World Population Research Articles

The Healthcare Subsidy Assessment Survey: A Novel and Validated Poverty Assessment Tool to Inform Medical Cost Subsidization in Rural Uganda.

Approximately 30% of the global burden of disease is surgical, but two-thirds of the world's population cannot access safe, affordable, and timely surgical care. An ambulatory surgical center (ASC) in Uganda offers subsidized and free care to some patients, but identifying patients in greatest need is challenging. We aimed to develop an unbiased tool appropriate for medical settings to determine subsidy eligibility to prevent catastrophic healthcare expenditure (CHE) for ASC's patients. Utilizing a modified simple poverty scorecard (SPS), expert opinions, and literature review, the center developed a new poverty assessment tool (PAT), the healthcare subsidy assessment (HSA). The HSA was implemented alongside the SPS at ASC. Principal component analysis (PCA) was used to refine the HSA and establish a correlation between the original HSA and SPS to predict CHE likelihood. A 21-question HSA was developed, and 175 patients completed both the HSA and SPS. The questionnaires had a correlation of R2=0.294, p<0.001. PCA identified six distinct components, and the HSA was refined to an 11-question survey (rHSA). After rescaling to 100 for comparison to the SPS and the original HSA, rHSA scores were significantly different between both (p<0.001) but had an improved correlation with the SPS (R2=0.457, p<0.001) and a strong correlation with the original HSA (R2=0.621, p<0.001). We successfully developed and validated the rHSA, a novel PAT tailored for a healthcare setting to better identify and support patients at risk.

Integrated Geriatric Healthcare and Related Innovative Models

The intensifying trend of population aging has made geriatric healthcare a key concern for countries worldwide. According to the United Nations, the global elderly population is projected to increase to 1.6 billion by 2050 at which time persons above 65 years old are expected to account for 16% of the world's population (United Nations, 2023). To address this challenge, proactive and systematic approaches as well as innovative models are needed to implement practices, education, research, and policy measures (Mohd Tohit & Haque, 2024). Innovative healthcare models and policies are being continuously developed that address aspects such as interdisciplinary collaboration, diverse gender needs, talent cultivation, community assessment and management, and home-based emergency care. For the column in this issue, we invited experts from various fields of geriatric healthcare to share their significant developments and application experiences. Their articles highlight several key related points.

Advancing vegetable genetics with gene editing: a pathway to food security and nutritional resilience in climate-shifted environments.

As global populations grow and climate change increasingly disrupts agricultural systems, ensuring food security and nutritional resilience has become a critical challenge. In addition to grains and legumes, vegetables are very important for both human and animals because they contain vitamins, minerals, and fibre. Enhancing the ability of vegetables to withstand climate change threats is essential; however, traditional breeding methods face challenges due to the complexity of the genomic clonal multiplication process. In the postgenomic era, gene editing (GE) has emerged as a powerful tool for improving vegetables. GE can help to increase traits such as abiotic stresstolerance, herbicide tolerance, and disease resistance; improve agricultural productivity; and improve nutritional content and shelf-life by fine-tuning key genes. GE technologies such as Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR-associated protein 9 (CRISPR-Cas9) have revolutionized vegetable breeding by enabling specific gene modifications in the genome. This review highlights recent advances in CRISPR-mediated editing across various vegetable species, highlighting successful modifications that increase their resilience to climatic stressors. Additionally, it explores the potential of GE to address malnutrition by increasing the nutrient content of vegetable crops, thereby contributing to public health and food system sustainability. Additionally, it addresses the implementation of GE-guided breeding strategies in agriculture, considering regulatory, ethical, and public acceptance issues. Enhancing vegetable genetics via GE may provide a reliable and nutritious food supply for an expanding global population under more unpredictable environmental circumstances.

A phase 1 dose escalation/expansion study of GSK5764227 (GSK’227), a B7-homolog 3 (B7-H3) protein targeted antibody-drug conjugate (ADC), in patients with advanced solid tumors, including gastrointestinal (GI) cancers.

TPS847 Background: B7-H3 is an immune checkpoint protein overexpressed in multiple solid tumors with limited expression in normal tissues. GSK’227 (HS-20093), a novel B7-H3-targeted ADC, is composed of a human anti–B7-H3 monoclonal antibody linked to a topoisomerase I inhibitor via a protease-cleavable linker, and has shown acceptable safety and promising antitumor activity in patients of Asian origin with advanced solid tumors (NCT05276609; NCT05830123). The current study will evaluate the safety, tolerability, efficacy, and pharmacokinetics (PK) of GSK’227 in patients with solid tumors, including GI cancers, in a global population. Methods: This two-part (dose-escalation [1a] and expansion [1b]) global, open-label, Phase I study (NCT06551142) will enroll ~260 patients, with enrollment currently ongoing. Key eligibility includes: aged ≥18 years, histologically confirmed advanced solid tumors, including those with colorectal cancer, esophageal squamous cell carcinoma, and pancreatic cancer, with measurable disease per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1), Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, and no prior B7-H3 treatment. Eligible patients will receive intravenous GSK’227 every 3 weeks (Q3W) until progression, toxicity, loss to follow-up, or death. For Phase 1a, a Bayesian optimal interval design will be used to determine the maximum tolerated dose. Phase 1a primary endpoints are safety and tolerability, including incidences of adverse events (AEs) and serious AEs. Secondary endpoints include objective response rate (ORR), disease control rate, duration of response, immunogenicity, and PK. The Phase 1b primary endpoint is progression-free survival (extensive-stage small cell lung cancer cohort) or ORR (GI and other solid tumors cohort). Secondary endpoints include additional efficacy assessments, PK, safety and tolerability. For Phase 1a and 1b, efficacy will be assessed per RECIST v1.1, with imaging conducted Q6W from first dose then Q12W after 24 weeks. Safety follow-up will be conducted at 30, 60, and 90 (±7) days after the last dose. Safety, tolerability, and efficacy analyses will be conducted using descriptive statistics and, for efficacy analyses, point estimates with 2-sided 95% confidence intervals. This abstract was previously submitted to the European Society for Medical Oncology (ESMO) Immuno-Oncology Congress 2024 and is submitted on behalf of the original authors with their permission. Funding: GSK (Study 223054). Medical writing support was provided by Avalere Health, funded by GSK. Clinical trial information: NCT05830123 .

Cross-Cultural Adaptation and Content Validation of the Yonsei Lifestyle Profile for Older Adults in the United States.

As the global population ages, there is a growing need for tools to assess lifestyle factors that impact the health and quality of life of older adults. The Yonsei Lifestyle Profile (YLP), originally developed in SouthKorea, is a comprehensive tool for evaluating key lifestyle domains. However, cultural and linguistic differences between countries necessitate the adaptation of such tools for use in diverse populations. This study addresses the gap by developing an English version of the YLP (YLP-E) for older adults in the United States. As the global population continues to age, maintaining and improving the health and quality of life of older adults has become increasingly important. This study aimed to develop a YLP-E, a cross-cultural adaptation of the Korean version of the YLP, that can be used for older American adults. The Delphi method was used to consult expert panels regarding the cultural and linguistic appropriateness of the translation. The translation process involved a two-way translation-back-translation procedure and iterative revisions based on expert feedback. The final YLP-E tool, which incorporated feedback on linguistic and cultural adequacy, consisted of 3 lifestyle domains (physical activity, activity participation and nutrition) with 62 items. The second round improved the content validity, with the linguistic content validity ratio (CVR) and cultural CVR reaching 0.86 and 0.94, respectively. The YLP-E is a valuable tool for comprehensively assessing and monitoring the lifestyle of older American adults and holds promise for further refinement and validation across diverse demographic settings. Future research needs to focus on utilizing the YLP-E to develop personalized interventions aimed at improving the health and quality of life of older adults and evaluating the tool's efficacy in promoting healthy aging.

C/EBPβ in Alzheimer's Disease: An Integrative Regulator of Pathological Mechanisms.

Alzheimer's disease (AD) stands as one of the most prevalent neurodegenerative disorders, characterized by a progressive decline in cognitive function, neuroinflammation, amyloid-beta (Aβ) plaques, and neurofibrillary tangles (NFTs). With the global aging population, the incidence of AD continues to rise, yet current therapeutic strategies remain limited in their ability to significantly alleviate cognitive impairments. Therefore, a deeper understanding of the molecular mechanisms underlying AD is imperative for the development of more effective treatments. In recent years, the transcription factor C/EBPβ has emerged as a pivotal regulator in several pathological processes of AD, including neuroinflammation, lipid metabolism, Aβ processing, and tau phosphorylation. Through intricate post-translational modifications, C/EBPβ modulates these processes and may influence the progression of AD on multiple fronts. This review systematically explores the multifaceted roles of C/EBPβ in the pathogenesis of AD, delving into its crucial involvement in neuroinflammation, Aβ production, tau pathology, and lipid metabolism dysregulation. Furthermore, we critically assess therapeutic strategies targeting C/EBPβ, examining the challenges and opportunities in regulating this factor. By synthesizing the latest research findings, we offer a more comprehensive understanding of the role of C/EBPβ in AD and discuss its potential as a therapeutic intervention target.

Obstetric Penicillin Allergy Evaluations

BackgroundPenicillin allergy is reported in 5-15% of the world population, with 3-10% of pregnant women reporting the same. However, more than 90% of these patients can tolerate penicillin after appropriate evaluation. Penicillin is indicated for various issues that arise in pregnancy, and a history of allergy can have negative individual and public health consequences. ObjectiveTo prospectively evaluate the feasibility, safety, and select obstetric outcomes of obstetric penicillin allergy evaluations arranged through a direct referral phone line from obstetric practices to an employed allergy/immunology practice. MethodsPatients were referred via direct phone line for evaluation during their antenatal visits between May 2019 and May 2022. Patients skin prick testing, and those with negative PST were given an amoxicillin challenge. In select cases, direct oral challenge was performed with a low-risk history. Data were analyzed using descriptive statistics. For detailed Methods, please see the Methods section in this article's Online Repository at www.jacionline.org ResultsOf the 324 patients referred between May 2019 to May 2022, 251 (77.5%) presented for in-office evaluations. 239/251 (95.2%) patients underwent penicillin skin testing followed by oral challenge if negative, 12 (4.8%) patients underwent direct challenge without skin testing, and all of them passed the challenge. Of the patients undergoing penicillin skin testing, 230 (97.2%) had negative skin testing and 229 tolerated subsequent oral amoxicillin doses, with 1 patient experiencing a delayed reaction to the amoxicillin. The patients who presented for evaluation had more people who lived in Zip codes that have been attributed to have high socioeconomic status, compared to the no-show group (73.7% vs 63.3%). ConclusionWe are the largest study to date to demonstrate the safety and feasibility of a phone line for obstetric penicillin allergy referrals. We demonstrate a better show rate than previous analyses, with most of these patients successfully de-labeled.

Effect of Excess Mortality on Longevity During the COVID-19 Pandemic in South Asia.

Throughout the twentieth century and beyond, a global trend of declining mortality rates and an increase in life expectancies was noted until the onset of the coronavirus disease 2019 (COVID-19) pandemic. A reduction in life expectancies was observed in most countries, including South Asia, during 2020 and 2021 due to the excess mortality caused by the pandemic. This study aims to examine the change in life expectancy in selected South Asian countries and the relative change in age- and sex-specific mortality rates over time due to the COVID-19 pandemic. In addition to that, we further examined the effect of a pandemic on a short-term forecast of life expectancy. Estimated age- and sex-specific mortality rates of seven South Asian countries were utilised from the 2022 revision of the World Population Prospects (WPP 2022). Changes in life expectancies are estimated using standard life table estimation techniques. To estimate the relative change in age- and sex-specific mortality levels and change in mortality forecasts as a result of the pandemic, we applied the Lee-Carter method. The application of the Lee-Carter model revealed age- and sex-specific variations in mortality improvements, reflecting heightened mortality rates within the region. This decline in mortality improvement is highly observed for both sexes in Pakistan, followed by India and Bangladesh. Populations exhibiting slower rates of improvement throughout their lifespan demonstrated minimal alterations attributable to the pandemic's impact. Comparative life expectancy forecasts indicate a slower rise in post-pandemic life expectancy at birth and in remaining life expectancies at older ages among most of these populations. These findings highlight the pandemic's profound impact on mortality dynamics, emphasising the need for targeted interventions to mitigate its long-term effects on population health and longevity.

Recent trends in the treatment of vitiligo using novel drug delivery system.

Vitiligo is a complex dermatological disorder involving the loss of melanocytes, with resultant patches of depigmentation. It affects 1% of the world population, affecting patients' mental health and quality of life. With all the improvement seen, conventional treatment methods-steroids, phototherapy, and immunomodulators-come with the limitations of being less effective, having more side effects, and low compliance. Advances in novel drug delivery systems now provide promising alternatives for better therapy. The general view of the pathophysiology of vitiligo is provided in this manuscript, mainly on oxidative stress, autoimmune mechanisms, and melanocyte apoptosis as chief factors. New approaches towards treatment, especially drug delivery systems based on nanotechnology, such as liposomes, polymeric nanoparticles, and hydrogels are discussed. These systems can facilitate the improvement of stability, penetration, and targeted delivery of drugs, thus reducing systemic exposure to adverse effects. There is also a potential improvement in microneedles, transdermal patches, and gene therapy like CRISPR-Cas9 to correct pigmentation by correcting the underlying factors at the cellular and molecular level. Other novel therapies include Janus Kinase (JAK) inhibitors and cell-based approaches, among them melanocyte-keratinocyte transplantation, which may have the potential to give sustained repigmentation. The article also deals with the role of phytoconstituents, like curcumin, quercetin, and ginkgo biloba, with antioxidant, anti-inflammatory, and immunomodulatory properties, thus it can be a natural adjuvant to conventional treatment. The multidisciplinary approach may be necessary in the incorporation of pharmacological advances along with new delivery systems into an enhancement strategy of treatments of vitiligo. This approach corrects some of the traditional weaknesses and taps emerging technologies for an even better treatment approach, patient oriented. Follow-up studies should then be directed toward clinical trials for the substantiation of such observations and treatment regimens for more universal applications.

The spatiotemporal and paradoxical roles of NRF2 in renal toxicity and kidney diseases.

Over 10% of the global population is at risk to kidney disorders. Nuclear factor erythroid-derived 2-related factor 2 (NRF2), a pivotal regulator of redox homeostasis, orchestrates antioxidant response that effectively counters oxidative stress and inflammatory response in a variety of acute pathophysiological conditions, including acute kidney injury (AKI) and early stage of renal toxicity. However, if persistently activated, NRF2-induced transcriptional cascade may disrupt normal cell signaling and contribute to numerous chronic pathogenic processes such as fibrosis. In this concise review, we assembled experimental evidence to reveal the cell- and pathophysiological condition-specific roles of NRF2 in renal chemical toxicity, AKI, and chronic kidney disease (CKD), all of which are closely associated with oxidative stress and inflammation. By incorporating pertinent research findings on NRF2 activators, we dissected the spatiotemporal roles of NRF2 in distinct nephrotoxic settings and kidney diseases. Herein, NRF2 exhibits diverse expression patterns and downstream gene profiles across distinct kidney regions and cell types, and during specific phases of nephropathic progression. These changes are directly or indirectly connected to altered antioxidant defense, damage repair, inflammatory response, regulated cell death and fibrogenesis, culminating ultimately in either protective or deleterious outcomes. The spatiotemporal and paradoxical characteristics of NRF2 in mitigating nephrotoxicity suggest that translational application of NRF2 activation strategy for prevention and interventions of kidney injury are unlikely to be straightforward - right timing and spatial precision must be taken into consideration.

Sudden cardiac death associated with fatty liver disease.

Fatty liver disease or steatotic liver disease (SLD) affects 25% of the global population and has been associated with heart disease. However, there is a lack of postmortem studies in the context of sudden cardiac death (SCD). To investigate the relationship between SLD and SCD. A post-mortem case-case study was conducted in victims of SCD from an ongoing community-based study in Southern California (Ventura, CA, 2015-2023). Diagnosis of SLD was determined from post-mortem liver histopathology reports. For each patient, demographic variables, laboratory values, and presence of co-morbidities were ascertained from medical records and were compared between patients with and without SLD. Of 162 individuals with SCD, there were 101 SLD cases and 61 without SLD. Individuals with SLD were found to have higher BMI (31.6±7.6 vs. 26.7±5.7, p<0.001), higher prevalence of heavy drinking (28% vs. 12%, p=0.008), heavier liver weights (2433.6g±940.6 vs 1934.7g±505.3, p<0.001), and were more often Hispanic (37 vs. 18%, p=0.01). Patients with SLD had lower prevalence of coronary artery disease (CAD) (49% vs. 70%). Multivariable logistic regression analysis showed that CAD was a negative predictor of SCD with SLD (OR = 0.35, 95% CI 0.14 - 0.83). Among adults with SCD, SLD was associated with higher prevalence of Hispanic ethnicity and lower prevalence of CAD. Given the major rise in SLD burden, these ethnicity-based differences as well as the specific nature of non-ischemic SCD etiologies warrant urgent further investigation.

Pharmacogenomic profiling of variants affecting efficacy and toxicity of anti-infective medicines in a south Asian population from Sri Lanka

BackgroundAnti-infective medicines are crucial for treating infections, but improper dosing can cause toxicity, resistance and treatment failure. Pharmacogenomics can address genetic variations affecting drug efficacy and safety. Despite the high burden of diseases like TB and HIV in Sri Lanka and South Asia, pharmacogenomic data for these populations are limited. This study aims to fill this gap by investigating pharmacogenomic variants in a South Asian population from Sri Lankan.MethodsPharmacogenomic data on anti-infective medicines were obtained from the PharmGKB database, selecting variants with evidence levels 1 A, 1B, 2 A, and 2B. Sri Lankan genetic data were sourced from an anonymized database of 670 Sri Lankans maintained by the Centre for Genetics and Genomics, Faculty of Medicine, University of Colombo. MAFs were compared between Sri Lankan sub-populations and global data from gnomAD, with statistical significance set at p < 0.05.ResultsMAFs of NAT2 gene rs1041983 and rs1799931 variants were, 43.7% (95%CI:41.1–46.4), 7.3% (95%CI:6.0-8.8), respectively. The UGT1A1 rs4148323 variant had a MAF of 3.5% (95%CI:2.6–4.6). In the CYP2B6 gene, 109 individuals were homozygous for the rs3745274 (poor metaboliser) variant, with a MAF of 39.6% (95%CI:37.0-42.3), while the rs34097093 and rs28399499 variants had no individuals homozygous for the variant (MAF: 0.2% [95%CI:0-0.5] (poor/intermediate metaboliser), and 0.1% [95%CI:0-0.4] (poor/intermediate metaboliser), respectively). The MAFs of the CYP2C19 rs12769205 (poor/intermediate metaboliser), rs4244285 (poor/intermediate metaboliser), rs3758581 (poor/intermediate metaboliser), and rs4986893 (poor/intermediate metaboliser) variants were 41.9% (95%CI:39.3–44.6), 41.9% (95%CI:39.2–44.7), 9.7% (95%CI:8.2–11.4), and 0.5% [(95%CI:0.2–1.1), respectively. Most variants showed significant differences compared to global populations, with some exhibiting higher frequencies, particularly when compared to Europeans. CYP2C19 rs12769205 and rs4244285 exhibited higher MAFs in Sri Lankans compared to both other South Asians and Europeans. The NAT2 rs1041983, NAT2 rs1799931, CYP2C19 rs4986893, CYP2C19 rs3758581, and CYP2B6 rs3745274 variants demonstrated significantly higher MAFs than in Europeans but not significantly different from South Asians.ConclusionThis preliminary study identifies variants in NAT2, UGT1A1, CYP2B6, and CYP2C19 genes relevant to the metabolism of anti-TB drugs, antiretrovirals, and voriconazole among Sri Lankans. Several variants, including CYP2C19 rs12769205 and rs4244285, showed higher MAFs, particularly in comparison to European populations, indicating potential differences in drug response. However, the nature of the study limits the ability to explore clinical correlations with the genotypes, therefore further research focusing on clinical correlation and functional validation is required.

Structural insights into the role of the prosegment binding loop in a papain-superfamily cysteine protease from Treponema denticola.

Periodontal diseases afflict 20-50% of the global population and carry serious health and economic burdens. Chronic periodontitis is characterized by inflammation of the periodontal pocket caused by dysbiosis. This dysbiosis is coupled with an increase in the population of Treponema denticola, a spirochete bacterium with high mobility and invasivity mediated by a number of virulence factors. One such virulence factor is TDE0362, a multidomain protein with a carboxy-terminal papain-superfamily cysteine protease (C0362). Most papain-superfamily cysteine proteases are produced as proenzymes with a prodomain that interacts with the prosegment binding loop (PBL), requiring proteolytic processing for full activation. Previous studies have indicated that C0362 is not produced as a proenzyme, suggesting an alternative regulatory mechanism. We previously determined the crystal structure of C0362 captured in an inactive conformation with an oxidized catalytic cysteine and a disordered PBL. In this follow-up study, we evaluated the active-site architecture and the PBL in two mutant (Y559A and C412S) structures and an inhibitor-bound (E64) structure to provide insight into the role that the PBL plays in the generation of active enzyme. Our results implicate Tyr559 as playing a critical role in the transition of the enzyme to an active state. We subsequently utilized the structural information to generate models of C0362 bound to human complement factors C3 and C4. Collectively, our results provide insight into the regulatory mechanism and putative substrate-binding interfaces of C0362, highlighting avenues of further research towards inhibition of this essential virulence factor.

Amplifying Women's Voices in Menopause Research: The Importance of Inclusive Perspectives.

Menopause, a significant life transition for half the global population, intersects biological, cultural and social dimensions. Despite its universal occurrence, menopause research has historically been dominated by biomedical perspectives, often neglecting women's voices and diverse experiences. This article highlights the importance of including women's perspectives in menopause research to ensure relevance, accuracy and equity. It explores cultural variations in menopause experiences, the impact of socioeconomic status and the often-overlooked emotional and psychological dimensions. This article advocates for participatory approaches, emphasising that women's involvement enhances research design, implementation and policy development. Evidence-based interventions that are tailored to the individual can better address the diverse needs of menopausal women. The discussion extends to addressing health disparities, calling for inclusive research and policies to ensure equitable access to care. Ultimately, empowering women through co-designed research and inclusive policies can transform the menopause journey into an enriching life phase, promoting resilience and inclusivity across communities. This paradigm shift in menopause research and policy highlights the need for diversity, collaboration and evidence-based approaches to improve health outcomes and quality of life for all women. PATIENT OR PUBLIC CONTRIBUTION: This article has been informed by a menopause service user group who discuss their experiences of menopause. The group was formed because of initial qualitative research and now meet on a regular basis to co-design and co-produce activities that inform ongoing research for the menopause taskforce.

Intradermal versus subcutaneous immunization: Effects of administration route using a lipid-PLGA hybrid nanoparticle tuberculosis vaccine.

Tuberculosis (TB) remains a significant global health challenge, latently affecting around a quarter of the global population. The sole licensed TB vaccine, Mycobacterium bovis Bacillus Calmette-Guérin (BCG), shows variable efficacy, particularly among adolescents and adults, underscoring the pressing need for more effective vaccination strategies. The administration route is crucial for vaccine efficacy, and administration via the skin, being rich in immune cells, may offer advantages over conventional subcutaneous routes, which lack direct access to abundant antigen-presenting cells. This study compared the immunogenic effects of intradermal versus subcutaneous administration of a candidate TB vaccine delivering a Ag85B-ESAT6-Rv2034 (AER) multiphase fusion recombinant protein, in lipid-poly(D,L-lactic-co-glycolic acid) (lipid-PLGA) nanoparticles in mice. In-depth evaluation of immune responses in splenocytes was performed using 27-marker spectral flow cytometry. Both routes elicited significant T-cell responses. However, intradermal administration uniquely increased polyfunctional CD4+ and CD8+ T-cells producing IL-2, IFNγ, and TNFα, associated with protection against TB. Additionally, it significantly increased CD69+ B-cell counts and induced higher AER-specific antibody titers, particularly IgG2a. These results underscore the superior immunogenic potential of intradermal vaccine administration by effectively inducing immune cells associated with TB protection, highlighting its significance in the development of new vaccine strategies.

The potential of digital health interventions to address health system challenges in Southeast Asia: A scoping review.

The World Health Organization (WHO) Southeast Asian region, comprising a quarter of the global population, faces significant healthcare challenges influenced by diverse economic and social conditions. The objective of this study is to map the Digital Health Intervention (DHI) functionalities across the nine axes of the healthcare system challenges (HSCs) model; we use WHO's DHIs classification framework and the Health System Challenges model. Our study findings help identify the gaps in the potential of the existing DHIs in addressing health system challenges in low- and middle-income countries. Using SCOPUS, EMBASE and PUBMED databases, a scoping review was conducted to identify the existing DHIs in the Southeast Asia region and map the DHIs with the HSCs related to availability, information, utilization, quality, accountability, efficiency, equity, cost and acceptability. Out of 278 studies, 337 DHI functionalities were identified. A majority of the identified DHIs address challenges related to information (35.6%), availability (34.7%) and utilization, while less than 10% of the DHIs address challenges related to quality (8.9%), accountability (5%) and efficiency (3.9%) in the health system. Most of the existing DHIs in SEA region address challenges related to availability of services and lack of information, while they fall short in addressing challenges related to quality of services, efficiency, and accountability. Acknowledging the inter-linkages across the health system challenges, this gap identification may well guide future investments and planning in DHIs.

Aging and Gender: Inclusive Care Practices and Policies for Lesbian, Gay, Bisexual and Transgender Older Adults

In line with global population aging, the number of lesbian, gay, bisexual, and transgender (LGBT+) older adults is expected to continue to increase. Compared to their heterosexual peers, LGBT+ older adults have poorer physical and psychological health status, experience less social support, and face more barriers when accessing healthcare services, which may lead to higher health disparities and a lower quality of life within LGBT+ older populations. Healthcare providers have been shown to be inadequately prepared to address the unique healthcare needs and challenges of LGBT+ older adults, often leaving these individuals forced to receive care that does not meet their health needs and expectations. Based on the Declaration on Universal Health Coverage proposed by the United Nations and the World Health Organization, medical care and long-term care facilities must provide to healthcare providers training courses in culturally competent care and foster LGBT-friendly care environments to achieve health equity and universal health coverage for LGBT+ populations.

On the Improvements of the Performance of Bayes-Net Classification for Diagnosis of Diabetes: A Cross-validation Approach

Introduction: This study intends to support medical professionals in the early and precise detection and diagnosis of type1 and type2 Diabetes. Many complexities occur if Diabetes is unidentified and remains untreated. 9.3% of individuals worldwide have Diabetes as of 2019, according to data from the World Health Organization. The anticipated increase would be close to 11% of the global population by 2045. Diabetes mellitus is a chronic, one of the deadliest diseases that causes Body blood glucose levels to be above average level knowing a blood sugar. Diabetes can be type1 (T1D) and type2(T2D). An autoimmune condition called Type 1 diabetes is frequently found in young children. Adults are frequently diagnosed with type 2 diabetes, which is not autoimmune. A branch of artificial intelligence called machine learning has the potential to be successful in the field of predictions. Method: This research aims to design a machine learning model to predict Diabetes in a patient. The collective performance of the four algorithms is evaluated on various measures like accuracy, precision, sensitivity, and specificity. Therefore, four machine learning classification algorithms, namely Bayes-Net, Naïve-Bayes, J48, and Random Forest, were used to predict Diabetes in the early stage using 10–fold cross validation. Result: For experiments, a standard PIMA Indian diabetes dataset is used. According to the results, Bayes-Net performs better than other algorithms, with an accuracy rate of 87.72%. Conclusion: Diabetes Mellitus may harm kidneys, nerves, eyes, and other organs if it is not diagnosed in time. Therefore, early diagnosis and treatment could save countless lives. The process is tedious because patients visit a diagnostic facility and see a doctor, but various machine learning and deep learning approaches solve this clinical problem earlier.

Biochemical, photosynthetic and metabolomics insights of single and combined effects of salinity, heat, cold and drought in Arabidopsis.

Ensuring food security is one of the main challenges related to a growing global population under climate change conditions. The increasing soil salinity levels, drought, heatwaves, and late chilling severely threaten crops and often co-occur in field conditions. This work aims to provide deeper insight into the impact of single vs. combined abiotic stresses at the growth, biochemical and photosynthetic levels in Arabidopsis thaliana (L.). Reduced QY max was recorded in salinity-stressed plants, NPQ increased in heat and salinity single and combined stresses, and qP decreased in combined stresses. MDA and H2O2 content were consistently altered under all stress conditions, but higher values were recorded under salinity alone and in combination. Salinity alone and in stress combinations (especially with cold) provided a stronger hierarchical effect. Despite glycine and GABA osmolytes not significantly changing, proline highlighted the hierarchically stronger impact of salinity, while glycine-betaine was decreased under drought combinations. Untargeted metabolomics pointed out distinct metabolic reprogramming triggered by the different stress conditions, alone or in combination. Pathway analysis revealed that abiotic stresses significantly affected hormones, amino acids and derivates, and secondary metabolites. Flavonoids accumulated under drought (alone and combined with heat and cold stresses), while N-containing compounds decreased under all combined stresses. Looking at the interactions across the parameters investigated, antagonistic, additive, or synergistic effects could be observed depending on the biochemical process considered. Notwithstanding, these results contribute to delving into the impact of various stress combinations, hierarchically highlighting the stress-specific effects and pointing out different combinations.

Prerequisites for self-care actions in individuals with restless legs syndrome-A deductive qualitative analysis based on the COM-B model.

Restless Legs Syndrome (RLS) affects 3% of the world's population, causing tingling sensations primarily in the legs. Incorporating self-care activities could improve the management of RLS symptoms, yet knowledge about effective self-care actions is limited. This study employs the Capability, Opportunity, and Motivation-Behaviour (COM-B) model to explore self-care behaviours in individuals with RLS, as research in this area is sparse. Qualitative content analysis of interviews with 28 participants with RLS, 26 subcategories emerged, aligning with the COM-B model's components. The first part, Capability, highlighted the importance of being able to be in motion, while the second, Opportunity referred to situations where there was a lack of trust and guidance for self-care. The third part, Motivation, emphasised the importance of fixed routines of sleep, rest, and activity. These identified prerequisites can inform the development of screening instruments and patient-reported outcome measures to evaluate self-care needs and interventions for individuals with RLS.