Global Health Issue Research Articles

A Good Practice for Learning with Public Health Professionals Globally: Humphrey Fellowship Program

Abstract Background International collaborations are valuable yet often undervalued assets that enhance the quality of public health education and bolster the development of the public health workforce. Objectives The Humphrey Fellowship Program, part of the Fulbright Exchange Program, facilitates mid-career professionals’ visits to US-based host universities for an academic year. Fellows engage in a semi-structured fellowship period to achieve self-defined goals, emphasizing professional development, expanded experience, and intercultural exchange. This study advocates for the program’s contribution to enhancing public health education. Results Currently, two universities host fellows in public health. Over decades, fellows have engaged with faculty and professionals, participated in classes and meetings, visited institutions for development purposes, and completed US-based affiliations, contributing significantly to their own and the public health workforce’s advancement. This interaction-based learning approach aids in navigating social and ethical challenges by fostering a deeper understanding of public and global health issues across countries. Conclusions The Humphrey Fellowship Program in public health stands as a commendable model. Similar initiatives could be beneficially replicated in the European region, leveraging local and global successes to strengthen ties with public health education institutions, student communities, and beyond. Key messages • Programs that facilitate international interactions can enhance public health professionals’ understanding of global perspectives. • The Humphrey Fellowship Program in the US stands as a commendable practice for mid-career public health professionals, contributing significant value to the education at host universities.

4.P. Round table: Advancing genomic diagnostics for rare genetic diseases: a focus on non-clinical domains of HTA

Abstract Genetic rare diseases are a burning global public health issue requiring a thorough assessment of the related burden. Unfortunately, curative therapies are oftentimes unavailable for genetic rare diseases; nevertheless, a prompt diagnosis could allow clinicians to elaborate supportive care plans for patients and their caregivers, determine the best care setting, and potentially consider enrolling them in clinical trials, if suitable. Innovative, effective, and sustainable diagnostic techniques, such as Whole genome sequencing (WGS), are needed to address this growing health concern. At global level, there is a paucity of research that specifically investigates the implementation of WGS into clinical practice which is even more constrained at the European level. Furthermore, given the current challenges impacting pediatric patients suspected of having genetic diseases without a definitive diagnosis, there is an urgent need to improve the diagnostic workflow based on genomic techniques, such as WGS. Delving into this topic could contribute valuable insights that can inform policymakers, at macro-level, and health professionals, at micro-level, on how to develop suited genomic policies and clinical guidelines for the proper adoption of WGS within the daily clinical practice. From an international standpoint, it could be argued that these considerations resonate with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (i.e., “Good health and well-being”) and 10 (i.e., “Reduced inequalities”), as a priority for research and action. Notwithstanding, the broader implementation of WGS encounters hindrances owing to its complexity and the multifaceted social, economic, organizational, and ethical implications. In view of these challenges, Health Technology Assessment (HTA), as an integrated and multidisciplinary process, provides a comprehensive framework for the evaluation of these dimensions. This round table is intended to provide attendees with insights into nonclinical domains of HTA of WGS which, unlike clinical domains, demand a nuanced approach within the framework of the HTA. The intended objective is pursued through the initial presentation of a case study on the evaluation of WGS in paediatric genetic disorders from the Italian National Health Service perspectives followed by an open discussion with experts. The discussion will delve into issues related to economics, genomics, health services organization and ethics. Key messages • For pediatric patients suspected of having a genetic disease, WGS could shorten the so-called diagnostic odyssey. • Context-depending aspects of implementing WGS should be properly taken into account through HTA.

Determinants of COVID-19 vaccination acceptance based on the novel Omale INDEPT FORCIS Framework and recommendations for subsequent pandemics: a qualitative study among community members in Ebonyi state, Nigeria

BackgroundThe unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics.MethodsThis qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four ‘Cis’) Determinants of Vaccination Acceptance Conceptual Framework – Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach.ResultsThe many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual’s condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns.ConclusionThe evidence illuminates complex and interrelated, specific underlying, and peculiar policy-relevant LONING determinants of COVID-19 vaccination acceptance and emphasizes the need for concerted and comprehensive LONING strategies (involving all the relevant LONING stakeholders/policy makers) in addressing these determinants to increase vaccination acceptance among community members in subsequent outbreaks/pandemics in Ebonyi state/Nigeria and similar settings.

6.X.2. Food Insecurity in Europe: Voices from across Europe

Abstract Food insecurity (FI), “lack of regular access to enough safe and nutritious food for normal growth and development and an active and healthy life”, is a global public health issue. The United Nations (UN) have identified achieving food security as a key Sustainable Development Goal (SDG), where all people should “have access to safe, nutritious, and sufficient food all year round.” However, disasters related to the consequences of changing climates, pandemics, wars, displacement of populations, high inflation rates, changes in social protection systems, and food system changes challenge the achievement of this SDG. FI persists even in high-income countries including Europe. This workshop session will foster a knowledge, research and experience exchange on the situation of individuals / different population groups in the context of FI in different European countries. Starting with a contribution from Austria, the term food poverty is introduced and considered from a food system perspective / from an equity perspective. The second contribution illuminates the relationships between FI, shopping behaviours and social support among food bank users in Germany during the COVID-19 pandemic. The final third contribution comes from the Netherlands and explores the needs and perceptions regarding healthy eating among people at risk of FI. In all three studies, standardized measurement tools were applied to measure FI but recruiting methods and data collection methods varied considerably between and within the studies. The session enhances the knowledge on FI in Europe from different perspectives. Key messages • Food insecurity does exist in Europe: there is a need for regular, consistent monitoring across European countries. • Food insecurity involves more than just access to food; it also considers nutritious and climate-friendly options, addressing the link between climate, health, and equity.

What is driving food insecurity risks in UK households with children?

Abstract Background Food insecurity is a global public health issue, disproportionately affecting households with children in the UK. Despite increased research attention, there remains a gap in understanding why prevalence of food insecurity is higher in this demographic. This study aims to address this gap. Methods Utilising data from the 2021/22 and 2022/23 Family Resources Survey, an UK annual cross-sectional survey, we investigate the association between sociodemographic and economic factors, and the risk of food insecurity among households with children. Logistic regression analysis was used, with food security treated as a binary outcome variable. Control variables included receiving means-tested benefits, disabilities in a household, region within the UK, and the ethnicity, highest education level and marital status of the household reference person. A total of 41127 households were included, with 10137 being households with children. Results Our preliminary findings reveal stark inequalities, with 12.0% of households with children experiencing food insecurity, compared to 6.4% of households without children (p-value for comparison <0.0001). After adjusting for control variables, the odds of food insecurity among households with children was 1.40 (95% CI: 1.27, 1.54) compared to households without children. Adding equivalised household income after housing costs attenuated the relationship but households with children remained at significantly higher odds of food insecurity (OR: 1.32 (1.20, 1.45)). Conclusions This preliminary analysis demonstrates that, after adjusting for control variables and equivalised household income after housing costs, having children in a household is still associated with a higher risk of food insecurity. This underscores the need to understand the mechanisms underlying this relationship further. Such insights are essential for informing targeted policies and interventions aimed at mitigating food insecurity among households with children. Key messages • Having children independently increases the risk of food insecurity in households in the UK. • Moving forward, our aim is to understand the mechanisms underlying the relationship between households with children and food insecurity.

Smartphone addiction among medical students in the University of Monastir, Tunisia

Abstract Background Smartphone addiction is a global mental health issue with diverse psychological and socioeconomic concerns. The aim of this study was to determine the prevalence of smartphone addiction and its associated factors among medical students in the university of Monastir, Tunisia. Methods We conducted a cross-sectional survey among medical students of the faculty of medicine of Monastir in October 2020. The data were collected through a self-administered anonymous questionnaire that included the SAS-SV scale to assess smartphone addiction levels. A multivariate logistic regression model was employed to identify associated factors. The threshold of statistical significance was set at p < 0.05. Results A total of 626 medical students participated in this study, with an average age of 21.76 ± 3.12 years and a sex ratio of 0.41. The prevalence of smartphone addiction was 30.2% (95% CI: 26.0% - 33.79%). Associated factors with smartphone addiction included academic repetition(OR = 4.30; 95% CI [1.38 - 13.42]), fast food consumption scores (OR = 1.55; 95% CI [1.21 - 2.00]),addiction to the Facebook social network (OR = 6.36; 95% CI [1.92 - 21.07]), cohabitation with colleagues (OR = 2.13; 95% CI [1.03- 4.43]), cohabitation with family members(OR = 2.10; 95% CI [1.01 - 4.36]) and stress level (OR = 1.13; 95% CI [1.07 - 1.18]). Conclusions This study identified associations between smartphone overuse and other behavioral and mental health indicators. Based on these findings, several interventions should be undertaken to address this growing concern. Key messages • The prevalence of smartphone addiction among medical students in the University of Monastir was 30.2% (95% CI: 26.0% – 33.79%). • The main associated factors with smartphone addiction were academic repetition, fast food consumption, addiction to Facebook, cohabitation with colleagues and with family members and stress level.

Ethics in social listening in infodemic management in health emergencies

Abstract Issue During the COVID-19 pandemic and subsequent outbreaks, health organizations have increased the use of social listening to inform infodemic management and outbreak response activities. This demonstrated the need to provide ethical guidance to organizations, and individuals engaging in social listening practices before, during and after public health emergencies, whilst protecting human rights. Description of the problem Social listening as a public health activity draws on analysis of conversations in social media, internet platforms, and feedback from geographically localized communities. Infodemic insights are generated rapidly, to support agile action by health organizations that improves outbreak response, health information delivery, community engagement, or reduction of unintended harm experiences by communities. Social listening involves use of social media and internet trace data, which were traditionally not used in public health for understanding community expressions, WHO convened a panel of experts to develop a framework on ethical considerations for social listening in infodemic management to provide recommendations for health authorities and researchers on practical tools that support setting up new data analysis and use of insights hereto not used in routine. Results The guidance framework has been structured into segments that vary from ethical principles and challenges in social listening and generation of infodemic insights, alignment with human rights, substantive principles, procedural principles, and practical guidance for translating these principles into real-world practice. Lessons This guidance aims to illuminate the intricate ethical dimensions of social listening and stress the urgent need for ethical guidance in this realm. The framework is a comprehensive inquiry of the ethical scope in social listening, providing valuable insights, practical guidance, and case studies to enhance understanding of this critical global health issue. Key messages • While essential, social listening and infodemic insights come with ethical risks, including potential harm to populations in vulnerable situations, erosion of trust, and misuse of data. • This ethical framework will govern social listening practices and ensure responsible and ethical social listening.

What are the health system impacts of engaging with global health activity? A qualitative study

Abstract Background Global health partnerships between high-income health systems and low- and middle-income countries (LMICs) are becoming more common as there is an appreciation of the need for collaboration to solve global health issues through knowledge and skill exchange. However, partnership evaluations largely focus on the benefits to individual participants and recipient systems, with little evidence of the impacts on the high-income system. Therefore, the aim of this study was to explore the health system-wide impacts of engaging with global health activity and consider the arguments for and against adopting these partnerships. Methods We carried out semi-structured interviews with individuals from three UK health systems that engage with global health activity to explore their motivations to in doing so. Transcripts were thematically analysed. Results We found that engagement in global health activity can contribute to workforce recruitment, retention, development, and upskilling, benefiting the system. Examples were also given of system-wide clinical, reputational, and economic benefits. However, this activity impacts short term staffing and can cause personal emotional issues that systems need to support. We also explored facilitators of engaging in global health work which included operational support, supporting healthcare staff to engage, and system acceptance. Barriers included lack of senior buy-in, opportunity access inequities, operational challenges, and the current UK health system challenges. Conclusions This study demonstrated the potentially significant system-level benefits of engaging in global health activity. These focused on improved workforce, which is a major public health issue worldwide. We have also identified system characteristics, such as buy-in and operational support, which influence success. We hope this work provides a building block demonstrating there are benefits to be had for donor health systems, but barriers must be overcome. Key messages • The potential benefits and drawbacks that may arise from high-income health systems engaging in global health, as well as facilitators and barriers, are explored. • This study creates a foundation to understand donor-system benefits and encourages further research, particularly in systems who do not engage with global health activity to understand why this is.

The 5-Item Modified Frailty Index (mFI-5) for risk stratification of patients with infective endocarditis undergoing cardiac surgery

Abstract Background population aging has led to an increased burden of frailty as an emerging global health issue, and variables for its quantification in patients with infective endocarditis (IE) are lacking in current surgical risks scores. The 5-item modified frailty index (mFI-5) score has shown to be effective in the prediction of surgical outcomes in other medical scenarios. Purpose this study aimed to assess the role of the mFI-5 in the prediction of surgical outcomes in patients with left-sided IE undergoing cardiac surgery. Methods a total of 112 cases of confirmed left-sided IE undergoing surgery, were consecutively collected and followed during one year after diagnosis in two tertiary hospitals between 2016 and 2021. The mFI-5 score included 5 baseline patient-specific comorbidities: diabetes, congestive heart failure, non-independent functional status (Barthel index <80), hypertension and chronic obstructive pulmonary disease (range 0-5), and patients were categorised as mFI-low (<2, n=65), and mFI-high (>=2, n=47). Results mean age was 66 [SD 15] years, 67% were men and community-acquired infections were 75%. As shown in Table 1, mFI-high patients were older and, aside from the specific comorbidities included in the score, with more chronic kidney disease. The most isolated pathogen was S. viridans (n=32), predominantly in mFI-low, in contrast to enterococcal and polymicrobial IEs, which were more frequent in mFI-high. Larger vegetations were reported in mFI-high [16 (10) vs 13 (9) mm, p 0.03], with no differences regarding infection site or periannular complications. Acute kidney injury, decompensated heart failure and higher natriuretic peptides were more common in mFI-high. Regarding mortality, in-hospital deaths were more frequent in mFI-high group. When analyzing mFI-score as a discrete variable, in-hospital mortality was associated with higher median scores values [2 (2) vs 1(1) points, p 0.02], being 2 points the optimal cutoff point for prediction [AUC 0.64 (95% CI 0.54-0.73), Fig.1A]. Among survivors who completed follow-up (n=82), rehospitalization and all-cause mortality rates in mFI-high exceeded those from mFI-low. Predictors of in-hospital and 1-year mortality were assessed by logistic regression (Fig. 1B), confirming the independent prognostic association of mFI-5-score in patients with IE undergoing surgery. Conclusions patients with IE undergoing cardiac surgery with higher mFI-5 scores were older, more predisposed to enterococcal and polymicrobial infections, and had a greater comorbidity burden with a more complicated clinical course. The mFI-score was independently associated with in-hospital mortality as well as rehospitalizations and 1-year mortality, positioning itself as an additional tool for risk stratification in this cluster of patients.Table 1Figure 1

Multidisciplinary approach to asylum seekers health assessment: a 5-year experience in Modena, Italy

Abstract Background Asylum seekers’ well-being represents a global health issue. They face significant challenges to their physical and mental health due to their migratory path. In the Modena province (Northern Italy), a multidisciplinary approach has been applied to the care of asylum seekers by Department of Public Health (DPH), with a team of specialists in infectious diseases, dermatology, gynaecology, obstetrics, psychology and preventive medicine. Asylum seekers receive a first visit, including medical and psychological assessment and screening for infectious diseases. Ad hoc pathways are also active for asylum seekers who need secondary-level care. This study aims to investigate the health status of asylum seekers referred to Modena Centre. Methods This cohort study enrolled asylum seekers hosted in Modena between November 2018 and May 2023. During the first visit, personal and anamnestic data were collected aided by cultural mediators, along with clinical assessment. Furthermore, Tuberculin-Skin-Test (TST) and blood tests for HBV-HCV-HIV-Syphilis were performed. Results A total of 646 migrants were included, 94% were males with a median age of 26 years (range: 15-50), the majority from Bangladesh (39%). Females were mostly from Ivory Coast (36%), median age of 30 years (range: 17-45). Most conditions were treated at the primary care level and were related to cutaneous disease (22%), only 11% of subjects required second-level diagnostics. Positive TSTs were 41% (N = 265). Of them, 55.5% (N = 147) also tested positive for QuantiFERON-TB. Screening for infectious diseases revealed positivity rates of 4% for HBsAg, 1% for HCVAb, 0.8% for HIV and 1.4% for TPPA+RPR. Conclusions The multidisciplinary approach is the innovative and strength point of this protocol for asylum seekers’ health ensuring prompt management of pathologies after their arrival. Moreover, data collection is useful for improving intake services and implementing public health programs for vulnerable individuals. Key messages • The innovation of this protocol for asylum seekers’ health lies in its multidisciplinary approach. • Clinical data collection will support health policies’ choices to protect vulnerable individuals.

Emerging Roles of ncRNAs in Type 2 Diabetes Mellitus: From Mechanisms to Drug Discovery

Type 2 diabetes mellitus (T2DM), a high-incidence chronic metabolic disorder, has emerged as a global health issue, where most patients need lifelong medication. Gaining insights into molecular mechanisms involved in T2DM development is expected to provide novel strategies for clinical prevention and treatment. Growing evidence validates that non-coding RNAs (ncRNAs) including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) function as crucial regulators in multiple biological processes of T2DM, inspiring various potential targets and drug candidates. In this review, we summarize the current understanding of ncRNA roles in T2DM and discuss the potential use of ncRNAs as targets and active molecules for drug discovery.

Effectiveness of robotic metabolic and bariatric surgery in patients with BMI ≥ 50-59.9 and BMI ≥ 60 for the treatment of severe obesity in a national medical center in Mexico.

Obesity is a global health issue that significantly increases morbidity and mortality when the Body Mass Index (BMI) reaches values ≥ 50. While metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, it carries risks. Robotic surgery is promising but not extensively studied in Mexico, which presents an opportunity for research at a National Hospital with an academic program. This retrospective study reviewed 44 patients who underwent robotic MBS using the da Vinci surgical system from January 2018 to August 2023 at Centro Médico Nacional 20 de Noviembre, ISSSTE. Data collected included surgery type, duration, complications, and weight loss metrics over 54months post-operatively. The study involved 44 patients with severe obesity including BMI ≥ 50-59.9kg/m2 for group 1 and BMI ≥ 60kg/m2 for group 2. The average initial BMI was 54.7kg/m2 for group 1 and 68kg/m2 for group 2. The average operative times for group 1 were 10.09min for docking, 86.23min for robotic console time, and 95.73min for total intraoperative time. Group 2 had average times of 9.80min for docking, 82.4min for robotic console time, and 92.2min for total intraoperative time. Follow-up showed significant weight loss initially, with weight recurrence after 24months due to different factors. No serious complications or mortality were observed. Robotic MBS at a national academic medical center in Mexico shows promising outcomes for patients with BMI ≥ 50-59.9 and BMI ≥ 60, with significant weight and BMI improvements at 54month follow-up. Further studies with larger cohorts and longer follow-up are needed to strengthen these findings.

ASSOCIATION OF SERUM ADENOSINE DEAMINASE LEVELS WITH ACUTE KIDNEY INJURY IN DIABETIC PATIENTS

Diabetes mellitus is a significant global health issue, and complications such as acute kidney injury (AKI) are prevalent in patients with type 2 diabetes. Serum adenosine deaminase (ADA) has been suggested as a potential biomarker for various metabolic conditions, including inflammation and kidney injury, but its association with diabetic kidney health remains understudied. Objective: To assess the association of serum adenosine deaminase (ADA) levels with acute kidney injury (AKI) in patients with type 2 diabetes. Methods: This observational comparative study was conducted at DHQ Teaching Hospital KDA, Kohat, from February 7, 2023, to August 7, 2023, following ethical approval. A total of 120 participants were enrolled, including 60 patients with type 2 diabetes and 60 non-diabetic controls. Laboratory investigations for both groups included serum ADA (U/L), HbA1c (%), and estimated glomerular filtration rate (eGFR) (mL/min/1.73 m²). Statistical comparisons between groups were made using appropriate tests, and correlations between serum ADA and other parameters were assessed. Results: The mean age of diabetic patients was 55.40 ± 8.29 years, and that of controls was 54.58 ± 21.64 years. The mean serum ADA level in diabetic patients was significantly higher at 43 ± 4.29 U/L compared to 16.32 ± 1.20 U/L in controls (p = 0.0001). Diabetic patients had a mean HbA1c of 8.30 ± 0.59%, significantly higher than that of controls (5.28 ± 0.59%) (p = 0.0001). The mean eGFR in diabetic patients was 82.61 ± 17.22 mL/min/1.73 m², lower than in controls (105.97 ± 12.07 mL/min/1.73 m²) (p = 0.0001). In diabetic patients, serum ADA levels were positively correlated with HbA1c (indicating poorer glycemic control) and negatively correlated with eGFR (suggesting declining kidney function). Conclusion: Elevated serum adenosine deaminase levels in type 2 diabetic patients are significantly associated with poor glycemic control and decreased kidney function. These findings indicate that serum ADA could serve as a potential biomarker for monitoring glycemic status and kidney health in diabetic patients at risk for acute kidney injury.

Impact of Obesity Severity on Hepatic Steatosis and Systemic Inflammatory Markers: A Comparative Analysis Across Obesity Classes

Introduction: Obesity has become a global health issue, with its prevalence steadily increasing. It is closely linked to several metabolic disorders, cardiovascular diseases, non-alcoholic fatty liver disease, and chronic low-grade inflammation and can progress to more severe liver conditions. This study evaluates the relationship between obesity and inflammatory markers in individuals with different obesity levels. Methods: A cross-sectional study was conducted among 50 patients categorized into three obesity classes based on body mass index (BMI). Blood samples were taken to evaluate inflammatory and metabolic markers, including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP). Results: There were no statistically significant differences in inflammatory markers such as WBC, NLR, or CRP; a trend toward higher CRP levels was observed in Class 3 obesity. Conclusion: In our study, no statistically significant association was observed between inflammatory markers and the degree of obesity. Although the sample size was relatively small, it is essential to acknowledge that obesity is a multifaceted condition, and genetic variations may play a role in these results.

Reasons for Patients Preferring Extraction over Root Canal Treatment in a Tertiary Care Hospital

Introduction: Dental caries is a major global oral health issue, potentially progressing to irreversible pulpitis and causing substantial discomfort. Although advancements in materials, instruments and knowledge have improved the success rates of root canal procedures, some patients opt for tooth extraction instead of root canal treatment. This choice can result in tooth loss, necessitating costly prosthetic replacements. Objective: The objective of this study was to determine the reasons for patients choosing extraction over root canal treatment. Methods: A descriptive cross-sectional study was conducted among 205 patients visiting the Department of Conservative Dentistry and Endodontics at Kathmandu Medical College for the treatment of irreversible pulpitis, who ultimately opted for extraction. A structured questionnaire was utilized, and responses were recorded and analyzed using the Statistical Package for the Social Sciences. Mean, standard deviation, frequency and percentage were calculated depending upon the nature of data. Results: The study found that the primary reason for patients not undergoing root canal treatment (RCT) was the high cost of RCT and crown, accounting for 42.9% (88 patients), followed by the need for more appointments with pain, at 31.2% (64 patients). Conclusions: This study revealed the cost of RCT and crown to be the major factor for patients opting out from RCT. The study provides valuable insights into the psychology of patients regarding RCT, highlighting reasons for its rejection. Such understanding assists dentists and specialists in tailoring treatment plans that align with patient preferences and needs.

A bibliometric analysis of bladder cancer and microRNA research: Trends and advances from 2008 to 2022.

Bladder cancer (BC) is a significant global health issue with high incidence and mortality rates. MicroRNAs (miRNAs) play a crucial role in regulating gene expression and have been found to be dysregulated in BC. Understanding the role of miRNAs in BC development could lead to targeted therapies and improved patient management. Our study presents a thorough examination of the correlation between BC and miRNA research from 2008 to 2022. With the help of 3 powerful methods, including VOSviewer, Biblioshiny, and CiteSpace software, we analyzed the retrieved documents from "Core Collection databases online" on the Web of Science. In total, 798 articles were extracted from the Web of Science, and the number of published papers showed an upward trend from 2008 to 2019. The total number of citations was 21,233, of which the highest paper was a review article written by Chan Jiajia et al in 2018 with 752 citations. Based on the result of the coauthor analysis, Seki Naohiko was the most productive writer and China had the highest volume of published articles. Co-citation analysis was used to reveal the knowledge structure of the research field. In addition to the keywords "Bladder cancer" and "miRNA," "Proliferation," "Biomarkers," and "Apoptosis" were the high-frequency used keywords. Recently, increasingly researchers have paid more attention to the field about BC and miRNA around the worldwide. Through in-depth communication and close collaboration, the veil of miRNA in BC has gradually been unveiled. Bibliometric analysis helps to identify hotspots in research and areas for future investigation.

Machine-learning-based diabetes classification method using blood flow oscillations and Pearson correlation analysis of feature importance

Abstract Diabetes is a global health issue affecting millions of people and is related to high morbidity and mortality rates. Current diagnostic methods are primarily invasive, involving blood sampling, which can lead to infection and increased patient stress. As a result, there is a growing need for noninvasive diabetes diagnostic methods that are both accurate and fast. High measurement accuracy and fast measurement time are essential for effective noninvasive diabetes diagnosis; these can be achieved using diffuse speckle contrast analysis (DSCA) systems and artificial intelligence algorithms. In this study, we use a machine learning algorithm to analyze rat blood flow signals measured using a DSCA system with simple operation, easy fabrication, and fast measurement for helping diagnose diabetes. The results confirmed that the machine learning algorithm for analyzing blood flow oscillation data shows good potential for diabetes classification. Furthermore, analyzing the blood flow reactivity test revealed that blood flow signals can be quickly measured for diabetes classification. Finally, we evaluated the influence of each blood flow oscillation data on diabetes classification through feature importance and Pearson correlation analysis. The results of this study should provide a basis for the future development of hemodynamic-based disease diagnostic methods.

Natural compounds targeting miRNAs: a novel approach in oral cancer therapy.

Oral cancer (OC) is a significant global health issue, with high rates of both mortality and morbidity. Conventional treatments, including surgery, radiation, and chemotherapy, are commonly used, but they often come with serious side effects and may not fully eliminate cancer cells, resulting in recurrence and resistance to treatment. In recent years, natural products derived from plants and other biological sources have gained attention for their potential anticancer properties. These compounds offer advantages such as lower toxicity compared to traditional chemotherapy. Notable natural compounds like quercetin, berberine, curcumin, andrographolide, nimbolide, ovatodiolide, and cucurbitacin B have demonstrated effectiveness in inhibiting OC cell growth by targeting various signaling pathways involved in cancer progression. Recent breakthroughs in molecular biology have highlighted the crucial role of microRNAs (miRNAs) in the development of OC. Targeting dysregulated miRNAs with natural products offers a promising strategy for treating the disease. Natural compounds exert anticancer effects by influencing both altered cellular signaling pathways and miRNA expression profiles. This study aims to explore the role of miRNAs as potential molecular targets in OC and to investigate how natural products may regulate these miRNAs. Additionally, this review will shed light on the therapeutic potential of phytochemicals in modulating miRNA expression and their significance in OC treatment.

Exploring the Antidiabetic and Antihypertensive Potential of Peptides Derived from Bitter Melon Seed Hydrolysate

Background/Objectives: Type 2 diabetes (T2D) has become a critical global health issue, with an increasing prevalence that contributes to significant morbidity and mortality. Inhibiting dipeptidyl peptidase-IV (DPP4) is a promising strategy for managing T2D. This study aimed to explore the DPP4 inhibitory peptide derived from bitter melon seed protein (BMSP) hydrolysate. Methods: Reversed-phase high-performance liquid chromatography (RP-HPLC) was utilized to fractionate the hydrolysate. Peptide in the highest activity fraction was analyzed using liquid chromatography-mass spectrometry (LC-MS/MS). Peptide synthetic was used for further characterizations, such as bioactivity exploration, inhibition mechanism, molecular docking, and peptide stability against in vitro simulated gastrointestinal (SGI) digestion. Results: The BMSP hydrolysate was digested with gastrointestinal proteases (GP) and assessed for DPP4 inhibitory activity, yielding an IC50 of 1448 ± 105 μg/mL. Following RP-HPLC fractionation, MPHW (MW4) and VPSGAPF (VF7) were identified from fraction F8 with DPP4 IC50 values of 128.0 ± 1.3 µM and 150.6 ± 3.4 µM, respectively. Additionally, MW4 exhibited potential antihypertensive effects through ACE inhibition with an IC50 of 172.2 ± 10.6 µM. The inhibitory kinetics and molecular docking simulations indicated that both MW4 and VF7 were competitive inhibitors of DPP4, while MW4 was also a competitive inhibitor of ACE. Importantly, both peptides remained stable during simulated gastrointestinal digestion, suggesting their resistance to human digestive processes and their capacity to maintain biological activity. Conclusions: The findings suggest that BMSP-GP hydrolysate may have potential in terms of the development of health foods or therapeutic agents. However, in vivo studies are also essential for further confirmation of efficacy.

Risk Factors of Hepatitis Associated With Time to Adopting a New Cancer Screening Model Under Diffusion of Innovation Theory-A 10-Year Cohort Study in Taiwan.

Hepatitis is a serious global health issue. To reduce mortality, early screening for liver disease has been recommended in community health policies, particularly for asymptomatic individuals. This study explored the link between liver function biomarkers and how quickly people adopt a new multiple cancer screening program, using the diffusion of innovation (DOI) Theory. The study included 57,939 participants from a community-based screening program in Keelung, Taiwan, between January 1, 2001, and December 31, 2010. Data on demographics and lifestyle habits were collected through questionnaires, and blood samples were analyzed to measure biomarkers related to liver function. On average, participants took 3.48 years to accept the new screening program. People with healthier lifestyles, such as those who drank alcohol less often, were more likely to adopt the screening early. Additionally, those with higher levels of liver-related biomarkers like albumin, total protein, and ALT joined even sooner. In conclusion, using DOI theory, the study found that personal lifestyle and liver function play a role in how quickly individuals adopt a new screening system. These insights can help healthcare providers improve early screening efforts, particularly for people at risk of hepatitis and liver cancer, potentially reducing related deaths.