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BackgroundDue to limited diagnostic capacity and availability of point-of-care tests, diagnosis of Clade I mpox in the geographical regions most affected is usually on clinical grounds. This may be complicated due to the similarity between mpox and varicella (chickenpox) lesions. Visual assessment of lesions is also used for determining clinical progress and to assess patient outcomes in clinical trials. However, there has been no investigation into whether clinicians can (i) identify Clade I mpox compared to other viral lesions (ii) differentiate between Clade I mpox lesion stages.Methodology/principle findingsThe objective of this study was to evaluate inter-rater reliability and agreement between clinicians assessing lesions in patients with Clade I mpox. We presented experienced clinicians with 17 images of Clade I mpox or varicella and asked them to independently indicate the most likely diagnosis-mpox or varicella-and to categorise the lesions according to their stage. When selecting the most likely diagnosis, accuracy varied across all images, the inter-rater reliability was poor (κ = 0.223; z = 10.1) and agreement was moderate (Po = 68%). When categorising lesions according to their type, if a single lesion type was present in the image, inter-rater reliability was moderate (κ = 0.671, z = 40.6) and agreement was good (Po = 78%), but when multiple lesion types were shown in an image, both inter-rater reliability (κ = 0.153, z = 10.5) and agreement (Po = 29%) decreased substantially.ConclusionsThis study demonstrates that there are presently limitations in using visual assessment to diagnose Clade I mpox and evaluate lesion stage and treatment outcomes, which have an impact on clinical practice, public health and clinical trials. More robust indicators and tools are required to inform clinical, public-health, and research priorities, but these must be implementable in countries affected by mpox.

There is a complex interplay between infectious disease outbreaks and the stigmatization of affected persons and communities. Outbreaks are prone to precipitating stigma due to the fear, uncertainty, moralisation, and abatement of freedoms associated with many infectious diseases. In turn, this stigma hampers outbreak control efforts. Understanding this relationship is crucial to improving coordinated outbreak response. This requires valid and reliable methods for assessing stigma towards and within impacted communities. We propose adopting a cross-outbreak model for developing the necessary assessment tools. A stigma-informed approach must then be integrated into outbreak preparedness and response efforts to safeguard public health and promote inclusivity and compassion in future outbreaks.

Abstract Background Breast cancer is the most common type of cancer, accounting for 15% of all new cases. Hormone therapy (HT) is extremely effective in reducing breast cancer recurrence. However, adherence to HT medication is often poor due to negative side effects such as fatigue and sleep disturbances. Physical activity has been identified as a possible intervention to improve quality of life and reduce side effects of HT. Objective The objective of this systematic review was to summarise evidence of exercise interventions for women being treated with HT for breast cancer. Method Electronic searches were conducted from inception to March 2022 using Medline, SPORTdiscus, Embase, Scopus, PsycINFO and Web of Science databases. Searches included a combination of terms related to breast cancer, exercise, sleep disturbances, fatigue and HT. Results Ten eligible papers were identified, and their quality was assessed. Type, frequency, duration and intensity of exercise interventions varied. Exercise types included aerobics, strength/resistance training, walking and yoga. Heterogeneity of data made it difficult to draw conclusions. However, aerobic exercise interventions provide clear improvements in fatigue and sleep disturbances. Conclusions This review identified a lack of consistency in exercise recommendations for women being treated for breast cancer. It identifies that aerobic exercise can successfully improve fatigue and sleep disturbances, consistent with existing literature. Exercise has a range of benefits for this population, including improving psychological well‐being and quality of life. Clinicians should strongly advocate for engagement in exercise to promote overall physical and psychological well‐being in women being treated for breast cancer.