Public Health Challenge Research Articles

Machine Learning Analysis of RNA-Seq Data Identifies Key Gene Signatures and Pathways in Mpox Virus-Induced Gastrointestinal Complications Using Colon Organoid Models.

Mpox, caused by the Mpox virus (MPXV), emerged globally in 2022 with the Clade IIb strain, presenting a critical public health challenge. While MPXV is primarily characterized by fever and rash, gastrointestinal (GI) complications, such as diarrhea and proctitis, have also been observed. This study is a reanalysis of GSE219036 without own data and focuses on the impact of MPXV infection on the colon, using human-induced pluripotent stem cell-derived colon organoids as a model. We applied a tailored statistical framework for RNA-seq data, Generalized Linear Models with Quasi-Likelihood F-tests and Relaxed Magnitude-Altitude Scoring (GLMQL-RMAS), to identify differentially expressed genes (DEGs) across MPXV clades: MPXV I (Zr-599 Congo Basin), MPXV IIa (Liberia), and MPXV IIb (2022 MPXV). Through a novel methodology called Cross-RMAS, we ranked genes by integrating statistical significance and biological relevance across all clades. Machine learning analysis using the genes identified by Cross-RMAS, demonstrated 100% accuracy in differentiating between the different MPXV strains and mock samples. Furthermore, our findings reveal that MPXV Clade I induces the most extensive alterations in gene expression, with significant upregulation of stress response genes, such as HSPA6 and FOS, and downregulation of genes involved in cytoskeletal organization and vesicular trafficking, such as PSAP and CFL1. In contrast, Clade IIb shows the least impact on gene expression. Through Gene Ontology (GO) analysis, we identified pathways involved in protein folding, immune response, and epithelial integrity that are disrupted in infected cells, suggesting mechanisms by which MPXV may contribute to GI symptoms.

Insights into the Rising Threat of Carbapenem-Resistant Enterobacterales and Pseudomonas aeruginosa Epidemic Infections in Eastern Europe: A Systematic Literature Review.

Antimicrobial resistance is a major global public health challenge, particularly with the rise of carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA). This study aimed to describe the characteristics of CRE and CRPA infections in Eastern Europe, focusing on Bulgaria, Croatia, Czechia, Greece, Hungary, Poland, Romania, Serbia, Slovakia, and Slovenia. Following MOOSE and PRISMA guidelines, a systematic literature review of articles published between 1 November 2017 and 1 November 2023 was conducted using the MEDLINE, Embase, Web of Science, CDSR, DARE, and CENTRAL databases. The search strategy used a combination of free text and subject headings to gather pertinent literature regarding the incidence and treatment patterns of CRE and CRPA infections. A total of 104 studies focusing on infections in both children and adults were included in this review. This review revealed a significant prevalence of carbapenem-resistant Gram-negative isolates and underscored the effectiveness of imipenem/relebactam and ceftazidime/avibactam (CAZ/AVI) against Klebsiella pneumoniae carbapenemase-producing Enterobacterales and of ceftolozane/tazobactam, imipenem/relebactam and ceftazidime/avibactam against non-metallo-β-lactamase-producing CRPA strains. This study highlights the urgent need for comprehensive measures to combat the escalating threat of CRE and CRPA infections in Eastern European countries. At the same time, it shows the activity of the standard of care and new antimicrobials against carbapenem-resistant Gram-negative pathogens in Eastern Europe. Clinical real-world data on the treatment of carbapenem-resistant infections in Eastern Europe are needed.

Exome Sequence Data of Eight SLC Transporters Reveal That SLC22A1 and SLC22A3 Variants Alter Metformin Pharmacokinetics and Glycemic Control.

Background: Type 2 diabetes (T2D) is one of the leading causes of mortality and is a public health challenge worldwide. Metformin is the first-choice treatment for T2D; its pharmacokinetics (PK) is facilitated by members of the solute carrier (SLC) superfamily of transporters, it is not metabolized, and it is excreted by the kidney. Although interindividual variability in metformin pharmacokinetics is documented in the Mexican population, its pharmacogenomics is still underexplored. We aimed to identify variants in metformin SLC transporter genes associated with metformin PK and response in Mexican patients. Methods: Using exome data from 2217 Mexican adults, we identified 86 biallelic SNVs in the eight known genes encoding SLC transporters, with a minor allele frequency ≥ 1%, which were analyzed in an inadequate glycemic control (IGC) association study in T2D metformin treated patients. Metformin PK was evaluated in a pediatric cohort and the effect of associated SNVs was correlated. Results: Functional annotation classified two SNVs as pathogenic. The association study revealed two blocks associated with IGC. These haplotypes comprise rs622591, rs4646272, rs4646273, and rs4646276 in SLC22A1; and rs1810126 and rs668871 in SLC22A3. PK profiles revealed that homozygotes of the SLC22A1 haplotype reached lower plasma metformin concentrations 2 h post administration than the other groups. Conclusions: Our findings highlight the potential of pharmacogenomics studies to enhance precision medicine, which may involve dosage adjustments or the exploration of alternative therapeutic options. These hold significant implications for public health, particularly in populations with a high susceptibility to develop metabolic diseases, such as Latin Americans.

Metals in honey, cow’s milk and eggs in North-East Algeria and health risk

ABSTRACT Metal contamination of foodstuffs is a major public health challenge of increasing concern. The present study aimed to determine lead, cadmium and mercury in honey, cow’s milk and poultry eggs collected from the North-Eastern region of Algeria and to evaluate the health risks associated with their regular consumption. To this aim 30 samples of each foodstuff were analysed using ICP-MS. Among the quantified heavy metals, Pb was found at the highest level in both honey (0.752 ± 0.16 µg g−1) and poultry egg (0.988 ± 0.19 µg g−1) in the region of Skikda. The highest values of Cd (0.798 ± 0.12 µg g−1) and Hg (0.097 ± 0.02 µg g−1) were found in poultry eggs collected from the same region. For infants the Hazard Index was well above 1 in honey samples from all three locations, in cow’s milk collected from Mila and Skikda and in poultry eggs collected from Skikda.

Determinants of under-five mortality in informal settlements in Nairobi, Kenya from 2002 to 2018

BackgroundChildhood mortality persists as a significant public health challenge in low and middle-income countries and is uneven within countries, with poor communities such as urban informal settlements bearing the highest burden. There is limited literature from urban informal settlements on the risk factors of mortality. We assessed under-five mortality and associated risk factors from the period 2002 to 2018 in Nairobi urban informal settlements.MethodsWe used secondary data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), a longitudinal surveillance platform that routinely collects individual and household-level data in two informal settlements (Viwandani and Korogocho) in Nairobi, Kenya. We used Kaplan-Meier curves to estimate overall survival and the Cox proportional hazard model with a frailty term to evaluate the impact of risk factors on survival time.ResultsOverall under-five survival rate was 96.8% and this improved from 82.6% (2002-2006) to 95% (2007-2012) and 98.4% (2012-2018). There was a reduced risk of mortality among children who had BCG vaccination, those born to a married mother or a mother not engaging in any income-generating activity (both from 2007 to 2011), children from singleton pregnancy, children born in Viwandani slum and ethnicity of the child.ConclusionUnder-five mortality is still high in urban informal settlements. Targeted public health interventions such as vaccinations and interventions empowering women such as single mothers, those with multiple pregnancies, and more impoverished slums are needed to further reduce under-five mortality in urban informal settlements.

From Hong Kong to the UK: A Community and Public Health Nursing Researcher's Reflections on an International Fellowship.

Our globalized world means that most public health challenges cannot be tackled alone; they require unified and collaborative working across countries. Overseas fellowships offer an immersive experience that empowers nursing researchers to enhance global collaborations and synergize diverse research expertise from various cultural contexts. This enriched collaboration leads to more innovative solutions to public health issues and significantly enhances the overall impact of their research. This paper presents a self-reflection from the perspective of a community and public health nursing researcher, based in Hong Kong. During a 2-month research secondment at a university in the UK, I explored ways to leverage my fellowship to strengthen global connections, expand collaborations, and enhance my research capabilities in addressing health equity issues among LGBTQ+ populations, particularly concerning sexual violence. By sharing my journey, I aim to inspire more nursing researchers to engage with global academic communities and collectively advance global public health initiatives.

Gastric cancer in Spain: evaluating productivity loss and economic impact

Introduction In 2018, gastric cancer (GC) was estimated to account for over 1.03 million new cases globally, making it one of the most frequently diagnosed malignancies. In Spain, about 6,913 new cases were diagnosed in 2022. GC is an aggressive cancer originating in the stomach and ranks fifth in cancer incidence and third in cancer-related deaths worldwide. Despite treatment, only 25% of patients survive more than 5 years after diagnosis. Methods To estimate the economic impact of premature mortality due to GC, the human capital method was employed. This approach involved collecting data on mortality rates, average salaries, and unemployment rates. The study spanned a 10-year period, from 2013 to 2022, to integrate the latest and most pertinent data for analysis. The goal was to quantify the economic consequences GC-related deaths, providing valuable information for policy makers and healthcare professionals. Results GC caused 51,814 deaths over the study period with a slight annual decline, predominantly affecting men. Approximately 23% of deaths occurred among people of working age, amounting to a total of 122,632 YPLL. In economic terms, GC deaths accounted for costs of €1,239.34 million in 2013, rising to €1,242.04 million by 2021, for a total of €11,469.07 million over the study period. Conclusions The incidence of gastrointestinal cancers has decline in some types, but they remain a substantial public health challenge. These findings underline the significant health and economic challenges posed by GC, highlighting the need for targeted interventions to mitigate its impact on both individuals and healthcare systems.

Effect of telomere shortening on disease progression in patients with inflammatory bowel disease: A systematic review and meta-analysis protocol.

Inflammatory bowel disease (IBD) remains a major public health challenge worldwide. In recent years, it has been discovered that a link between telomere shortening and disease progression in IBD patients has been present. However, there is controversy as to whether telomere shortening precipitates disease progression or disease progression causes telomere shortening. There is also a shortage of systematic reviews and data synthesis to explain the association between telomere shortening and disease progression in individuals with IBD. We aimed to systematically review the association between telomere shortening and disease advancement in individuals with IBD to inform future studies. We will undertake a thorough search of the electronic database from the beginning until December 31, 2023. We will search the databases: MEDLINE/PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), VIP, Wanfang Database (Wanfang), CMB, Cochrane Library, Cochran Clinical Trials Registry, and the World Health Organization International Clinical Trials Registry Platform. Two reviewers will assess the discovered citations for eligibility based on the title and abstract before proceeding to the full-text and data extraction phases. These reviewers will debate and settle any conflicts that arise during the inclusion process; a third reviewer will settle any issues that remain. The validated data extraction form will be used to collect data for eligible research. The included studies will undergo a quality and bias check and will proceed meta-analysis. This systematic review and meta-analysis will reveal a positive correlation between illness progression and telomere shortening in individuals with IBD, perhaps demonstrating three causal links between them. This study will conduct the first systematic review and meta-analysis examining the correlation between telomere shortening and illness advancement in individuals with IBD. Exploring the connection between these two situations can enhance the comprehension of the development and advancement of IBD. PROSPERO registration number: CRD42024501171.

Clinically Guided Adaptive Machine Learning Update Strategies for Predicting Severe COVID-19 Outcomes

Background: Machine learning algorithms are essential for predicting severe outcomes during public health crises like COVID-19. However, the dynamic nature of diseases requires continual evaluation and updating of these algorithms. This study aims to compare three update strategies for predicting severe COVID-19 outcomes post-diagnosis: 'naive' (a single initial model), 'frequent' (periodic retraining), and 'context-driven' (retraining informed by clinical insights). The goal is to determine the most effective timing and approach for adapting algorithms to evolving disease dynamics and emerging data. Methods: A dataset of 1.11 million COVID-19 patients from diverse U.S. regions was used to develop and validate an XGBoost algorithm for predicting severe outcomes upon diagnosis. Data included patient demographics, vital signs, comorbidities, and immunity-related factors (prior infection and vaccination status) from January 2007 to November 2021. The study analyzed the performance of the three update strategies from March 2020 to November 2021. Results: Predictive features changed over the pandemic, with comorbidities and vitals being significant initially, and geography, demographics, and immunity-related variables gaining importance later. The 'naive' strategy had an average AUC of 0.77, the 'frequent' strategy-maintained stability with an average AUC of 0.81, and the 'context-driven' strategy averaged an AUC of 0.80, outperforming the 'naive' strategy and aligning closely with the 'frequent' strategy. Conclusion: A context-driven approach, guided by clinical insights, can enhance predictive performance and offer cost-effective solutions for dynamic public health challenges. These findings have significant implications for efficiently managing healthcare resources during evolving disease outbreaks.

An accumulated mutation gained in mosquito cells enhances Zika virus virulence and fitness in mice.

Zika virus (ZIKV) is an important arbovirus with a global impact. Experimental evolution by serial passaging of ZIKV in susceptible cells has led to the identification of a panel of critical amino acid substitutions with specific functions. Herein, we identified a mosquito cell-derived substitution, H401Y, in the ZIKV E protein via experimental evolution. The H401Y substitution significantly enhanced viral virulence and fitness in mammal cells and mice. Notably, the H401Y substitution has been detected in recent mosquito and human isolates from regions spanning Asia to the Americas. Our work elucidates unrecognized virulence determinant in the ZIKV genome that warrants urgent attention. Moreover, the findings underscore the critical need for extensive molecular surveillance and rigorous clinical observation to establish the potential impact in natural circulation. These endeavors are crucial for unraveling the potential of mutation to act as a catalyst for future epidemics, thereby preempting the public health challenges it may pose.

Identifying Candida auris transmission in a hospital outbreak investigation using whole-genome sequencing and SNP phylogenetic analysis.

Candida auris poses a global public health challenge, causing multiple outbreaks within healthcare facilities. Despite advancements in strain typing for various infectious diseases, a consensus on the genetic relatedness threshold for identifying C. auris transmission in local hospital outbreaks remains elusive. We investigated genetic variations within our local isolate collection using whole-genome-based single nucleotide polymorphism (SNP) phylogenetic analysis. A total of 74 C. auris isolates were subjected to whole-genome sequencing (WGS) and SNP phylogenetic analysis via the QIAGEN CLC Genomics Workbench. Isolates included known related strains from the same patient, strains from different hospitals, strains from our hospital patients with no epidemiological link, and 19 patient isolates from a recent C. auris outbreak. All but three isolates were identified to be Clade IV. By examining the genetic diversities of C. auris within patients and between patients, we identified a SNP variation range of 0-13 for identifying related isolates. During an outbreak investigation, utilizing this range, maximum likelihood phylogenetic analysis revealed two distinct clusters that aligned with the epidemiological links. Determining a SNP variation range to delineate genetic relatedness among isolates is crucial for the application of WGS and SNP phylogenetic analysis in identifying C. auris transmission during hospital outbreak investigations. The use of WGS SNP phylogenetic analysis via the CLC Genomics Workbench has emerged as a valuable method for typing C. auris in clinical microbiology laboratories.

Bactericidal and Synergistic Effects of Lippia origanoides Essential Oil and Its Main Constituents against Multidrug-Resistant Strains of Acinetobacter baumannii.

Bacterial resistance in Acinetobacter baumannii is a significant public health challenge, as these bacteria can evade multiple antibiotics, leading to difficult-to-treat infections with high mortality rates. As part of the search for alternatives, essential oils from medicinal plants have shown promising antibacterial potential due to their diverse chemical constituents. This study evaluated the antibacterial, antibiofilm, and synergistic activities of the essential oil of Lippia origanoides (EOLo) and its main constituents against multidrug-resistant clinical isolates of A. baumannii. Additionally, the antibacterial and antibiofilm potential of a nanoemulsion containing carvacrol (NE-CAR) was assessed. EOLo was extracted through hydrodistillation, and its components were identified via gas chromatography coupled with mass spectrometry. The A. baumannii isolates (n = 9) were identified and tested for antimicrobial susceptibility using standard disk diffusion methods. Antibacterial activity was determined by broth microdilution, while antibiofilm activity was measured using colorimetric methods with crystal violet and scanning electron microscopy. Synergism tests with antibiotics (meropenem, ciprofloxacin, gentamicin, and ampicillin+sulbactam) were performed using the checkerboard method. The primary constituents of EOLo included carvacrol (48.44%), p-cymene (14.58%), and thymol (10.16%). EOLo, carvacrol, and thymol demonstrated significant antibacterial activity, with carvacrol showing the strongest effect. They were also effective in reducing biofilm formation, as was NE-CAR. The combinations with antibiotics revealed significant synergistic effects, lowering the minimum inhibitory concentration of the tested antibiotics. Therefore, this study confirms the notable antibacterial activity of the essential oil of L. origanoides and its constituents, especially carvacrol, suggesting its potential as a therapeutic alternative for A. baumannii infections.

Reduction of the risk of biliary lithiasis caused by various weight reduction options in obesity

At present obesity is a major public health challenge globally, which accounts for a significant portion of all healthcare costs. Obesity and its complications, insulin resistance and dyslipidemia, have been identified as independent risk factors for cholelithiasis. Cholelithiasis is mainly caused by four factors: bile cholesterol overload caused by excess cholesterol made in the liver due to genetic factors; systolic dysfunction of the gallbladder wall; bowel dysfunction with excess absorption of cholesterol or cholesterol overload caused by impaired hepatic bile circulation; and accelerated growth of cholesterol crystals and solid cholesterol crystals. Rapid weight loss (≥1.5 kg/week) due to low-calorie diets as the main treatment method, or after bariatric surgery is one of the risk factors for gallstone formation. Bariatric surgery is effective for the treatment of obesity and its complications, but bariatric surgery does not reduce the incidence of cholelithiasis. On the contrary, many studies showed that bariatric surgery may increase the incidence of cholelithiasis. The rapid weight loss causes fat mobilization and then increases serum cholesterol and triglyceride levels. On the other hand, bowel dysfunction due to bariatric surgery is accompanied by decreased cholecystokinin levels, causing impaired gallbladder contractility. Cholelithiasis requires close attention after bariatric surgery, with 10% of patients undergoing bariatric surgery having to undergo cholecystectomy postoperatively due to a high risk of cholelithiasis. UDCA is a natural bile acid that is prescribed to be taken orally (by mouth). UDCA inhibits the absorption of cholesterol in the bowel, enhances the biosynthesis of bile acids, and reduces biliary cholesterol secretion. UDCA is a choleretic agent, as all bile acids, but differs from other dihydroxy bile acids in being non-cytotoxic. The use of UDCA while following a low-calorie diet and after bariatric surgery significantly reduces the risk of gallstone formation and cholecystectomy with associated complications.

Exploring the dynamics of leprosy transmission with treatment through a fractal–fractional differential model

Leprosy continues to be a significant public health challenge in many parts of the world, necessitating novel approaches to understanding and controlling its transmission. The dynamics of leprosy are examined in this study by means of a caputo fabrizio fractal–fractional differential system model. Leprosy transmission and treatment are complex and non-linear processes that can be captured by fractal–fractional derivatives. The temporal progression of the disease is the primary focus of our mathematical analysis, which evaluates a variety of parameter values, including initial population densities and compartmental transitions. Through simulations, we examine the impact of critical parameters on the severity and spread of diseases, as well as the rates of recovery and treatment. Numerical results of the model offer valuable insights into the impact of these parameters on leprosy dynamics, which is beneficial for public health interventions. The stability analysis of the model identifies supplementary conditions that are necessary for the success of disease control. By incorporating these novel mathematical techniques, we hope to improve our understanding of leprosy transmission and ultimately contribute to more effective control strategies. Based on our findings, additional studies investigating the relation between population density, treatment accessibility, and recovery rates are warranted. We hope that by graphically representing the relationships between these factors, we can draw attention to the possibility of targeted interventions that can reduce the transmission of leprosy. This study provides a strong basis for future studies on infectious disease modeling and aids leprosy-affected communities in developing strategies to mitigate the disease’s impact.

Risk factor control and adherence to recommended Lifestyle among US hypertension patients

BackgroundAlthough hypertension is a significant public health challenge globally, only a few studies have assessed the effectiveness of risk factor control and adherence to recommended lifestyle among United States hypertension patients.MethodsIn this study, a detailed, stratified analysis of the 1999–2018 National Health and Nutrition Examination Survey was conducted to assess the adequacy of risk factor control and conformity to recommended lifestyle among United States patients with hypertension. Logistic regression analysis was used to identify influencing factors associated with not acheving risk factors and lifestyle targets.ResultsA total of 21,770 participants (mean age, 62 ± 15 years) were enrolled in this study. About one in five (20%) participants achieved the recommended body mass index goal, 40% achieved the low-density lipoprotein cholesterol goal, and 30% achieved the recommended waist circumference. Most patients (80%) achieved the recommended smoking goal, 58% met the recommended alcohol consumption, and 19% achieved the recommended physical activity goal. Multivariate analysis demonstrated that age, gender, race, education, metabolic syndrome, and diabetes mellitus were independent predictors of not achieving risk factors and lifestyle targets.ConclusionsControlling risk factors and adherence to recommended lifestyles are not ideal for hypertension patients. Therefore, further research should assess how to improve the compliance rate and take targeted measures based on influencing factors for long-term prognosis.

Trends, Age-Period-Cohort Effects, and Projections in the Incidence and Mortality of HIV/AIDS among the Elderly in China.

HIV/AIDS among the elderly presents a new public health challenge in China. We aimed to explore historical trends (2004-2018) and project the future (2019-2030) burden of HIV/AIDS incidence and mortality among the elderly in China. We utilized data from the Data Center of China Public Health Science database on HIV/AIDS incidence and mortality, employing the Bayesian age-period-cohort model to reveal the age-period-cohort effect in the HIV/AIDS burden, and projecting the incidence and mortality rates up to 2030. From 2004 to 2018, HIV/AIDS incidence rates increased from 0.56/105 to 20.78/105 for men and 0.28/105 to 7.84/105 for women. The mortality rates also elevated in both genders. We observed the highest age effect in incidence among the men aged 70-74 and women aged 55-59, with the effect estimates being 0.02 (95% CI: -0.10 to 0.13) and 0.46 (95% CI: 0.35 to 0.57). Similar gender disparities were observed for the mortality, with the highest age effect observed in men aged 75-79 and women aged 50-54. However, no significant disparities were found between men and women in the period and cohort effects. By 2030, the incidence rates were projected to be 96.25/105 in men and 44.90/105 in women, while the mortality rates were projected to be 48.27/105 and 13.67/105. HIV/AIDS incidence and mortality rates rose notably among the elderly in China and are expected to keep increasing in the coming decades. Rates were consistently higher in men than in women. Tailored interventions for older men are crucial.

Immunohistochemical expression of PD-L1 in esophageal carcinoma and its correlation with histopathological features

Background: Carcinoma of the esophagus poses a considerable medical and public health challenge in many parts of the world. Despite advances in screening and multimodal management of this disease, overall survival remains poor. There is an utmost need to find a marker for the establishment of targeted immunotherapy. One immunohistochemical marker that has surfaced with the advent of anti-PDL1 immunotherapy is PD-L1 which has been proven to be advantageous. This study aimed to determine PD-L1 expression and its correlation with the grade of tumor and other histopathological parameters in 50 patients. Materials and Methods: A cross-sectional study was conducted on 50 cases of histopathologically proven esophageal carcinoma. Antibody used for PD-L1 was rabbit monoclonal (CAL10) Biocare. PD-L1 expression was considered positive when a complete or partial membranous or cytoplasmic staining pattern was noted in more than 5% of tumor cells. Correlation between PD-L1 expression and clinicopathological parameters was calculated. Proper consent was taken. The findings of the study were statistically analyzed using Statistical Package for the Social Sciences (SPSS) software version 21.0, a statistical program for Microsoft Windows. Results: This study revealed that PD-L1 positivity increases as the histopathological grade of esophageal squamous cells increases. Conclusions: The expression of PD-L1 increases with grade and shows more positive expression in poorly differentiated tumors. This indicates that PD-L1 overexpression is associated with aggressive disease. Targeted therapy against PD-L1 may prove to be beneficial in such patients.

Experiences of Indonesian nurses as Hajj health personnel in caring for Hajj pilgrims: A qualitative study.

Investigating the experiences and roles of nurses during Hajj is vital due to the unique public health challenges posed by the mass gathering of diverse pilgrims. Nurses play a crucial role in disease surveillance, infection control, and managing emergencies like heat stroke and injuries. Their insights can improve emergency preparedness and public health management. This study aimed to explore the experiences of Indonesian nurses as Hajj health personnel caring for Hajj pilgrims during the 2023 Hajj season. This study employed a qualitative descriptive design and selected participants through purposive sampling from hospitals, public healthcare centers, and clinics in Yogyakarta, Indonesia. Nine nurses participated in the research, and data were collected through a focus group discussion in December 2023. Thematic analysis was used to analyze the data. Six themes emerged, including practicing ethical principles in providing health care during the hajj process, competency qualifications as a health worker, the health care process during Hajj, legal Requirements for Hajj, the importance of therapeutic communication skills to establish cooperation with various parties, and recognizing the role of duties and responsibilities during the hajj process. The study emphasizes the importance of competencies, ethics, communication, and strategic planning in Hajj healthcare. Effective online communication, especially via WhatsApp, was crucial for coordination. The findings emphasize the need for strategic workforce planning, resource allocation, and continuous training to enhance care quality for pilgrims, informing better planning and policy development for future Hajj seasons.

Diabetes self-care intervention strategies and their effectiveness in Sub-Saharan Africa: A systematic review.

Diabetes poses a significant public health challenge, predominantly affecting low-and middle-income countries (LMICs), including in Sub-Saharan Africa (SSA). The evolving landscape characterized by resource constraints, gaps in availability and functionality of healthcare system, and socio-demographic impediments has compounded these challenges. As an example, self-care interventions have played a crucial role in diabetes care. However, the effectiveness of these interventions in the SSA remains insufficiently explored. Therefore, this systematic review evaluated the effectiveness and implementation approach of diabetes self-care interventions in SSA. A comprehensive search was conducted across electronic databases including PubMed, Scopus, and Google Scholar, to identify studies focusing on diabetes self-care interventions in SSA from 2013 to 2023. The included studies reported interventions targeting dietary adherence, physical activity, medication adherence, blood glucose monitoring, foot care, and educational or support programs. The quality of the studies was assessed using the JBI checklist. Effectiveness was assessed through outcomes including glycemic control, adherence rate, complication reduction, and improvement in patient outcomes. Overall, 38.5% of interventions result showed positive changes in either primary or secondary outcomes. Studies that employed diabetes self-management education showed positive changes in approximately 28.6% of cases. However, SMS text messaging interventions did not demonstrate significant changes in the measured outcomes. Of the 13 studies reviewed, 12 used randomized controlled trial designs, whereas one study employed a quasi-experimental approach. The total of participants across intervention and control groups was 3172 adults with diabetes. The interventions employed various strategies including diabetes self-management education led by nurses and other professionals, SMS text messaging for treatment adherence, and other targeted approaches. The duration of these interventions varied from 2 to 12 months. Specific interventions, such as glucose machine provision with training, family support with culturally tailored educations, and periodontal treatment, exhibited notable improvement in adherences and reductions in HbA1c levels. The review underscores the significance of diabetes self-care interventions in SSA, showing varying effectiveness levels across different strategies. It emphasizes the importance of tailored approaches and highlight interventions that have shown promising outcomes, providing insights for future research, policy, and healthcare strategies in the region.

Phonocardiogram (PCG) Murmur Detection Based on the Mean Teacher Method.

Cardiovascular diseases (CVDs) are among the primary causes of mortality globally, highlighting the critical need for early detection to mitigate their impact. Phonocardiograms (PCGs), which record heart sounds, are essential for the non-invasive assessment of cardiac function, enabling the early identification of abnormalities such as murmurs. Particularly in underprivileged regions with high birth rates, the absence of early diagnosis poses a significant public health challenge. In pediatric populations, the analysis of PCG signals is invaluable for detecting abnormal sound waves indicative of congenital and acquired heart diseases, such as septal defects and defective cardiac valves. In the PhysioNet 2022 challenge, the murmur score is a weighted accuracy metric that reflects detection accuracy based on clinical significance. In our research, we proposed a mean teacher method tailored for murmur detection, making full use of the Phyionet2022 and Phyionet2016 PCG datasets, achieving the SOTA (State of Art) performance with a murmur score of 0.82 and an AUC score of 0.90, providing an accessible and high accuracy non-invasive early stage CVD assessment tool, especially for low and middle-income countries (LMICs).