World Health Organization Recommends Research Articles

Clinical and laboratory antenatal profile screening and its associate factors among pastoralist women in Northern Part of Kenya

IntroductionAll pregnant women are encouraged to visit Antenatal Care (ANC) during pregnancy to ensure their wellbeing and that of their unborn baby. World Health Organization (WHO) recommends that all pregnant women attend antenatal clinics for care at least eight times during pregnancy. During antenatal care a series of essential tests are done for pregnant women, both clinical examination and laboratory screenings to detect potential issues which will guide clinicians on management. This study aims to investigate the clinical examination and laboratory screening profile results of pastoralist pregnant women and its associated factors during their first ANC visit in Marsabit County, Kenya.MethodsA cross-sectional study was conducted among pregnant women who attended Integrated Maternal Mobile (IMMH) outreach clinics for ANC in 10 mobile pastoralist communities. Data were collected on demographic information, clinical examination information, and laboratory profile screening outcomes. Frequency and percentages were used to describe the categorical variables and means and standard deviations were used to describe the continuous variables. Bivariate and multivariate analysis was conducted using IBM SPPS 27.0 following STROBE guidelines. The level of significance was set at p < 0.05.ResultsData (N = 237) were extracted, the mean age was 26.62 ± 5.371, of which the majority were in the age group of 20–29, 212 (89.5%) were married 180 (75.9%) and multigravida, 27 (11.4%) visited ANC and 121 (51.1%) traveling more than 15 km to seek healthcare services. The mean weight was 55.56 ± 9.019 kg, mean blood pressure systolic was 118.94 ± 19.95 mmHg, and diastolic was 73.87 ± 13.46 mmHg. Out of all specimens processed and tested, 135 (57%) were anaemic with Hgb <11.5 g/dL), 6 (2.5%) had malaria, 8 (3.4%) were hepatitis B positive, and 21 (8.9%) showed intestinal infection. Those women who are illiterate displayed a 12-fold higher likelihood of becoming anaemic during pregnancy (OR 11.50, 95% CI: 2.47–53.47), and those who didn’t attend ANC also have a 5-fold higher likelihood of being anaemic (OR 5.43, 95% CI: 2.52–11.70).ConclusionAnaemia, hepatitis B, syphilis, malaria parasites, intestinal parasites, and urinary tract infections were observed among the study participants. Integrated outreach programs with laboratory screening and health education should be enhanced, and women within pastoralist communities should be empowered through health education.

A model for integrating palliative care into Eastern Mediterranean health systems with a primary care approach.

Palliative care in the Eastern Mediterranean Region (EMR) faces challenges despite the high number of patients in need. To provide accessible, affordable, and timely services, it is crucial to adopt a suitable care model. World health organization (WHO) recommends integrating palliative care with primary health care (PHC). Given the unique conditions of EMR countries, there is a need to design a model tailored to these contexts. This study is a multi-method research project conducted through several sub-studies, including a literature review, policy analysis, expert opinion (Delphi Method), dimension-specific analysis, model development, and its validation and refinement (Delphi Method). Drawing from the WHO model, six dimensions: policy, drug availability, education, community integration, service delivery, and research were considered to developing the model and implementation requirements. Within each dimension, evidence-based solutions tailored to the region's context were explored. A successful palliative care model requires, in the policy dimension, oversight by the Ministry of Health (MOH). Having a focal-person or working group within the MOH is crucial for policy-making, formulation, and approval of clinical guidelines, as well as addressing care challenges. It is essential to provide access to morphine and other essential medications, along with facilitating the administration and consumption of morphine at home. Conducting empowerment courses for care providers, can address various challenges. Community involvement through volunteers, charities, and non-governmental organizations (NGOs) is also important. To ensure service provision, monitoring and evaluating systems are crucial, along with striving for service continuity through an appropriate payment system. Lastly, research is necessary for needs assessment, evidence-based practice, and designing evaluation indicators. The proposed model relies on community health workers, especially nurses, as multitasking professionals available for community palliative care. In the presented model, special attention has been given to networking, collaboration, and the use of digital health technologies to support nurses. The model proposed for integrating palliative care into PHC should serve as a framework that enhances access to available and affordable services for countries in the region. While this model was developed based on the overall conditions of the region, each country can tailor it to its unique strengths and opportunities.

Prevalence and predictors of episiotomy among puerperal women accessing postnatal care in the Kumasi Metropolis.

This study investigated the prevalence and predictors of episiotomy among puerperal women accessing postnatal care in the Kumasi Metropolis. A cross-sectional survey was conducted among 1750 postnatal mothers who had spontaneous vaginal using a questionnaire. Descriptive statistics were conducted to show the rate of episiotomy. Chi-square and binary logistic regression analyses were conducted using Jamovi software version 2.5.3. The prevalence of episiotomy among the study population was 49.7% compared to the 10% of all deliveries recommended by World Health Organisation (WHO). Among those who had an episiotomy, 88.5% gave consent, and 77.6% required repairs. In the bivariate analysis educational status, age, perineal tearing, marital status, household monthly income, spontaneous vaginal deliveries and previous episiotomy had a significant association with episiotomy risk. In the multivariate analysis, married women, lower education levels, moderate household incomes, grand multiparous women, spontaneous vaginal delivery (SVD), instrumental deliveries, longer second stages of labour, and attending more antenatal care (ANC) sessions were all associated with a reduced likelihood of episiotomy. Higher one-minute Apgar scores and anemia also lowered the odds. Conversely, hypertensives, women with four or more previous vaginal deliveries, and those with a history of episiotomy were more likely to undergo the procedure. Episiotomies conducted was high, indicating potential overuse compared to WHO's recommendations. Antenatal attendance and timing should be prioritised to improve maternal preparation and outcomes. Policy interventions to reduce unnecessary episiotomies are needed. Midwifery education must also emphasise the importance of respectful maternity care.

Comparing the economic burden of disease by physical activity levels among persons with and without disabilities in the Republic of Korea

IntroductionThe World Health Organization recommends at least 150 min of physical activity per week for persons with and without disabilities. This study compared the differences in the economic burden of diseases between persons with and without disabilities based on their physical activity. What is known in the field is that physical activity is beneficial to health, but there is a disparity between persons without disabilities and persons with disabilities, and our research aims to increase physical activity among persons with disabilities.MethodsEconomic burden of disease includes service costs such as outpatient, hospitalization, and pharmaceutical expenses for disease treatment, and persons with disabilities are those who have received a disability classification legally registered by the Korean Ministry of Health and Welfare, and there are 15 types of disabilities. For exercise records, we calculated the cost in 2020 for people with exercise records in 2018 so that they can have at least 1 year of exercise records, as health checkups are available from January to December of the year. Physical activity attainment is defined as 150 min or more of physical activity per week based on World Health Organization guidelines.ResultsCalculating the economic burden of disease by physical activity for persons with and without disabilities, both experienced a difference in hospitalization costs owing to fewer hospital days with physical activity achievement, with the difference being greater for persons with disabilities. Regarding disability type, achievers showed a 41.1% difference in total costs for mental class disorders, 16.7% for external bodily function disorders, and 11.1% for internal organ disorders.DiscussionPhysical inactivity has a significant impact on the economic burden of persons with disabilities compared to persons without disabilities, with 11.8% fewer persons without disabilities who were physically active for 150 min or more per week compared to 21.4% fewer persons with disabilities. In terms of healthcare spending, exercise can help keep persons with disabilities healthy. Therefore, there is a need for exercise programs tailored to persons with disabilities to increase physical activity in line with World Health Organization recommendations to reduce health inequalities between persons with and without disabilities.

Parental Voices on Screen Time Guidelines in Early Childhood

This article critically engages with the concept of screen time. We explore the screen time recommendations from the World Health Organization (WHO) and their application in the Swedish context. We also investigate the experiences and opinions on the recommendations and advice on screen time and screen media use in early childhood among parents of young children (0–3 yrs.) in Sweden. The study draws from qualitative semi-structured interviews during multiple home visits from a diverse sample of 16 families. Findings are discussed through the prism of the ‘moral economy’ of the household and the ‘social imaginaries’ underpinning this. We have identified two types of approaches to guidelines on screen time among parents, and based on our findings we recommend organizations in Sweden and beyond, to rethink and revise the current guidelines, including the WHO recommendations.

Practical cut-off value for radon concentration in indoor air using an activated-charcoal radon collector.

The World Health Organization (WHO) recommends that countries adopt the reference level of 100Bqm-3 for indoor radon gas. Adopting the reference level requires a preliminary assessment of the indoor radon concentration. In the preliminary investigation, a cut-off value is useful, which is a value for selecting samples that can be reliably determined to be below the reference level (in this paper, the WHO reference level) using a straightforward method. If the true value was the WHO reference level, then the cut-off value of the PicoRad collector for selecting samples was determined as 80Bqm-3 through the analysis of the 95% prediction interval.

Association between health-enhancing physical activity and the social factors, lifestyle and dietary characteristics.

The World Health Organization (WHO) recommends minimum of 150 minutes of moderate intensity aerobic physical activity or 75 minutes of vigorous intensity aerobic physical activity along with at least two sessions of muscle strengthening exercises per week. Compliance with these recommendations is classified as Health Enhancing Physical Activity (HEPA). The aim of this study was to analyze the association between the HEPA and the social factors, lifestyle and dietary characteristics. We conducted the secondary analyses of the data from the Serbian National Health Survey 2019, on 12067 adult participants classified in two groups: with HEPA and without HEPA based on the compliance with the WHO recommendations. Prevalence of HEPA was 3.3% (394/12067). Multivariate logistic regression analysis showed positive association between HEPA and male sex (OR: 4.25, 95% CI: 2.68-6.73), average (OR: 3,01, 95% CI: 1.13-8.04), good (OR: 3.10, 95% CI: 1.21-7.94) and very good (OR: 4.64, 95% CI: 1.82-11.84) income quintile being single (OR: 1.85, 95% CI: 1.16-2.95), the number of portions of fruits per day (OR: 1.29, 95% CI: 1.09-1.53), the frequency fresh fruit/vegetable juice consumption (OR: 1.20, 95% CI: 1.02-1.40), and being non-smoker (OR: 1.67, 95% CI: 1.03-2.73). There was a negative association between HEPA and age (OR: 0.96, 95% CI: 0.95-0.98), BMI (OR: 0.94, 95% CI: 0.88-1.00), average self-rated health (OR: 0.18, 95% CI: 0.12-0.60), and the frequency of non-alcoholic beverages consumption (OR: 0.75, 95% CI: 0.62-0.89). Since only a small percentage of the adult population in Serbia meets the WHO recommendations for physical activity, action is required. This should involve creating future strategies and policies, as well as initiatives focused on education and raising awareness about the importance of physical activity and health.

Prevalence and factors associated with undernutrition among 15-49-year-old women in Sierra Leone: A secondary data analysis of Sierra Leone Demographic Health Survey of 2019.

Undernutrition of women of childbearing age is pertinent for maternal and offspring health. This study aimed to determine the prevalence and factors associated with undernutrition (underweight and stunting) among women of reproductive age (15-49 years) in Sierra Leone using a secondary data analysis of the 2019 Demographic Health Survey. Anthropometric measurements and maternal characteristics were obtained from the Sierra Leone Demographic Health Survey (SLDHS) of 2019. The heights and weights of women were measured, and BMI in kg/m2 was calculated. Based on the World Health Organization's recommendations, stunting was defined as heights <145cm and being underweight as BMI <18.5kg/m2. Multivariate logistic regression analyses were conducted to identify factors associated with undernutrition, with a significant level set at p<0.05. A total of 7,514 women of reproductive age, 15-49 years were analyzed in this study. The prevalence of stunting and underweight were 1.5% (113/7514) and 6.7%(502/7,514), respectively. Women with primary education had a 47% lower likelihood of being stunted (adjusted Odds Ratio [aOR] = 0.53, 95% Confidence Interval [CI]:0.30-0.94;p = 0.029) than secondary education. Women in the poorest wealth index had a 51% lower likelihood of being stunted (aOR = 0.49,95%CI:0.27-0.88;p = 0.017) than the middle wealth index. Underweight was 1.48 times more likely among women with a parity of one-to-four (aOR = 1.48,95% CI:1.08-2.03;p = 0.015) than women who never gave birth. Also, underweight was 1.41 times more likely among women who listened to radios (aOR = 1.41,95% CI:1.14-1.74;p = 0.002) than those who did not. Age groups of 15-19 years and 40-49 years had a 54% (aOR = 0.46,95%CI:0.34-0.62;p<0.001) and 34% (aOR = 0.66,95%CI:0.45-0.97;p = 0.035) lower likelihood of being underweight than 20-29-year age group, respectively. Women with primary education had a 26% lower likelihood of being underweight (aOR = 0.74,95%CI:0.56-0.99;p = 0.042) than those with secondary education. However, none of the wealth indices was significantly associated with being underweight. The prevalence of underweight and stunting among women of reproductive age (15-49 years) in Sierra Leone was lower than regional and world data. This study highlights similarities and differences in this population's prevalence and factors associated with undernutrition. Underweight and stunting were less likely in women with primary education, while parity of one to four and listening to radios were significantly associated with being underweight. Further trend studies using DHS data from 2010, 2014, and 2019 are warranted to understand the dynamics of undernutrition among women (15-49 years) in Sierra Leone.

In vitro Antileishmanial Effect of Scrophulariabavanatia Extract on Leishmania (L) tropica [MHOM/NADIM3

Background: Cutaneous Leishmaniasis (CL) is a widespread parasitic disease that causes skin lesions and ulcers. Although the World Health Organization recommends Glucantime as a treatment for CL, this remedy presents unexpected side effects and high costs. This study investigates the in vitro antileishmanial effect of Scrophulariabavanatia hydroalcoholic extract on Leishmaniatropica promastigotes. Objectives: This study aims to evaluate the in vitro antileishmanial effects of a local Scrophulariabavanatia hydroalcoholic extract on Leishmania (L.) tropica [MHOM/NADIM3] promastigotes. Methods: Various concentrations (0.2, 1, 5, 25, and 125 mg/mL) of Scrophulariabavanatia methanol extract were prepared and added to cultures containing the parasite. The amastigote form of the L. tropica strain [MHOM/IR/NADIM3] was isolated from mouse spleens and transformed into promastigotes in Novy-Nicolle-Mac Neal medium. The antileishmanial activity of Scrophulariabavanatia extract was then compared to Glucantime using cell proliferation ELISA. Results: The LC50 values in the stationary stage for both Scrophulariabavanatia extract and Glucantime (mg/mL) were greater than in the dynamic stage. The extract at concentrations of 0.2, 1, 5, 25, and 125 mg/mL did not show significant differences after 24 and 48 hours (P &gt; 0.05) compared to negative controls but did show a significant effect after 72 hours (P = 0.000). The extract demonstrated increased effectiveness with higher concentrations and longer exposure times. Conclusions: Scrophulariabavanatia extract inhibits the survival and growth of Leishmania promastigotes. Future studies should further explore its effects on in vivo survival of the parasite.

Determinants of out-of-pocket expenditure on medicines among adults in Saudi Arabia: a cross-sectional study

IntroductionTo achieve universal health coverage consistent with World Health Organization recommendations, monitoring financial protection is vital, even in the context of free medical care. Toward this end, this study investigated out-of-pocket (OOP) expenditure on medicines and their determinants among adults in Saudi Arabia.MethodsThis analysis was based on cross-sectional data derived from the Family Health Survey conducted by the General Authority for Statistics in 2018. Data analyses for this study were based on the total sample of 10,785 respondents. Descriptive statistics were used to identify the sample distribution for all variables included in the study. Tobit regression analysis was used to examine the determinants of OOP expenditure on medicines.ResultsThe average OOP expenditure on medicines was estimated to be 279.69 Saudi Riyal in the sampled population. Tobit regression analysis showed that age, average household monthly income, education level, and suffering a chronic condition were the main determinants of OOP expenditure on medicines. Conversely, being married and employed were associated with a lower probability of OOP expenditure on medicines.ConclusionThis study could assist policy makers to provide additional insurance funding and benefits to reduce the possibility of catastrophic OOP expenditure on medicines, especially for the most vulnerable demographic.

Antimicrobial stewardship in sub-Saharan African community pharmacies: a systematic review of community pharmacists’ knowledge, practice and challenges faced

Abstract Introduction The indiscriminate use of antimicrobials contributes significantly to antimicrobial resistance (AMR). The World Health Organization (WHO) recommends antimicrobial stewardship (AMS) as one of the global sustainable development interventions to tackle AMR. Implementation of AMS interventions have been documented to be successful in high-income countries 1, however, there is paucity of data regarding the implementation and effectiveness of AMS in low-income settings including sub-Sahara Africa (SSA). Community pharmacies in the SSA play a critical role in the dispensing of medicines, including antibiotics. Aim To evaluate community pharmacists' knowledge, practice, and challenges faced in relation to AMS in SSA community pharmacies. Methods The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework guided the review. We searched six electronic databases (PubMed, Web of Science, ProQuest Central, Google Scholar, African Journal Online and Wiley Online library) from January 2010 to December 2022. Reference lists of included articles were screened for additional studies. Studies published in English that described AMS interventions, antibiotic dispensing practices, community pharmacists’ knowledge and perceptions of AMS/AMR were included. Literature reviews and systematic reviews were excluded. AMS in hospital pharmacy and animal studies were also excluded. Two reviewers independently screened the abstracts and full texts according to pre-defined inclusion criteria. Disagreements were resolved through discussion. The Mixed Methods Appraisal Tool (MMAT) was employed to assess the quality of the included studies2. Data were extracted using a standardised form in Microsoft excel and double checked for accuracy. Data were synthesised using narrative synthesis. The review protocol was registered with PROSPERO (CRD42023381320). The study did not require ethical approval because it did not involve conducting primary or secondary research involving human participants. Results The review identified 1972 articles, of which 23 studies met the inclusion criteria. Studies varied in settings, design, and data collection methods. Two broad categories were identified from the narrative synthesis. (1) Community pharmacists’ knowledge, attitude, perception, and dispensing practices (n=20). Studies reported that community pharmacists displayed an understanding of how antibiotics work. They also acknowledged threats posed by AMR. Some studies reported misconceptions on clear guidelines about the practical implementation of AMS, other studies described good adherence to antibiotic dispensing practices, including taking medication histories, assessing symptoms, advising on completion of antibiotic courses and making referrals. One study described the perception of community pharmacists of AMS as crucial for improving patient care. (2). Determinants of non-prescription antibiotic sales (n=3). The studies explored factors influencing the sale of antibiotics without prescription. Studies identified pharmacy owners’ expectations (profitability) and lack of public awareness regarding the risks of non-prescription antibiotic use as contributing factors. Limited patient access to doctors and low economic status in SSA were also cited as determinants. Conclusions Community pharmacists have knowledge of antibiotics, and they also acknowledged the importance of AMS. There were also positive dispensing practices despite existing challenges regarding implementation of AMS and sales of antibiotics without prescription. Further research should prioritize well-designed studies that evaluate the effectiveness of AMS in this setting and address the challenges identified. Heterogeneity of study methods limits the generalisability of findings.

Cross-Sectional Survey to Assess Hospital System Readiness for Hemorrhage During and After Cesarean Delivery in Africa.

Mothers in Africa are 50 times more likely to die after cesarean delivery (CD) than in high-income countries, largely due to hemorrhage. It is unclear whether countries across Africa are adequately equipped to prevent and treat postpartum hemorrhage (PPH) during and after CD. This was a cross-sectional survey of anesthesiologists and obstetricians across the African Perioperative Research Group (APORG). The primary objective was to determine readiness of the hospital system to implement the World Health Organization (WHO) recommendations for prevention and treatment of PPH during and after CD. The secondary objectives were to evaluate the availability of blood products, skilled human resources and establish available postoperative care after CD. Survey question format was close-ended or Likert scale, with options "always," "sometimes," or "never." Responses were analyzed from 1 respondent from each of 140 hospitals from 29 low- and middle-income countries across Africa. Most respondents completed every data field on the case report form. Regarding WHO recommendations on prevention of PPH, oxytocin and misoprostol were available in 130/139 (93.5%) and 101/138 (73.2%) hospitals, respectively. There was limited access to heat-stable carbetocin (12/138 [8.7%]) and ergometrine (35/135, [25.9%]). Controlled cord traction for removal of placenta was always performed in 133/135 (98.5%) hospitals. Delayed cord clamping when neonatal resuscitation was not indicated, was not performed universally (86/134 [64.2%]). Regarding the treatment of PPH, crystalloids were always available in 133/139 (95.7%) hospitals, and the preferred initial resuscitation fluid (125/138 [90.6%]). Uterine massage was always performed in 117/139 (84.2%) hospitals. Tranexamic acid was always available in 97/139 (69.8%) hospitals. The availability of intrauterine balloon tamponade devices was limited. Most had immediate access to theater (126/139 [90.6%]). Responses concerning organizational recommendations showed that 113/136 (83.1%) hospitals had written protocols for the treatment of PPH. Protocols for patient referral and simulation training were limited. Most hospitals had access to emergency blood (102/139 [73.4%]). There was limited access to blood component therapy, with platelets available at 32/138 (23.2%), cryoprecipitate at 21/138 (15.2%) and fibrinogen at 11/139 (7.9%) hospitals. In-person specialist cover was reduced after-hours. Important WHO-recommended measures to reduce hemorrhage during and after CD, are not currently available in many hospitals across Africa. It is likely that the lack of a combination of factors leads to failure to rescue mothers in Africa from postoperative complications. These findings should facilitate codesign of quality improvement initiatives to reduce hemorrhage related to CD.

Individual- and system-level determinants of breastfeeding in a low-resource setting

The benefits of breastfeeding are widely established and therefore the World Health Organization recommends that every child be exclusively breastfed for the first 6 months of life and continue breastfeeding up to 2 years of age or beyond. However, the rate of exclusive breastfeeding is low globally and has declined in Bangladesh in recent years. In this review, Bangladesh is used as an example to demonstrate the complex individual- and system-level determinants of breastfeeding in a low-resource setting. Mothers face barriers to breastfeeding within the context of marketing by commercial milk formula companies, limited safe alternatives to breastfeeding directly from the breast, and insufficient resources to support breastfeeding in the hospital, community, and workplace setting. Future research and implementation science is required to investigate the overlapping effects between breastfeeding and the high antibiotic use and Caesarean section rates in Bangladesh, along with public health efforts to promote breastfeeding based on robust evidence.

Freeze-drying donor human milk allows compositional stability for 12 months at ambient temperatures

Breastfeeding, which is recognised as the optimum nutrition for infants, offers numerous benefits. However, circumstances can arise when infants are unable to be breastfed from birth. In such cases, the World Health Organisation (WHO) recommends donor human milk (DHM) as the safest alternative. Current practices freeze DHM and transport it under a cold supply chain, which can create logistical challenges. Here, we investigated the efficacy of freeze-drying as a method for determining the compositional stability of DHM. The samples were freeze-dried and stored at −20°C, 4°C and ambient temperature, with sampling at 1, 3, 6, 9, and 12 months. The macronutrient composition was assessed before and after freeze-drying, protein and lipid profiles were studied using MALDI-TOF MS, and the metabolite profile was analysed through LA-REIMS. The findings revealed that freeze-drying did not significantly alter the macronutrient composition and that microbiological safety was preserved. Lipid, protein, and metabolite fingerprints remained consistent across storage conditions over 12 months. This work provides a broad insight into the compositional stability of DHM after freeze-drying. It suggests the applicability of freeze-drying for long-term preservation without a cold supply chain. The use of freeze-dried DHM may broaden its use in emergency situations and resource-limited settings.

Review of the role of ultrasound in assessing plasma leakage in dengue fever and a proposed scanning protocol

AbstractBackgroundThe clinical course of dengue can range from mild to severe and predicting the course can be challenging. The World Health Organisation (WHO) recommends prognostication via the presence of warning signs, to aid in disposition and management. Plasma leakage is a key warning sign in dengue, and ultrasound can be utilised as a screening tool.ObjectivesThe objectives were to describe the literature on the use of ultrasound in dengue, summarise the findings, and propose a standardised point‐of‐care ultrasound protocol.MethodsWe reviewed the current literature on the role of ultrasound in dengue and its key features.ResultsUltrasound is a useful tool in the evaluation of patients with dengue and has been shown to be able to detect plasma leakage even prior to clinical and laboratory findings. In particular, gallbladder wall thickening is an early sign that can aid the clinician in prognosticating patients.ConclusionDetecting plasma leakage early with ultrasonography can help the clinician determine appropriate disposition and management. We propose a standardised point‐of‐care ultrasound protocol (FASD) for early detection of plasma leakage in dengue, in the routine care of dengue patients.

A wearable hip exoskeleton for anaerobic exercise in healthy adults

Guidelines encouraging social distancing, limited outings, and remote work due to COVID-19 have increased sedentary periods and reduced levels of physical activity. These habits increase the risk of metabolic diseases, obesity, cardiovascular disease, and diabetes mellitus. The World Health Organization recommends muscle-strengthening exercises as well as regular physical activity to promote overall health. This study investigates the effect of a wearable hip exoskeleton on muscle activity and heart rate during anaerobic exercise in 40 healthy adults (mean age of 40.00 ± 11.51 years; n = 20 females). Bot Fit, a wearable hip-type robotic exoskeleton, was developed by Samsung Electronics Co., Ltd. (Suwon, Republic of Korea) to enhance the effects of both aerobic and anaerobic exercise. All study participants performed a fitness exercise protocol, including knee-ups, good mornings, squats, mountain climbs, kick-backs, reverse lunges, and split jacks, with and without a Bot Fit. To evaluate the effect of anaerobic exercise with the Bot Fit, muscle activity and heart rate were measured during fitness exercises with and without a Bot Fit. Measured muscles were the rectus abdominis (RA), erector spinae (ES), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), tibialis anterior (TA), gastrocnemius medialis (GCM), and gluteus maximus (GM). During anaerobic exercises with the Bot Fit, there was a significant increase in muscle activity compared to exercising without the Bot Fit. Muscle activity increased significantly in the RA, RF, VL, BF and TA muscles during knee-ups; in the ES, BF, and GM during good mornings; in the RF, VL, VM, BF, and GM during squats; in RA, RF, VL, VM, and GM during mountain climbs; in the RA and BF during kick-backs; in the RF, BF, and GCM during reverse lunges; and in the RF and VL during split jacks (p < 0.05). Heart rates showed a statistically significant increase during good mornings, mountain climbs, and reverse lunge exercises while wearing the Bot Fit (p < 0.05). This study demonstrated that anaerobic exercises by healthy adults using a Bot Fit led to enhanced activation of abdominal and lower-limb muscles as well as an improved heart rate, maximizing the effect of anaerobic exercise compared with the same exercise protocol without a Bot Fit. This suggests that use of a Bot Fit can increase the effectiveness of anaerobic exercise in healthy adults.

Isoniazid Preventive Therapy Adherence and Its Predictors Among Soldiers on HIV Antiretroviral Therapy at a General Military Hospital in Uganda.

Uganda faces a significant dual challenge with tuberculosis (TB), ranking among these countries most affected by the disease worldwide. The World Health Organization (WHO) recommends isoniazid preventive therapy (IPT) for managing latent TB. However, the adherence to IPT in military settings remains under-explored in Uganda. This study aims to assess IPT adherence and identify its predictors among soldiers undergoing HIV antiretroviral therapy at a General Military Hospital in Uganda. We conducted a cross-sectional study involving 300HIV-positive soldiers receiving antiretroviral therapy (ART) at the General Military Hospital in Uganda. Due to the small sample size, we employed a consecutive sampling method. We utilized descriptive statistics and modified Poisson regression model for prevalence of IPT adherence and associated factors respectively. Among the 300 clients, the prevalence of isoniazid preventive therapy (IPT) was 94.7%, 95% CI: 92.1-97.2; adherence to IPT was associated with being aged ≥ 50 years, with a prevalence ratio (PR) of 1.061 and 95% CI: 1.01-1.12; being married, with a PR of 1.438, 95% CI:1.12-1.84; having social support, with a PR of 1.498, 95% CI:1.17-1.92; and having social support played a significant role in IPT adherence among married participants, with a PR of 0.817,95% CI:0.72-0.93. To enhance adherence to isoniazid preventive therapy among young soldiers with HIV, targeted interventions are crucial, as older individuals tend to adhere better. Implementing marital support programs and strengthening community engagement can bolster adherence through social support networks. Educational campaigns should focus on the importance of IPT, while regular follow-ups will ensure effective monitoring and support. Further research is needed to explore how social support can mitigate stigma associated with HIV. The findings highlight the importance of improving IPT adherence among married soldiers and suggest that this approach could be effective in other low-resource settings.

What Do People Want from an AI-Assisted Screening App for Sexually Transmitted Infection-Related Anogenital Lesions: A Discrete Choice Experiment.

One of the World Health Organization (WHO) recommendations to achieve its global targets for sexually transmitted infections (STIs) is the increased use of digital technologies. Melbourne Sexual Health Centre (MSHC) has developed an AI-assisted screening application (app) called AiSTi for the detection of common STI-related anogenital skin conditions. This study aims to understand the community's preference for using the AiSTi app. We used a discrete choice experiment (DCE) to understand community preferences regarding the attributes of the AiSTi app for checking anogenital skin lesions. The DCE design included the attributes: data type; AI accuracy; verification of result by clinician; details of result; speed; professional support; and cost. The anonymous DCE survey was distributed to clients attending MSHC and through social media channels in Australia between January and March 2024. Participant preferences on various app attributes were examined using random parameters logit (RPL) and latent class analysis (LCA) models. The median age of 411 participants was 32 years (interquartile range 26-40 years), with 64% assigned male at birth. Of the participants, 177 (43.1%) identified as same-sex attracted and 137 (33.3%) as heterosexual. In the RPL model, the most influential attribute was the cost of using the app (24.1%), followed by the clinician's verification of results (20.4%), the AI accuracy (19.5%) and the speed of receiving the result (19.1%). The LCA identified two distinct groups: 'all-rounders' (88%), who considered every attribute as important, and a 'cost-focussed' group (12%), who mainly focussed on the price. On the basis of the currently available app attributes, the predicted uptake was 72%. In the short term, a more feasible scenario of improving AI accuracy to 80-89% with clinician verification at a $5 cost could increase uptake to 90%. A long-term optimistic scenario with AI accuracy over 95%, no clinician verification and no cost could increase it to 95%. Preferences for an AI-assisted screening app targeting STI-related anogenital skin lesions are one that is low-cost, clinician-verified, highly accurate and provides results rapidly. An app with these key qualities would substantially improve user uptake.

Single-dose human papillomavirus vaccination: an update.

Human papillomavirus (HPV) vaccines received regulatory approval and were recommended for use in young girls nearly 2 decades ago. Uptake is mostly high in resource-rich settings. In resource-limited settings, where the burden of cervical cancer is disproportionately high, access to and uptake of HPV vaccines are nowhere near satisfactory, despite evidence that HPV vaccination is highly cost-effective and a significant value-for-money investment. The discovery that only a single dose of the HPV vaccines may be needed to confer adequate protection may make equitable access to HPV vaccines possible. Indeed, the recent World Health Organization recommendation allowing for 1 or 2 doses is already gaining traction. This monograph aims to update the state of the science related to single-dose HPV vaccine protection and includes both primary data and modeling efforts that address key gaps in the knowledge regarding 1) durability of protection of a single dose of the HPV vaccine, 2) single-dose HPV vaccine effectiveness in both high-income and low-income settings, 3) implementation of single-dose HPV vaccination, and 4) how to accelerate control of cervical cancer by integrating a 1-time screen for cervical disease. The content published in this monograph will continue to advance the science of HPV vaccination and will be vital as new countries make informed decisions about how best to use this remarkable vaccine.

When blood is not an option. The awareness of bloodless medicine among Polish nurses

ObjectivesBlood transfusions (BTs) are generally safe and potentially life-saving but come with risks. The World Health Organization advocates reducing unnecessary transfusions and using patient blood management strategies and techniques. However, providing bloodless medical care to patients who prefer to avoid blood-related treatments is a challenge. This is because healthcare professionals’ beliefs about blood transfusion may not align with those of their patients. This study delves into Polish nursing personnel's attitudes toward bloodless medicine (BM), highlighting the potential gap between their knowledge and patient needs. MethodsWe conducted an online survey among 202 Polish nurses on non-blood management techniques, risks related to BT and BM, and nurses’ educational needs regarding BM. ResultsAlthough many nurses had some knowledge of BM, Polish nurses’ awareness of non-blood management techniques is relatively low: while less than half knew alternative treatment methods and drugs used in BM, many were unaware of the various risks or side effects related to BM. It also shows that more than three-quarters of nurses believed that patients should have the right to make an informed refusal of BT. While 87.1% of nurses rated their knowledge about BM insufficient or very poor, 66.3% did not feel prepared to care for patients who require non-blood management techniques. ConclusionsThis study underscores the urgent need to educate nurses on blood conservation methods, blood substitutes, and techniques of non-blood management. Incorporating these into the nursing curriculum is crucial for patients’ safety and well-being and our healthcare system's effectiveness. The potential impact of these findings on the healthcare system is significant, underlining the urgency and importance of addressing the knowledge gap in non-blood management techniques. Public Interest SummaryAlthough the World Health Organization recommends using non-blood management techniques, most nurses providing bloodless medical care to patients who wish to avoid blood transfusion do not feel prepared to care for such patients. This study describes the attitudes of Polish nursing personnel toward bloodless medicine. It demonstrates that Polish nurses do not possess knowledge of non-blood management techniques, and their awareness of patient blood management methods and drugs used in bloodless medicine is low. However, it also reveals a positive aspect: Most Polish nurses are interested in broadening their knowledge of bloodless medicine. This strong motivation to improve their skills and knowledge in this area is encouraging and should be harnessed to drive positive change in the field of bloodless medicine.