Negative and stigmatising attitudes towards human rights and mental health exist worldwide. The Ghanaian government has attempted to tackle such discriminatory attitudes and practices to align with a human rights-based approach in mental healthcare through the implementation of the World Health Organisation QualityRights Initiative in Ghana. As part of the initiative, the World Health Organisation has developed a range of capacity building tools on mental health, disability, human rights and recovery. National stakeholders in Ghana completed the WHO QualityRights e-training to build capacity and change attitudes to promote recovery and respect for human rights for people with mental health conditions, psychosocial and intellectual disabilities. Participants completed pre- and post-training questionnaires assessing perceived attitude and practice change. Thematic analysis was conducted on the open-ended questions on the post e-training questionnaires to discover how attitudes were impacted by the e-training. Three themes emerged: “legal capacity and the right to decide”, “coercion, violence and abuse” and “equality and community inclusion.” Attitudes on the right to make decisions, treatment of individuals with mental health conditions, psychosocial and intellectual disabilities, equality, social inclusion and non-discrimination had improved to be more in line with a human rights-based and recovery-oriented approach to mental health. The QualityRights training shows promise as a scalable intervention to reduce stigma, promote rights, and improve care for individuals with mental health conditions, psychosocial and intellectual disabilities.

Anorexia nervosa (AN) is a complex psychiatric illness with severe and life-threatening medical sequelae, including death. Existing evidence-based treatments are linked to good prognosis and full recovery in many. For a small minority of critically ill patients, treatment decisions extend beyond voluntary engagement. Severe cases may involve involuntary hospitalisation, nasogastric feeding, physical restraint, and other coercive measures. While these interventions are sometimes necessary to prevent death, they raise profound ethical concerns. This article explores the ethical tensions in treatment of individuals with AN through the lens of the four principles of biomedical ethics, respect for autonomy, beneficence, non-maleficence, and justice, examining the implications for clinical practice. It also outlines the legal mechanisms in Ireland governing involuntary treatment for AN. It considers treatment principles in children and adolescents as well as adults.

Hemodialysis is a life-sustaining treatment for individuals with kidney failure; however, it is associated with substantial physical and psychosocial challenges that can negatively affect quality of life and self-management. Wearable health technologies have gained increasing attention as tools for continuous monitoring of physiological and behavioral indicators, with potential relevance for disease management and psychosocial adaptation in hemodialysis care. This systematic review aimed to evaluate the impact of wearable technologies on disease management and psychosocial adaptation among individuals receiving hemodialysis. Systematic review. Adults receiving maintenance hemodialysis. A comprehensive literature search was conducted across five electronic databases. Study selection and screening were performed independently by two reviewers using a standardized review management system, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following screening and eligibility assessment, eight studies were included in the review, comprising three randomized controlled trials, two cohort studies, two cross-sectional studies, and one quasi-experimental study. Wearable technologies were primarily used to monitor physical activity, electrolyte imbalance, fluid status, and oxygen saturation. Across the included studies, wearable-based applications were associated with improved monitoring capabilities and showed potential benefits for self-management behaviors and selected psychosocial outcomes. Wearable technologies may serve as supportive tools for monitoring disease-related parameters and promoting self-management among individuals receiving hemodialysis. However, the current evidence remains limited and heterogeneous, highlighting the need for further high-quality studies to clarify their clinical and psychosocial impact.

Anticoagulants for the prevention and treatment of venous thromboembolism in humans exposed to microgravity: A hybrid systematic and narrative review.

Lifestyle changes-such as adopting healthy nutrition and increasing physical activity-are essential for alleviating symptoms in patients with knee osteoarthritis (OA) and overweight, with weight loss being a key outcome of these changes. Since 2019, healthcare professionals (HCPs) in the Netherlands have been able to refer these patients to a reimbursed combined lifestyle intervention (CLI). This study aims to identify determinants affecting CLI implementation for individuals with knee OA and overweight from both patient and HCP perspectives. Semistructured interviews were conducted in a qualitative study with 23 individuals with knee OA and overweight and 16 HCPs (general practitioners (GPs) and lifestyle coaches). Interviews were transcribed verbatim and coded independently by two researchers using the updated Consolidated Framework for Implementation Research (CFIR). Primary care, including GPs and lifestyle coaches from the Greater Rotterdam region in the Netherlands. 23 individuals with knee OA and overweight and 16 HCPs (GPs and lifestyle coaches). Determinants were explored within four CFIR domains: innovation, outer setting, inner setting and individuals. Key facilitators included recognition of the programme's potential, strong social support and positive participant-coach relationships. Major barriers involved the absence of an exercise component, financial constraints limiting its inclusion, scepticism among GPs about care quality, limited expertise of lifestyle coaches addressing OA-specific needs and difficulties adapting the programme to participants' diverse knowledge levels and health literacy. To improve the implementation of the CLI for patients with knee OA, it is essential to incorporate a tailored exercise component, strengthen lifestyle coaches' expertise, address financial barriers and build trust among GPs through education and clear communication of programme outcomes. Tailoring the CLI to better meet participant needs is crucial to ensure its long-term effectiveness and sustainability as a treatment for individuals with knee OA and overweight. Netherlands Trial Registry (NL9355).

Throughout the conflicts of Operation Iraqi Freedom and Operation Enduring Freedom, military medicine changed significantly. The greatest developments were the pivotal advancements in emergency medicine which saved the lives of many service members who sustained complex limb trauma and other forms of polytrauma. These developments led to changes in training, policy and other systemic advancements. However, the parallel advancements in post-acute treatment and rehabilitation of individuals with significant limb trauma did not result in the development of training, policy and systematic advancement. To mitigate this gap, the Extremity Trauma and Amputation Center of Excellence initiated the development of knowledge, skills, and abilities (KSAs) for rehabilitation specialists. This article focuses on the development of KSAs and learning objectives for occupational therapists who are providing traumatic amputation care. The authors used a pseudo-Delphi method of literature review and internal subject matter expert (SME) interviews with consensus achieved through adjudication of comments, feedback to commenters, and agreed upon language. The SMEs converted 57 identified competencies and28 2014 Clinical Practice Guidelines (CPG) recommendations into the OT specific KSAs. After completion of draft documents, external experts reviewed the materials with a repeat of the process. The result was a total of 290 KSAs developed across four clinical topic areas: (1) individual and multiple limb loss, (2) medical management, (3) other orthopedic injury, and (4) military other. The final Program document had 23 instructional modules with 28 terminal learning objectives and 231 enabling learning objectives. The KSAs and learning objectives presented here are the first steps in the process of understanding essential OT advanced amputation rehabilitation clinical and operational standards. Creating a formal limb loss rehabilitation training protocol that identifies rehabilitation needs for individuals with all levels of limb loss will ensure we are ready for the next influx of SMs who sustained amputations. The educational offerings to be derived from this Program will allow competency assessment, enduring education, and a platform upon which further mastery can be developed.

The aim is to provide an overview of the current evidence on the effectiveness of psychosocial interventions in the social environment and the recommendations of the updated S3 guideline "Psychosocial Therapies for Severe Mental Illness" of the DGPPN in this area. The established AWMF methodology for the (further) development of S3 guidelines was applied: systematic literature search and appraisal, GRADE-EtD, and structured consensus procedures, accompanied by a comprehensive guideline committee. The systematic search highlights international evidence with a focus on family interventions (recommendation grade A). The effectiveness of caregiver and parent interventions, as well as interventions in a broader social context, has been investigated far less frequently (recommendation grade B). In addition to effectiveness research, aspects of needs assessment and implementation are discussed. The findings point to a substantial need for further research and practical implementation.

ABSTRACT Transgender and Gender Diverse (TGD) individuals in forensic settings navigate a legal system that frequently lacks the specific guidance necessary for accurate forensic practice. This article provides sixteen research-informed recommendations to integrate gender-affirming principles into forensic assessment and treatment. These recommendations address critical domains including interviewing, diagnostic formulation, psychometric testing, and report writing. By merging respectful, affirming practices with a focus on objectivity and accuracy, this framework bridges the gap between clinical standards and legal demands. It provides practitioners with the tools to minimize bias and produce rigorous, ethically grounded, and scientifically accurate forensic work.

No randomized clinical trial has directly compared the effectiveness of sodium-glucose cotransporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment in reducing acute and chronic kidney outcomes. To examine the comparative effectiveness of SGLT2i and GLP-1RA treatment for acute and chronic kidney outcomes in individuals with type 2 diabetes. This comparative effectiveness study with a target trial emulation design used nationwide, population-based data from Denmark. Participants were individuals with metformin-treated type 2 diabetes who initiated SGLT2i or GLP-1RA treatment from January 2014 to November 2020, with follow-up through October 2024. Initiation of an SGLT2i or a GLP-1RA. The 2 coprimary outcomes were chronic kidney disease (CKD; 40% reduction in estimated glomerular filtration rate [eGFR], severe albuminuria, or kidney failure) and acute kidney injury (AKI). Secondary outcomes included the individual components of CKD, albuminuria, and death. Intention-to-treat effects were estimated using inverse probability of treatment weights, comparing risks for CKD assessed by the Aalen-Johansen estimator, and AKI burden by mean cumulative counts (MCCs; mean number of events per individual as multiple AKI events were possible). Subgroup analyses included stratification by preexisting cardiovascular or kidney disease. The study included 36 279 individuals who initiated an SGLT2i and 18 782 who initiated a GLP-1RA (median [IQR] age, 63 [55-71] years vs 61 [52-70] years), with comparable diabetes duration, eGFR, and urine albumin-creatinine ratios. The weighted 5-year risk of CKD was 6.7% (95% CI, 6.4%-7.0%) for SGLT2i initiators and 8.2% (95% CI, 7.8%-8.6%) for GLP-1RA initiators (risk ratio: 0.81 [95% CI, 0.76-0.87]; risk difference: -1.5% [95% CI, -2.0% to -1.0%]). The 5-year MCC of AKI per 100 individuals was 25.2 (95% CI, 24.4-26.1) for SGLT2i initiators and 28.7 (95% CI, 27.4-30.0) for GLP-1RA initiators (MCC ratio: 0.88 [95% CI, 0.83-0.93]; MCC difference: -3.5 [95% CI, -5.0 to -2.0]). In contrast, the secondary outcomes of albuminuria and mortality were slightly reduced in GLP-1RA initiators. Results were consistent across subgroups, with the most pronounced CKD and AKI reductions with SGLT2i observed among individuals without preexisting kidney disease. This comparative effectiveness study found that initiation of SGLT2i vs GLP-1RA treatment in individuals with type 2 diabetes was associated with a lower 5-year risk of CKD and a lower 5-year count of AKI. These findings underscore the potential of SGLT2i treatment for primary prevention of kidney disease in individuals with type 2 diabetes.

Soil-transmitted helminths (STHs) remain a significant public health concern among children in Sub-Saharan Africa and other developing regions like Nigeria, including Port Harcourt, largely due to factors such as poverty, inadequate sanitation, poor hygiene, low literacy levels, ecosystem variability, and overcrowding. This study investigated the prevalence of STHs among school-aged children in the Mile III area of the Port Harcourt Metropolis. Demographic data were obtained through a structured questionnaire, while stool samples were collected and examined using standard parasitological techniques. A total of 109 stool samples were analyzed, and various STHs were recovered. Ascaris lumbricoides was the most prevalent (67%), followed by Necator americanus (19%), Trichuris trichiura (11%), and Ancylostoma duodenale (3%). Overall, STH infection occurred in 18.3% of the study population. Females had a higher prevalence (17%) compared to males (10%), and infection was most common among children aged 3–10 years. The identified risk factors, such as poverty, poor sanitation, inadequate hygiene, low literacy, environmental influences, and overcrowding, were strongly linked to STH transmission in the area. To reduce the burden of STHs, the study recommends improved sanitation and hygiene practices, routine deworming of school children, health education programs, and prompt treatment of infected individuals.

This guideline provides evidence-based recommendations for clinicians, patients, and other stakeholders on the management of functional seizures. Following a National Academy of Medicine-compliant process, a multidisciplinary panel conducted a systematic review and integrated the findings with the authors' clinical experience to develop recommendations. A systematic review of the available evidence from first published articles to February 25, 2025, identified 12 Class II-III studies. The review found that psychological interventions are possibly effective in increasing the likelihood of achieving freedom from functional seizures, decreasing the frequency of functional seizures, decreasing anxiety, and improving health-related quality of life and psychosocial functioning for individuals with functional seizures. Key recommendations state that, when evaluating patients with seizure-like episodes, clinicians should seek historical and semiological information (including smartphone videos) from both patients and witnesses and may obtain video-EEG of all typical seizure-like episodes where feasible. Clinicians should evaluate patients diagnosed with functional seizures for co-occurring psychiatric disorders and co-occurring epilepsy. Clinicians should adhere to universal standards of care for patients, including speaking respectfully, refraining from unnecessary harm, and avoiding stigmatizing behavior. Clinicians should provide a specific diagnostic label and rationale for the diagnosis, should engage in shared decision making regarding the treatment plan, and should provide continuity of care to individuals diagnosed with functional seizures. When psychological interventions for functional seizures are indicated, clinicians should counsel patients regarding the potential benefits and risks of these interventions and should refer interested and appropriate patients to these interventions for the treatment of functional seizures. Clinicians should involve family, caregivers, or others in the social support network in the psychological treatment of individuals with functional seizures. Clinicians should not prescribe benzodiazepines or antiseizure medications for patients with functional seizures without co-occurring epilepsy or another indication for these medications and should counsel patients regarding the potential risks and lack of evidence of benefit for using these medications for functional seizures. Clinicians should taper off antiseizure medications for patients with functional seizures and without another indication for these medications. The guideline also identifies gaps in the available evidence and outlines potentially clinically impactful avenues for future research.

In the realm of dental treatment for individuals with disabilities, ethics plays a fundamental role by emphasizing the foundational principles of respect, dignity, and equitable access to dental care. Living with disabilities exerts a considerable impact upon the daily lives of affected individuals-one recognized by Ecuadorian disability law-which highlights the imperative role of caregivers in providing necessary support. Therefore, the objective of this study was to identify the perception of ethics in dental treatments of people with disabilities. The conducted study, involving the participation of thirty-five dentists in Ecuador, seeks to discern ethical perceptions surrounding dental treatments. It underscores the pressing need to synchronize ethical-moral values with tailored procedures to achieve truly inclusive care. A comprehensive approach to ethics in dentistry for individuals with disabilities is imperative. This entails a thorough consideration of individual needs and the application of ethical-moral values. Continuous education and interdisciplinary collaboration stand out as indispensable components to provide quality and respectful care. The study serves to underscore the paramount importance of ethics in the dental field, emphasizing the need to adapt to diversities and ensure inclusion in the provision of care to patients with disabilities.

BackgroundMycobacterium ulcerans is the etiologic agent of Buruli ulcer (BU), an infectious disease characterized by progressive cutaneous ulcerations that can lead to disability, loss of economic productivity, and stigma. Current World Health Organization (WHO) guidelines recommend treatment initiation in the hospital setting or coordinated in a decentralized health center. This prospective pilot study sought to evaluate feasibility and effectiveness of a community-care-based model of BU care.MethodsFor this ongoing study, the setting is outpatient general medical clinics in the Plateaux region of Togo, Africa. Consenting adults with cutaneous lesions less than 15cm (WHO Grade I-II or III with multiple small lesions) consistent with BU were enrolled. Participants were provided with standard-of-care, weight-based clarithromycin and rifampin and wound care supplies. The study team provided education on routine wound care that can be done at home. Enrolled participants were visited at home by a community leader every 2 weeks for wound care/dressing education during the 8 weeks of antibiotic treatment. Participants will have home follow-up visits at months 3 and 6 for outcome assessments. At each visit, ulcer measurements and photographs are taken, and standardized checklists are completed to assess treatment adherence, medication side effects, and paradoxical reactions.ResultsA total of 16 patients were screened, and 10 patients were enrolled and currently undergoing home-based antibiotic treatment and wound care. Three (33%) patients have not completed all follow-up visits. Of those who have completed all visits, they report 100% adherence to medications and wound care therapy at home. To date there have been no reported medication side effects, and 1 (10%) patient had findings consistent with a paradoxical reaction. Interim data shows ulcer size improved in all 7 patients that have completed visits, with an average reduction in size (cm3) of 64.7% and complete epithelization in 1 patient at the 6-week mark.ConclusionEarly results support the feasibility of community-based treatment for individuals with (WHO Grade I-II disease or Grade III with multiple lesions of small size) Mycobacterium ulcerans cutaneous disease.DisclosuresStephanie Kirk, PharmD, ViiV Healthcare: Grant/Research Support

BackgroundTau‐PET neuroimaging is increasingly applied to diagnose and stage, track progression, and assess response to putative disease‐modifying treatments in individuals with Alzheimer disease. However, it remains to be seen whether findings established in predominantly non‐Hispanic White (nHW) cohorts will generalize to Black and Latino participants who are underrepresented in dementia research.MethodCommunity‐dwelling Black (n = 83) and Latino participants (n = 27) completed MRI (with quantification of white matter hyperintensity volumes), and amyloid‐ (PiB or florbetapir) and tau‐ (flortaucipir) PET brain imaging as part of a longitudinal study of memory and aging at Mayo Clinic in Florida. Global and regional tau‐PET standardized uptake value ratios (normalized to the cerebellar crus) were determined in Black and Latino participants and compared with findings from an independent cohort of nHW participants (n = 110), 1:1‐matched for age, sex, education, and global Clinical Dementia Rating®. Conditional logistic modeling compared 47 regions of interest, adjusted for false discovery rate. Relevant associations between flortaucipir retention and clinical outcomes were assessed using Spearman rank correlations.ResultEighty‐three Black (mean 72±10.8‐years‐old, 63% female, 33% cognitively impaired) and 27 Latino participants (mean 65.8‐years‐old, 56% female, 11% cognitively impaired) completed neuroimaging. Data were compared with findings in 110 matched nHW individuals. Global tau‐PET burden was similar between matched cohorts (Black and nHW participants, mean SUVR: 1.34±0.39 vs 1.36±0.37, p = 0.71; Latino and nHW participants, mean SUVR: 1.17±0.09 vs 1.20±0.11, p = 0.66). Lower flortaucipir uptake was noted in the caudate (p = 0.005) and putamen (p = 0.022) of Black/Latino participants (vs nHW), although differences attenuated following adjustment for white matter hyperintensity volume. Global flortaucipir retention increased with age (Black: Rho=0.31; Latino: Rho=0.46; nHW: Rho=0.27; p <0.05), amyloid Centiloids (Black: Rho=0.65; Latino: Rho=0.41; nHW: Rho=0.58; p <0.05), and cognitive impairment (i.e., Clinical Dementia Rating® Sum‐of‐Box scores, Black/Latino: Rho=0.31, p = 0.07; nHW: 0.76, p <0.001).ConclusionTau‐PET patterns were similar across ethnoracial groups after adjusting for white matter hyperintensity volumes—a biomarker of small vessel disease. Flortaucipir retention increased with age, amyloid accumulation, and cognitive impairment across all cohorts. These findings affirm the clinical and research applications of tau PET in diverse cohorts.Acknowledgements: Flortaucipir precursor and technology was supported by Avid Radiopharmaceuticals.

Tuberculosis (TB) is the greatest cause of infectious disease deaths worldwide. In highly affected countries, effective TB control requires prompt identification and treatment of individuals with active disease. We examined the performance of TB case-finding in low- and middle-income countries based on a comprehensive analysis of TB diagnosis data reported to the World Health Organization. Using these data we estimated the total number of individuals correctly and incorrectly diagnosed with TB, for 111 countries with a collective 6.8 million TB notifications in 2023. Here we estimate that in 2023, 2.05 (1.83-2.27) million individuals were incorrectly diagnosed with TB (false-positives), and 1.00 (0.71-1.36) million received a false-negative diagnosis, at an assumed 25% disease prevalence among individuals evaluated for TB. As many as three of every ten TB notifications may not have TB, and many individuals with TB receive false-negative diagnoses. Compared to current diagnostic performance, scaling-up new polymerase chain reaction-based diagnostics would substantially reduce under-diagnosis but only produce a small reduction in false-positive diagnoses. Major improvements in TB diagnosis will likely require higher-sensitivity bacteriological tests combined with reduced reliance on clinical diagnosis.

BackgroundThe optimal treatment for individuals with high-normal blood pressure (BP, systolic BP 130–139 mmHg and diastolic BP < 90 mmHg) is debated. This study evaluates whether pharmacologically reducing systolic BP to below 130 mmHg could prevent major adverse cardiovascular events (MACE) in high-normal BP cases with no comorbidities and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5%.MethodsIn this randomized, controlled, parallel, unicentric trial, participants were assigned to either an intervention group (pharmacotherapy plus diet control) or a control group (diet control only). The study aimed for 1,600 participants but was terminated after the first phase due to limited resources and recruitment challenges. Fixed-dose combinations of valsartan and amlodipine were administered as BP-lowering agents. Follow-up visits every 3 months adjusted pharmacotherapy to maintain systolic BP < 130 mmHg in the intervention group and < 140 mmHg in the control group. MACE was the primary endpoint, with its components (cardiovascular death, myocardial infarction, stroke, and heart failure) as secondary endpoints. Multivariable Cox regression analysis was utilized to compare the group endpoints.ResultsOf 14,562 screened individuals, 231 in the intervention and 235 in the control group were included in the final intention-to-treat analysis. At baseline, the control group had a slightly higher mean age than the intervention group (67.7 vs. 66.1 years; P = 0.013). Females comprised a minority in both groups (19.5% in intervention vs. 16.2% in control; P = 0.397). The mean 10-year ASCVD risk was slightly higher in the control group (17.4% vs. 15.9%; P = 0.013). The MACE occurred in 9 participants (1.57 per 100 person-year) in the intensive treatment group vs. 24 (4.16 per 100 person-year) in the control group (adjusted hazard ratio [aHR], 0.26; 95% confidence interval [CI], 0.11–0.62; P = 0.003). The incidence of serious adverse events (hypotension, syncope, injurious falls, electrolyte imbalances, or acute kidney injury) was similar between the groups (aHR, 1.47; 95% CI, 0.82–2.62; P = 0.195).ConclusionsPRINT-TAHA9 findings suggest that pharmacological BP reduction may benefit healthy asymptomatic individuals with high-normal BP and ASCVD risk ≥ 7.5%.Trial RegistrationIranian Registry of Clinical Trials Identifier: IRCT20191002044961N1

Long-Term Outcomes of Surgical Drooling Treatment in Individuals with Neurodevelopmental Disabilities: A Retrospective Cohort Study.

Modelling transmission dynamics of typhoid fever with vaccination, isolation and treatment of infected individuals

Modelling transmission dynamics of typhoid fever with vaccination, isolation and treatment of infected individuals

Globally, Sexually Transmitted Infections (STIs) are a serious public health concern. The most common bacterial STI pathogen is Chlamydia trachomatis (C. trachomatis). Over 80% of individuals with this infection remain asymptomatic, which may lead to undiagnosed cases. A persistent infection with C. trachomatis can spread to the upper genital tract, resulting in Pelvic Inflammatory Disease (PID). If left untreated, this may lead to long-term sequelae, such as infertility. Early diagnosis and treatment of infected individuals are required to prevent the spread of the disease and its severe consequences. Tissue culture was once thought to be the most reliable method of diagnosis. However, diagnosis has become quick and simple with the development of improved diagnostic tools, especially molecular techniques, which are not only very sensitive and specific but also cost-effective. This review elucidates the effects of genital infections caused by Chlamydia on human health and recommends further research on the frequency, prevalence, and pathogenic mechanisms of C. trachomatis Infection (CTI) to gain a better understanding of the long-term consequences caused by this illness. Lastly present review confirms that the evidence presented can encourage changes in the country’s healthcare system in the future. For instance, future infection control measures could be planned, prevention campaigns could be created to increase public awareness of the risk factors for this infection, and screening techniques for Chlamydia could be updated.