As the world's population ages, the prevalence of chronic low back pain (CLBP) is increasing, placing a substantial burden on individuals and health care systems. Mobile health (mHealth) apps offer a potentially scalable solution to support self-management, but little is known about how, why, for whom, and under what circumstances such tools work in real-world settings. This study aimed to test and refine 3 program theories-developed through a previous realist review-on how mobile apps support CLBP self-management. The goal was to understand the key contextual factors and mechanisms that influence when and why a digital self-management intervention may succeed or fail. A realist evaluation was conducted using one-on-one telephone interviews with 9 participants who had used the Curable app for 3 months to self-manage their CLBP. Realist interviews followed a teacher-learner cycle to explore, test, and refine the program theories. Abductive and retroductive analysis was used to develop context-mechanism-outcome configurations (CMOCs), which were synthesized into refined theories of digital self-management in chronic pain. A total of 20 CMOCs were constructed, supporting 3 overarching program theories centered on empowerment, self-management burden, and timing. First, the app was empowering when it offered credible and accessible knowledge that helped participants understand their pain, build confidence, and reduce reliance on health care providers. However, engagement depended on individual beliefs and expectations: those with strong biomedical views struggled to connect with the app's psychosocial framing. Second, while the app could ease the burden of self-management by offering support between appointments, it could also increase burden during flare-ups, when users lacked the capacity to engage. Features such as proactive content delivery and low-demand interfaces were viewed as essential for continued use. Third, timing emerged as a key factor. Early introduction was beneficial for some, but others needed to first accept the chronicity of their condition before they were ready to engage with self-management tools. Trust in the source recommending the app also influenced engagement. While clinician endorsement was often valued-especially early in the self-management journey-participants who had experienced unmet needs or disillusionment in clinical encounters reported that peer recommendations or nonclinical sources held greater weight. This highlights the importance of aligning recommendations with individuals' evolving relationships with authority and trust. Mobile apps like Curable (Curable Inc) can support empowerment and continuity of care in CLBP, but their success depends on personalization, timing, and relational dynamics. To prevent feelings of abandonment, such tools should be introduced as an adjunct to-rather than a replacement for-ongoing clinical support.

Rice2035: A decadal vision for rice research and breeding.

Abstract BACKGROUND Detection of a PIK3CA mutation (PIK3CAmut) is a prerequisite for treatment with currently approved PI3K inhibitors in breast cancer (BC). However, this was only recently introduced in testing guidelines, and cross-assay concordance studies are limited. Using available blood and tissue specimens from participants (pts) screened for the Phase 3 INAVO120 trial (NCT04191499) of the recently approved PI3Kɑ inhibitor inavolisib, we compared the ability of various molecular tests to identify PIK3CAmut. METHODS Data from FoundationOne®Liquid CDx (F1LCDx®; Foundation Medicine, Inc.) profiling on circulating tumor (ct)DNA was available for 1422 pts, either from central screening for study eligibility (n = 1383) or post-enrollment testing of ctDNA from local blood / tumor tissue test eligible pts (n = 39). Due to data / sample sharing restrictions, 43 pts from China were excluded from an otherwise global population. Retrospective to enrollment, DNA extracted from available archival / fresh tumor tissue was assessed by FoundationOne®CDx (F1CDx®; n = 323) sequencing and / or the Cobas® PIK3CA Mutation Test (a polymerase chain reaction [PCR] test; n = 84). Depending on the sample data available, assay concordance was evaluated for samples from both enrolled and unenrolled individuals. For certain assay comparisons, the fraction of samples in which a PIK3CAmut was detected by both assays is reported; where otherwise appropriate, traditional positive (+), negative (-), and overall percent agreement (PPA, NPA, OPA) between assays are reported. RESULTS Of the 1383 individuals screened centrally with F1LCDx, 500 (36.2%) had an enrollment-eligible PIK3CAmut; 242 of these plus the 39 local test-identified pts (n = 281) were enrolled in the study and comprised the efficacy-evaluable population for this analysis. F1LCDx was performed on available ctDNA from 37 / 39 local test-identified pts; 27 / 37 samples (73.0%) had a PIK3CAmut identified by both assays. Of the ten discordances, most could be explained by low ctDNA tumor fraction (median 0.0% in discordant, 6.0% in remainder). F1CDx was performed on available tumor tissue from 29 local test-identified pts; a PIK3CAmut was identified in all 29 (100%). F1LCDx and F1CDx data were available for 315 pts (214 enrolled and treated, 101 screened but not enrolled / treated). For this F1LCDx vs F1CDx analysis, PPA ([F1LCDx+ and F1CDx+] / F1CDx+), NPA ([F1LCDx- and F1CDx-] / F1CDx-), and OPA ([F1LCDx+, F1CDx+, F1LCDx-, F1CDx-] / all data) were 93.0% (226 / 243), 73.6% (53 / 72), and 88.6% (279 / 315), respectively. Cobas PCR and F1CDx data were available for 84 pts (42 enrolled and treated, 42 screened but not enrolled / treated). PPA ([Cobas+ and F1CDx+] / F1CDx+), NPA ([Cobas- and F1CDx-] / F1CDx-), and OPA were 90.2% (46 / 51), 100% (33 / 33), and 94.0% (79 / 84), respectively. With regard to efficacy, pts enrolled by a local test (hazard ratio for progression-free survival [PFS] 0.7; 95% CI 0.3-1.5; n = 39) or the F1LCDx central test (hazard ratio for PFS 0.5; 95% CI 0.3-0.7; n = 242) showed a similar response to inavolisib plus palbociclib and fulvestrant over placebo plus palbociclib and fulvestrant. CONCLUSIONS This comprehensive concordance analysis utilizing INAVO120 specimens demonstrated the ability of both tissue- and blood-based PCR and next-generation sequencing assays to robustly identify a pt population with PIK3CA-mutated, hormone receptor-positive, HER2-negative advanced BC who may consistently benefit from this INAVO-based regimen. Citation Format: S. Hilz, K. Kalinsky, D. Juric, N. Turner, K. Jhaveri, S. Im, S. Loibl, S. Loi, C. Saura, P. Schmid, E. Shaddox, N. Pantoja Galicia, C. Guo, Y. Li, W. Darbonne, R. Desai, M. Pagan, P. Karavagul, J. Aimi, S. Royer-Joo, J. Schutzmann, T. Stout, C. Song, P. Bedard, K. Hutchinson. Comparative analysis of blood- and tissue-based PIK3CA mutation detection methods in the pivotal Phase 3 INAVO120 trial of palbociclib + fulvestrant ± inavolisib in hormone receptor-positive, HER2-negative advanced breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-10-26.

Mitochondria are essential for cellular energy production and biosynthesis, thermogenesis, and cell signalling, and thus help coordinate physiological responses to changing environments. Humans (Homo sapiens) have adapted to cope with a wide range of climatic conditions, however the role of the mitochondrial genome (mtDNA) in mediating this process remains poorly understood. Here we curated a dataset of 19,570 publicly available full human mitochondrial genomes, an approximate 40-fold increase on earlier studies, paired with modern climate and reconstructed paleoclimate variables. Using a Generalised Linear Model approach, we identify independent candidate variants significantly associated with climatic conditions, suggesting local adaptation in human mitochondrial genomes. Candidate variants are distributed across multiple loci in regulatory, tRNA, rRNA and protein-coding regions - including prominently in ND2 and ND4 complex I subunits. Specific variants are predicted to impact mtDNA transcription, ribosome or protein structure, and multiple have been associated with disease pathologies. We further show that candidate variant genotype distributions are each best modelled by different paleo-bioclimatic variables, consistent with environmental stressors linked to our measured variables exerting subtly distinct selective effects. These stressors may reflect dietary changes or different thermogenic demands at lower temperatures. Our results provide genetic evidence to support the accumulating body of work from functional studies that mitochondria can modulate adaptation to diverse environments. This work underscores the importance of mtDNA in evolutionary biology and its relevance for understanding both disease and physiological variation in global populations.

The Cooling Needs to Reduce Indoor Humid-Heat Risks for Global Low-Income Populations Should Be Incorporated into Global Carbon Emission Reduction Plans

The tiger (Panthera tigris) is an apex predator and plays a fundamental role in sustaining biodiversity through its native range in Asia. By controlling populations of large herbivores and mesopredators, tigers help maintain the structural integrity of habitats, thereby supporting a diverse array of flora and fauna. Despite its ecological importance, the tiger is one of the most threatened large carnivores globally. It is classified as Endangered on the IUCN Red List, although threat categories vary among subspecies, and it is listed in Appendix I of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), which covers all tiger subspecies. Over the past two decades, global tiger populations have declined by more than 90%. Consequently, they have become the focus of conservation efforts, including captive breeding and reintroduction initiatives. However, the reintroduction of captive-bred tigers into natural habitats presents significant scientific and logistical challenges. This review synthesizes current knowledge on the complexities of using captive tigers for reintroduction programs, with particular attention to welfare and behavioral competence of captive individuals, and genetic diversity and health of founder populations. It further addresses critical considerations for habitat suitability and managing potential human-tiger conflict and evaluates the overall effectiveness and feasibility of tiger reintroduction as a conservation strategy.

Over half of the global population resides in urban areas and a vast majority of adults worldwide own smartphones, which increasingly become pervasive sensing and intervention platforms, positioning human–computer interaction at the center of everyday behavior change (Harari & Gosling, 2023; Pawar, 2025; Ritchie et al., 2025). Building on this opportunity (An et al., 2023; Gao et al., 2024; Wang et al., 2023), we propose a scoping review that maps how digital health via smartphone (i.e., mobile health) uses artificial intelligence (AI) systems to assess and promote physical activity (PA) in urban areas (see Figure 1). The review will pay explicit attention to psychosocial theory integration, inclusivity and ethical considerations as well as sustainability aspects of AI systems. We will synthesize literature that spans mobile sensing, machine learning assessment, and AI-enabled interventions, while emphasizing design considerations for responsible, human-centered real-world deployment. The aims are to (1) chart the landscape of AI-enabled systems on smartphones as mobile health assessment (e.g., passive sensing, computer vision, natural language processing) and intervention (e.g., just-in-time adaptive interventions, on-device/in-cloud causal reasoning); (2) identify how psychosocial theory (e.g., Integrated Behavior-Change Model, Social-Cognitive Theory, Behavior Change Techniques) is operationalized in algorithms, interfaces, and user journeys; (3) reflect on surface equity, ethical considerations, accessibility practices (e.g., language, ability, context constraints), and existing gaps; and (4) articulate sustainability levers (e.g., energy-aware modelling, on-device vs. in-cloud computing). Following the PRISMA-ScR framework, we will implement a transparent, reproducible protocol with the following eligibility choices (Peters et al., 2022; Tricco et al., 2018): (a) Population: adults (18+), Concept: smartphone-based AI systems for PA - assessment and intervention - plus system development processes - psychosocial theory, inclusivity, ethics, and sustainability -, Context: urban areas globally; (b) Source databases spanning health and technology research (e.g., PubMed, PsycINFO, SportDiscus, Web of Science, Scopus, IEEE Xplore, ACM Digital Library) plus targeted citation searching on seed references (Hirt et al., 2024); (c) Timeframe includes studies from the first AI deployed on smartphones onward (i.e., Siri in 2011; Bosch, 2018) in English and German; (d) Data charting extracts methodological variables (e.g., design, sample, context) and outcome domains aligned with our conceptual framework: Technology (i.e., AI-type; on-device vs. cloud; sensing modalities), PA outcomes (e.g., exercise, daily activity, sedentary behavior disruption, active transport), psychosocial theory factors (e.g., intention, habit), inclusivity and ethics (e.g., accessibility, subgroup tailoring), sustainability (e.g., energy/climate considerations, nature-linked activity design), and system idea/development process (e.g., assessment or intervention, research vs. business, co-creation). Analysis will be descriptive (e.g., frequencies, evidence maps) with a conceptual synthesis of AI system designs and disseminations as mobile health via smartphones in urban areas. This review thus covers mobile health in applied contexts (i.e., PA promotion and behavior maintenance through AI via smartphones as everyday technology) and provides a rigorous map of current mobile health research, populations which are targeted, and conditions under which mobile health is implemented. A forward-looking agenda for informed, inclusive, ethical, and sustainable human–computer interaction in mobile health research and practice for the AI era concludes the review.

Psoriasis, long thought to be a chronic immune-mediated dermatological disease, is now being reclassified as a systemic inflammatory disease with substantial metabolic and hepatic complications. Psoriasis affects approximately 2-3% of global population and is associated with up to 50% risk of systemic comorbidities. This mini-review examines the evolving understanding of psoriasis pathogenesis, focusing on the interaction of immunological dysregulation, keratinocyte hyperproliferation, and systemic cytokine release. Tumour necrosis factor- alpha (TNF)-α, IL-17, IL-23, and IL-6 are pro-inflammatory mediators that cause cutaneous plaque formation and reach the systemic circulation, leading to insulin resistance, atherogenesis, and liver inflammation. The review identifies common immuno-metabolic pathways, including TNF-α/NF-κB activation, the IL-23/Th17 axis, and dysregulated PI3K/Akt/mTOR signalling, that contribute to psoriatic illness and associated disorders like metabolic syndrome and metabolic dysfunction-associated steatotic liver disease (MASLD). Epidemiological studies demonstrate that psoriasis patients have a high prevalence of obesity, type 2 diabetes, dyslipidaemia, regardless of established risk factors, supporting the updated classification of NAFLD as MASLD. These findings lend support to the idea that psoriasis is a multi-organ disease caused by chronic low-grade inflammation. Clinically, this requires a transition from skin-centred treatment to thorough systemic examination and customised, multidisciplinary management. Targeted biologic treatments, such as IL-17 and IL-23 inhibitors, offer potential for lowering both systemic inflammation and cutaneous symptoms. This review supports early screening, metabolic monitoring, and lifestyle changes as critical components of long-term psoriatic therapy. Recognising psoriasis as a systemic condition is critical for improving overall patient outcomes, lowering morbidity, and avoiding long-term consequences.

Decarbonisation of urban areas is essential to reaching climate neutrality, as cities house half the global population and account for over 70% of carbon emissions. However, applying innovative approaches, such as establishing positive energy districts (PEDs), remains challenging due to stakeholder engagement and funding constraints, largely driven by knowledge gaps and a lack of best practices. This study examines barriers, facilitators and lessons learnt from six case studies in Europe, Canada and Singapore through a mixed-methods approach, including stakeholder interviews, grey literature analysis and a semi-structured review. Findings highlight district heating networks, heat pumps and photovoltaics as key technologies, with regional variations. While Mediterranean regions prioritise solar energy, northern climates employ a diverse range of solutions, including geothermal and seasonal storage. Political commitment and funding enable progress, whereas regulatory gaps and stakeholder misalignment hinder it. The study underscores the need for sharing best practices to enable PED implementation.

The United Nations Human Development Index, which incorporates income, education and health, is arguably the most widely used alternative to gross domestic product. However, official country-resolution estimates (N=191) limit its use. We build on recent advances in machine learning and satellite imagery to produce and distribute global estimates of the Human Development Index for municipalities (N=61,530) and a 0.1°×0.1° grid (N=819,309). To construct these estimates, we develop and validate a generalizable downscaling technique based on satellite imagery that allows for training and prediction with observations of arbitrary size and shape. We show how our estimates can improve decision-making and that more than half of the global population was previously assigned to the incorrect Human Development Index quintile within each country due to aggregation bias. We publish the satellite features necessary to increase the spatial resolution of any other administrative data that is detectable via imagery.

Aquaculture is one of the fastest-growing food production sectors and is expected to meet the majority of future fish demand as the global population surpasses 8 billion. The sustainability issues with traditional fishmeal-based meals have prompted research on plant-based substitutes. This study summarizes studies on the use of unconventional plant resources in the diets of Labeo rohita (rohu), a significant large carp in India, such as sweet potato leaves, mustard oil cake, and Delonix regia leaf meal. We discussed impacts on growth, digestibility, enzyme activity, hematological parameters, immunological modulation, and anti-nutritional factors (ANFs). Plant feeds minimize environmental impacts, save costs, and promote fish health when processed adequately, with optimal inclusion levels of 10-40%. However, ANFs like tannins and phytates limit higher substitutions. Results back up plant feeds as practical, environmentally beneficial choices for sustainable rohu farming, along with processing suggestions.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a global health concern that affects nearly one-quarter of the world's population. General control non-repressed protein 5 (GCN5), a histone acetyltransferase (HAT), has been implicated in the progression of several diseases, but its role in MASLD remains unclear. Here, we provide the experimental evidence that progressive human and male murine MASLD is driven by GCN5, but not by p300/CREB binding protein associated factor (PCAF) activation. Hepatocyte-specific GCN5 overexpression accelerates MASLD progression, whereas its ablation alleviates disease severity. Moreover, pharmacological inhibition of GCN5 with CPTH2 protects against MASLD. Metabolomics and RNA-seq analyses demonstrate that GCN5 promotes de novo lipogenesis (DNL) by upregulating SREBP1c-mediated transcription of lipogenic genes. Mechanistically, GCN5 acetylates histone H3 at the SREBP1c promoter, enhancing transcription through its intrinsic acetyltransferase activity. Our findings further identify GCN5 as a key regulator of LXRα-induced SREBP1c expression, suggesting that targeting GCN5 may selectively inhibit SREBP1c-driven DNL without impairing LXRα-mediated reverse cholesterol transport (RCT). Notably, combined treatment with the Liver X Receptor (LXR) agonist T0901317 and CPTH2 synergistically reduced lipid accumulation in vitro and in vivo, highlighting a promising therapeutic strategy for MASLD.

Given that structural and systemic racism in the United States has led to significant wealth gaps for some global majority populations, student debt may have even more costly impacts on the career outcomes for Black arts graduates in comparison to their White peers. Therefore, we investigated the research question, what effects do race and student loan debt have on the career choices of U.S. Black college arts graduates? To answer this research question, we tested our hypothesis using data from the National Survey for College Graduates (NSCG). Relative to White arts graduates, Black arts graduates are more likely to have borrowed to pay for school, still owe on their debt, and conditional on having borrowed and owing; they borrowed and owe more. They are also 12.5% less likely to work in the arts relative to White arts graduates, and to pay for college with funding sources that do not require repayment such as assistance from family and personal savings. As a result of these findings, we pose implications for cultural policy, as well as pose further research for future inquiries.

Current research on risk factors of dementia predominantly focuses on genetics and lifestyle, yet maternal influences are understudied; we aimed to examine how maternal age at childbirth affects offspring's cognitive function in middle and older age. Data were derived from 3549 offspring in the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018). Maternal age was categorized into four groups (<22, 22-28, 29-35, and >35 years). Linear mixed‑effects models were used to estimate baseline differences and longitudinal rates of change, with covariates adjusted in a hierarchical sequence (demographic, socioeconomic, lifestyle, and health‑related). The negative association between advanced maternal age (>35years) and offspring baseline cognitive score attenuated with sequential covariate adjustment but remained significant: it was -0.290 SD (95% CI: -0.486, -0.093) in Model1 and -0.223SD (95% CI: -0.422, -0.024) in the final Model4. No significant difference in the rate of cognitive decline was observed across maternal age groups. This finding suggests that advanced maternal age is associated with poorer cognitive performance at baseline in middle and older age. Future studies should replicate these findings in diverse global populations and settings with longer follow-up periods to clarify the complex relationship between maternal age at childbirth and offspring's cognitive aging. Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of our research.

ABSTRACT Depression reduces the quality of life of older adults with disabilities, adversely impacting the healthy aging of the global population. This study examined whether social participation and self-rated health play a chain mediating role between socioeconomic status and depressive symptoms in elderly people with disabilities. The data were derived from the Chinese Longitudinal Healthy Longevity Survey (n = 1,354). Results indicate that total family income had a direct impact on depressive symptoms (β = −0.220, 95%CI: −0.417, −0.022) and an indirect impact through social participation (β = −0.040, 95%CI: −0.081, −0.009) and self-rated health (β = −0.149, 95%CI: −0.246, −0.055), with a significant serial mediation effect (β = −0.022, 95%CI: −0.040, −0.007). Policies should prioritize integrated delivery of economic support, social-participation facilitation, health security, and comprehensive services to provide targeted assistance to low-education disabled oldest-old adults, and should actively foster their sustained societal engagement through community-based, barrier-free, and low-tempo activity designs.

Background: Strabismus, a condition characterised by eye misalignment, affects 2-5% of the global population, leading to vision problems, psychological distress, and social challenges. Despite surgical interventions aiming to realign the eyes, predicting outcomes remains difficult, and there's a lack of data on strabismus surgery outcomes in Tanzania, hindering effective service planning and resource allocation. Aim: The study aimed to evaluate the outcomes of strabismus surgery and its associated prognostic factors among strabismus patients attending KCMC Hospital in Northern Tanzania over ten years. Participants and Methods: A hospital-based analytical cross-sectional study was conducted at the ophthalmology department of KCMC in Tanzania. Medical records of 115 patients undergoing first-time strabismus surgery from January 2011 to December 2020 were analysed. A successful outcome was defined as a postoperative deviation angle within 10 prism diopters of exotropia or 5 prism diopters of esotropia of orthophoria at 1 week postoperatively. Factors associated with surgery outcomes were assessed using a generalised linear model, considering variables with P &lt; 0.05 as statistically significant. Results: Over the study period, 115 patients underwent first-time strabismus surgery, with the majority presenting at or before age 9 and a significant proportion undergoing surgery at this age. Most cases had preoperative angles exceeding 45 degrees, following surgery, 71.3% achieved orthophoria, while complications were noted in 34.8% of cases, which were mainly under-corrected due to large angles. Analytically, associations between demographic and clinical factors and surgical outcomes were explored. Participants with acquired strabismus exhibited a significantly higher proportion of good outcomes compared to congenital cases (p = 0.015). Larger pre-operative angles (&gt; 45 degrees) were associated with poorer outcomes (p = 0.001), while smaller angles (≤ 20 degrees) showed a trend towards better outcomes (p = 0.083). Furthermore, age at presentation, laterality, and angle before surgery significantly influenced surgical outcomes. Participants aged 10-19 years were 1.4 times more likely to have a good outcome compared to those aged ≤ 9 years (CPR = 1.4, 95% CI: 1.12-1.70). Conclusion: Three-quarters of patients achieved orthophoria post-surgery. While factors like type of strabismus, preoperative angle, and type of horizontal strabismus showed clinical association with successful outcomes in crude analysis, they did not remain significant when adjusted. This study, like others, suggests that prognostic factors remain unpredictable for successful strabismus surgery outcomes.

According to the WHO, parasitic diseases affect 4.5 billion people, which is more than half of the world's population. Their prevalence depends on the level of hygiene habits of the population, sanitary and hygienic literacy, and preventive focus. An important aspect in this issue is the study of knowledge and the level of awareness of the population about parasitic diseases. Objective of the study: to analyze public awareness of parasitic diseases and the potential risks to human health associated with them. The preventive focus of the survey consisted of the development, publication and distribution of an information leaflet in the Internet community on ascariasis and enterobiasis. Material and methods: the survey was conducted from February to April 2025 on the Google Forms platform. A structured questionnaire consisted of 33 questions, the test group included 205 Internet users. Statistical processing of the obtained results was performed using SPSS version 28.0.1 software. Results: were based on the responses of 205 subjects aged 10-59 years, obtained using Google Forms through an online survey. A typical feature of the survey is the dominance of women - 60.5%, men accounted for 39.5%. In terms of education structure, respondents with higher education (51.2%) led, followed by secondary (43.4%) and primary (5.4%) education. The age of the subjects varied from 14 to 49 years, and the Kyrgyz prevailed in the national structure (52.1%). Their place of residence was most often associated with an urbanized environment (80.5%). The majority of respondents self-assessed their health as good (48.8%), then satisfactory (25.4%), excellent (22.0%), and only (3.8%) as poor. The assessment questions were designed in such a way as to take into account all routes of human infection with parasitic diseases. According to the alimentary route of infection, it was found that the absolute majority of respondents (97.7%) wash their hands before eating, while 41.0% of subjects did not wash their hands before eating after talking on mobile phones. An assessment of the waterborne route of infection showed that 39.5% of respondents had once drunk water from an open body of water. Social networks were the most popular way to obtain information about parasitic diseases (86.3%), followed by everyday communication with family, friends, and colleagues (80.5%), Google search (80%), scientific articles (59%), and news (58%). Conclusions: A survey of internet users revealed gaps in knowledge regarding parasitic diseases transmitted by various routes. While 15.6% of respondents reported having had a parasitic disease, only 9.8% reported having had one in the past 12 months. Most respondents neglect certain aspects of personal hygiene and dietary hygiene, thereby underestimating the risk of developing a parasitic infestation. They likely do not perceive parasitic diseases as severe, misjudging potential complications.

As the world's population increases, traditional food sources face various constraints. This has renewed interest in the domestication and value addition of alternative food sources such as edible insects for nutrition and food security, as they are rich in proteins, fats, amino acids, flavonoids, minerals, and vitamins. Among these insects, the larvae of Rynchophorus spp (Coleoptera: Curculionidae) have a demonstrated potential as a sustainable and nutritious food source. Attempts to develop new insect farming techniques, improved harvesting methods, and creation of value-added products from palm weevil larvae such as powder, flour, and snacks are on the increase. However, their potential is yet to be fully explored due to insufficient domestication and value addition efforts. The main obstacles to the success of palm weevil larvae value chains include lack of knowledge and awareness among farmers and consumers on nutritional value of the weevils and the scarcity of regulations and policies to govern their farming and marketing, leading to market limitations and hindering large-scale production. With concerted efforts and more investment in palm weevil larvae value chain development, these larvae can potentially contribute significantly to food and nutrition security. We recommend the adoption of sustainable palm weevil larvae farming practices, strengthening of quality control standards, and promotion of cultural shifts towards insect consumption. Implementing more efficient and automated production and processing methods, as well as exploring the potential of using the insects for animal feed and other valuable by-products, can help achieve a more sustainable approach to farming palm weevil larvae.

The global aged population is expected to reach 2.1 billion by 2050 and ∼40% of them will live in rural areas of low- and middle-income countries (LMICs). This systematic review aims to synthesize the qualitative literature on rural older adults' experiences of health-seeking in LMICs as well as explore the factors that influence their experiences during their health-seeking journeys. We searched Embase, MEDLINE, PsycINFO, and CINAHL to identify studies published from 1 January 2002 to 31 December 2024 (PROSPERO registration ID: Blinded For Review). We used a thematic synthesis approach to analyse included studies. Among the 19 studies with 28 articles and 484 participants included, 16 were rated as high quality, 9 as moderate quality, and 3 as weak quality. We identified four primary analytic domains associated with their experiences in health-seeking journeys: (i) individual-depicting the inner world of rural older adults; (ii) interpersonal-navigating the rural social network; (iii) organizational-navigating the rural health care systems, and; (iv) community and macrosystems-economy, society, and public policy in rural areas. Rural older adults in LMICs have experienced unique and multi-level challenges in seeking care. To overcome these challenges, rural older adults demonstrated resilience and creativity (e.g. utilizing informal institutions), to navigate their health-seeking journey. Future research should aim to better understand the resilience and agency in local older adults' health-seeking experiences and provide constructive solutions to overcome identified barriers to care.

Association between cardiovascular-kidney-metabolic syndrome and chronic obstructive pulmonary disease: a cross-national analysis from global, US, and Chinese populations.