock (C). In this work, we present an estimate of the balance between CO2 emissions and removals associated with land use and land cover changes for the Brazilian Chaco, considering the annual average of C loss or gain in living biomass and dead organic matter in three different periods: 1990 to 2000, 2000 to 2010 and 2010 to 2019. The methodology followed the one recommended by the Fourth National Communication of Brazil to the United Nations Framework Convention on Climate Change, with adaptations. The results show that the natural vegetation of the Brazilian Chaco has been replaced by pasture throughout the studied period (1990-2019). The Savanna Formations had the greatest reduction in area in this period. The balance points to a net emission of 0.12, 0.05, and 0.03 MgCO2 ha-1 year-1, respectively, in 1990-2000, 2000-2010, and 2010-2019. CO2 removals predominate especially in the Kadiweu Indigenous Land, and emissions prevail in the Chaco South region.

O Brasil conta com uma produção média de leite de 25 bilhões de litros por ano, sendo a pecuária leiteira de grande importância para o PIB do país por seus produtos, derivados e a geração de emprego. Contudo, grandes são os desafios frente a pecuária leiteira e dentre eles a mastite bovina. A mastite é a inflamação da glândula mamária que apresenta, alterações patológicas no tecido glandular e modificações físico-químicas no leite. Dentre os vários tratamentos, a ozonoterapia vem sendo explorada cada dia mais com ótimos resultados. O ozônio é um gás formado por três átomos de oxigênio, apresenta uma série de benefícios, curativos, preventivos e imunoestimuladores, devido às suas propriedades oxigenadoras, catalíticas e germicidas, capaz de agir contra bactérias, fungos e vírus. O presente trabalho foi realizado na propriedade Chácara Nossa Senhora de Aparecida, localizada em Palmas, Tocantins, no período de 1 a 12 de Fevereiro de 2023. A propriedade conta com rebanho de 30 vacas de leite das raças Gir, Girolando e Holandês. Foram selecionadas, por meio de exame de CMT – Califórnia Mastit test e teste caneca de fundo escuro, as vacas com mastite subclínica e clínica, sendo este o critério de escolha dos animais, animais negativo aos testes eram descartados do tratamento. Foram administrados 500 mL de solução fisiológica ozonizada em cada quarto mamário. Aguardou-se a ação por 10 min e foi realizada a ordenha. Após isso, foi feito o inflado do quarto mamário acometido com o gás ozônio com o aparelho calibrado em 40 µg/mg x 0,5 mg/min por 5 min cada quarto. No monitoramento, 24 horas após a primeira cessão de ozonioterapia, as vacas com mastite subclínica CMT++ (animal 2 e 3), apresentaram melhoras significativas, não apresentavam rubor, edema ou dor, nem alteração mínima no exame do CMT. A vaca com mastite subclínica CMT+ (Animal 5) não apresentou alteração clínica e não foi reativo para exame de CMT, enquanto as vacas com mastite clinica reduziram a inflamação para subclínica de CMT+ (Animal 1 e 4).

Objective Frequency voiding charts are commonly used to gain better insight into the voiding and drinking behaviours of patients with voiding symptoms. Non-compliance when filling out a chart is known to be high. The use of a digital application might increase adherence, but little research has been conducted on this topic. The aim of this study is to compare the quality (number of correctly filled out charts) and quantity (number of complete charts) of digital versus paper frequency voiding charts among children and their parents. Methods A multi-centre parallel randomised controlled trial was conducted. Participants were assigned either a 48-h digital frequency voiding chart or a 48-h paper frequency voiding chart. Completion rates were scored based on a predefined scoring method and transcribed into a percentage. Secondary objectives included user friendliness, feasibility, degree of the child's participation, and attractiveness. Trail registry data: NTR NL9383. Results Ninety-seven patients were randomised to either a digital ( N = 53) or paper ( N = 44) frequency voiding chart. No significant difference in complete and accurately filled out frequency voiding charts was seen between the groups, with 35% ( N = 18) for digital and 50% ( N = 22) for paper, p = 0.12. Subjects considered the digital application more appealing, more educative, and more inviting compared to the paper chart ( p

Background & Aims: Metabolic reprogramming is recognized as a cancer hallmark intimately linked to tumor hypoxia, which supports rapid tumor growth and mitigates the consequential oxidative stress. Phosphofructokinase-fructose bisphosphatase (PFKFB) is a family of bidirectional glycolytic enzymes possessing both kinase and phosphatase functions and has emerged as important oncogene in multiple types of cancer. However, its clinical relevance, functional significance, and underlying mechanistic insights in hepatocellular carcinoma (HCC), the primary malignancy that develops in the most important metabolic organ, has never been addressed. Methods: PFKFB4 expression was examined by RNA sequencing in The Cancer Genome Atlas and our in-house HCC cohort. The up-regulation of PFKFB4 expression was confirmed further by quantitative polymerase chain reaction in an expanded hepatitis B virus–associated HCC cohort followed by clinicopathologic correlation analysis. Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR-associated protein 9 (Cas9)-mediated PFKFB4 knockout cells were generated for functional characterization in vivo, targeted metabolomic profiling, as well as RNA sequencing analysis to comprehensively examine the impact of PFKFB4 loss in HCC. Results: PFKFB4 expression was up-regulated significantly in HCC and correlated positively with TP53 and TSC2 loss-of-function mutations. In silico transcriptome-based analysis further revealed PFKFB4 functions as a critical hypoxia-inducible gene. Clinically, PFKFB4 up-regulation was associated with more aggressive tumor behavior. Functionally, CRISPR/Cas9-mediated PFKFB4 knockout significantly impaired in vivo HCC development. Targeted metabolomic profiling revealed that PFKFB4 functions as a phosphatase in HCC and its ablation caused an accumulation of metabolites in downstream glycolysis and the pentose phosphate pathway. In addition, PFKFB4 loss induced hypoxia-responsive genes in glycolysis and reactive oxygen species detoxification. Conversely, ectopic PFKFB4 expression conferred sorafenib resistance. Conclusions: PFKFB4 up-regulation supports HCC development and shows therapeutic implications.

Objective: This study aimed to describe the effect of prophylactic phototherapy in the treatment of infants with Neonatal Hemolytic Disease. Method: A retrospective cohort study was carried out with 199 RhD-positive infants, born to RhD-negative mothers, alloimmunized for RhD antigen, between January 2009 and December 2018. Results: The incidence of exchange transfusions in the study population was 9.5%, with a mean maximum bilirubin value of 11.3 mg % (± 4.3mg %). Bilirubin's maximum peak was achieved with a mean of 119.2 life hours (± 70.6h). Conclusion: The low incidence of exchange transfusion, the extended maximum bilirubin peak for later ages, and the low mean of the maximum bilirubin values may indicate a positive effect of prophylactic phototherapy in the treatment of this disease. Further studies must be carried out to confirm these findings.

BackgroundAdolescents make up roughly a quarter of the population in Zambia; however, most nutrition-related programming is targeted at the under-five population. Understanding the scale of undernutrition in older children and adolescents is fundamental to alleviating food insecurity and addressing undernutrition across all age groups.MethodsA cross-sectional survey was performed in four low-income, peri-urban compounds in Chilanga District which included anthropometric measurements of children between ages 6 months-19 years and a household-level diet diversity and food security questionnaire. Wasting was used for children under 5 and thinness for children 5–19 years. Descriptive analysis and multivariate logistic regression were conducted to quantify the prevalence and distribution of malnutrition and understand the impact of food security.ResultsWe surveyed 393 households and 1,004 children between the ages of 6 months and 19 years. Children aged 6–9 years had the highest prevalence of severe thinness (5.2%) and adolescents (10–19 years) had the highest rates of moderate thinness (6.5%). Across all age groups, more than 75% of children were in households that worried about running out of food in the previous month. 24.9% of adolescents and 28.4% of older children were in households were more likely to go a whole day without eating compared to 16.9% of children under 5.ConclusionOur survey indicated that malnutrition in adolescents and older children living in Chilanga district was comparable to those under 5. Interventions to address undernutrition must be targeted at older children and adolescents in order to ameliorate this burden.

Objetivo: avaliar as repercussões da COVID-19 e do isolamento social durante a pandemia na saúde mental de estudantes de graduação em enfermagem. Métodos: estudo descritivo transversal, realizado no Ceará, Brasil, com 347 estudantes. Os dados foram coletados por meio de questionário para obtenção de dados sociodemográficas e informações sobre aspectos relacionados à pandemia, além do Inventário de Saúde Mental-38 (MHI-38). Resultados: percentual de 51,9% dos estudantes continuaram a graduação por meio de atividades de ensino remoto e avaliações on-line e 62,3% acessavam a internet essencialmente pelo celular. Para 76,9% dos estudantes, a maior preocupação era com a morte de um membro da família/amigo. Quanto à saúde mental dos estudantes, os escores na dimensão de Bem-estar Psicológico do MHI-38 foram em média 47,9 (± 16,8) e na dimensão de Sofrimento Psicológico a média foi 52,8 (± 18,5). A média de pontuação global no MHI-38 foi 51,0 (± 16,9), com diferenças entre os sexos (p = 0,039). Conclusão: os estudantes tiveram a saúde mental afetada pela pandemia de COVID-19 e o isolamento social, com maior impacto para as mulheres. Assim, instituições de ensino precisam desenvolver estratégias para monitorar e promover a saúde mental desta população no retorno às aulas no período pós-pandemia.

BackgroundsMany studies have shown particulate matter has emerged as one of the major environmental risk factors for diabetes; however, studies on the causal relationship between particulate matter 2.5 (PM2.5) and diabetes based on genetic approaches are scarce. The study estimated the causal relationship between diabetes and PM2.5 using two sample mendelian randomization (TSMR).MethodsWe collected genetic data from European ancestry publicly available genome wide association studies (GWAS) summary data through the MR-BASE repository. The IEU GWAS information output PM2.5 from the Single nucleotide polymorphisms (SNPs) GWAS pipeline using pheasant-derived variables (Consortium = MRC-IEU, sample size: 423,796). The annual relationship of PM2.5 (2010) were modeled for each address using a Land Use Regression model developed as part of the European Study of Cohorts for Air Pollution Effects. Diabetes GWAS information (Consortium = MRC-IEU, sample size: 461,578) were used, and the genetic variants were used as the instrumental variables (IVs). We performed three representative Mendelian Randomization (MR) methods: Inverse Variance Weighted regression (IVW), Egger, and weighted median for causal relationship using genetic variants. Furthermore, we used a novel method called MR Mixture to identify outlier SNPs.ResultsFrom the IVW method, we revealed the causal relationship between PM2.5 and diabetes (Odds ratio [OR]: 1.041, 95% CI: 1.008–1.076, P = 0.016), and the finding was substantiated by the absence of any directional horizontal pleiotropy through MR-Egger regression (β = 0.016, P = 0.687). From the IVW fixed-effect method (i.e., one of the MR machine learning mixture methods), we excluded outlier SNP (rs1537371) and showed the best predictive model (AUC = 0.72) with a causal relationship between PM2.5 and diabetes (OR: 1.028, 95% CI: 1.006–1.049, P = 0.012).ConclusionWe identified the hypothesis that there is a causal relationship between PM2.5 and diabetes in the European population, using MR methods.

Objective: to verify the most prevalent psychoactive substances used among undergraduate students in the health area and their interference in academic performance. Methods: a total of 115 Nursing and Physical Education students from a public university in inland Ceará, Brazil, answered the Drug Use Screening Inventory questionnaire in 2021. To analyze the results, Pearson's chi-square and likelihood ratio statistical tests were used. Results: a total of 65 (56%) students used analgesics, 54 (47%) drank alcohol and 14 (12.2%) smoked marijuana. There was no statistical association between use of psychoactive substances and academic performance. However, among those who used analgesics or alcohol, more than 1/3 analyzed their performance as poor/terrible or fair, and half of those who smoked marijuana analyzed it in the same way. Conclusion: the study contributed to understanding the psychoactive substances prevalent in the university context and associated aspects, emphasizing the need for interventions.