World Health Organization Research Articles

Rare atypical type a thymoma: a case report and literature review

BackgroundAn atypical type A thymoma variant was recently added to the World Health Organization classification of type A thymoma in 2015. This novel form of type A thymoma presents with hypercellularity, increased mitotic activity, and necrosis. In particular, necrosis seems to be related to postoperative recurrence and metastasis, but the clinical significance of these changes still needs to be studied.Case presentationA 76-year-old man underwent thoracoscopic surgery for tumour resection due to an anterior mediastinal mass. Pathological examination revealed that the tumour invaded the surrounding thymic tissue. Cells were arranged in nest-like and whirl-like patterns, accompanied by prominent comedo-like necrosis, increased cell density, mild atypia, and a mitotic count of 4–6 per 10 high-power fields. Immunohistochemistry revealed positive expression of cytokeratin 19 and P63 in the tumour cells. Lymphocytes in the background were positive for CD3 and CD5, did not express terminal deoxynucleotide transferase, CD20, or CD117, and had an MIB-1 labelling index(LI) value of 15%. On the basis of these findings, the tumour was finally diagnosed as an atypical type A thymoma variant.ConclusionsWe report a case of atypical type A thymoma and review the literature to enhance our understanding of and provide accumulated pathological data on this rare disease.

Pigtail Catheter Compared to Formal Intercostal Catheter for the Management of Isolated Traumatic Pneumothorax: A Systematic Review and Meta-Analysis

(1) Background: The optimal management approach for adults with traumatic pneumothorax without haemothorax remains an area of debate. Specifically, there is lack of consensus as to whether insertion of a pigtail catheter is superior to a formal intercostal catheter in improving complication rates. (2) Methods: Medline, EMBASE, Cochrane Central, and the World Health Organisation International Clinical Trials Registry Platform databases were systematically searched for studies evaluating pigtail catheters compared to formal intercostal catheters for the management of traumatic pneumothorax. Investigative outcomes of interest included pain, duration management, failure, need for formal thoracoscopic surgery, need for supplemental oxygen, length of stay, infection and overall total complications. (3) Results: Three studies evaluating 280 patients were included in this analysis. There was no significant difference in total complications, rates of failure, length of stay or duration of management between pigtail catheters and formal intercostal catheters. This evidence was based on studies of low to moderate risk of bias with poor control for confounding factors. (4) Conclusions: This systematic review and meta-analysis demonstrates lack of evidence to suggest pigtail catheters are superior to formal intercostal catheter for traumatic pneumothorax. These findings may reflect a true absence of effect between either approach for this patient cohort or non-committal findings in light of limitations of the underlying evidence. Further prospective trials with larger sample sizes and control for confounders are required to validate the outcomes between these two modalities of treatment.

Cervical precancer screening using self-sampling, HPV DNA testing, and mobile colposcopy in a hard-to-reach community in Ghana: a pilot study

BackgroundThe World Health Organization has set ambitious goals to eliminate cervical cancer, necessitating evidence on increasing coverage and access to screening and treatment in high-burden areas. We implemented a pilot program to assess the feasibility of obtaining self-collected specimens for high-risk human papillomavirus (hr-HPV) testing in Nzulezo stilt village, a hard-to-reach community in Ghana, and inviting only hr-HPV-positive women to a central location for colposcopy and possible treatment. Subsequently, this study aimed to investigate the prevalence of hr-HPV infection and cervical lesions among the women and to explore factors potentially associated with hr-HPV infection among them.MethodsThis pilot community-based cross-sectional study utilized data from screening sessions held from 2 to 20 November 2021 with specimens collected by participants using Evalyn brushes. HPV DNA testing was performed using the Sansure MA-6000 platform, while visual inspection utilized the Enhanced Visual Assessment (EVA) mobile colposcope. Univariate and multivariable nominal logistic regression was employed to explore factors associated with hr-HPV positivity.ResultsAmong 100 women screened (mean age, 43.6 ± 14.5 years), the overall hr-HPV prevalence rate was 39.0% (95% CI, 29.4–49.3). The prevalence rates of hr-HPV genotypes were stratified as follows: HPV16–8.0% (95% CI, 3.5–15.2), HPV18–5.0% (95% CI, 1.6–11.2), and other genotype(s) – 31.0% (95% CI, 22.1–41.0). Single-genotype infections with HPV16 and HPV18 were found in 4.0% (95% CI, 1.1–9.9) and 3.0% (95% CI, 0.6–8.5) of women, respectively. Mixed infections were observed in 1.0% (95% CI, 0.0–5.4) for HPV16 + 18, 3.0% (95% CI, 0.6–8.5) for HPV16 + other type(s), and 1.0% (95% CI, 0.0–5.4) for HPV18 + other type(s). The prevalence of cervical lesions among hr-HPV-positive women screened via colposcopy was 11.4% (95% CI, 3.2–26.7). In the multivariable model, reliance on other sources for medical bill payment was associated with hr-HPV infection (aOR, 0.20; 95% CI, 0.04–0.93), whereas age was not (aOR, 1.02; 95% CI, 0.99–1.05).ConclusionsA high hr-HPV infection prevalence was recorded among the women. Utilizing technologies such as self-sampling, HPV DNA testing, and mobile colposcopy enables screening and treatment in remote and hard-to-reach communities where access to cervical cancer screening and treatment would otherwise be limited. Further research is warranted to assess the value and scalability of this approach in similar remote areas and its potential implementation in future programs.

Bibliometric analysis of scientific literature on the use of suppositories in the treatment of prostate cancer patients

Nowadays, cancer remains one of the main causes of death worldwide. Statistical data from various literary sources indicate that more than 130,000 people in Ukraine receive this diagnosis as a sentence every year. Cancer can affect any organs of the human body and, over time, the entire organism. In 2024, the agency of the World Health Organization on cancer and the International Agency of Cancer Research published the latest statistical estimates of this pathology in a global format, where prostate cancer is among the five most common oncological pathologies and takes the fourth place. Oncological diseases are one of the priority areas of healthcare development in accordance with the Order of the Ministry of Health of Ukraine No. 1832 dated 07.10.2022 “On Approval of Priority Areas of Healthcare Development for 2023–2025”. It was this fact that determined the choice of the direction of this research in the matter of finding information on the provision of pharmaceutical care, namely the use of a drug – a rectal suppository for the treatment of prostate cancer. The aim of the work is to carry out a bibliometric analysis and further generalize the data of the scientific literature to study the prognostic value and features of the prescription of suppositories in the treatment of prostate cancer. Materials and methods. The data search was conducted in the PubMed electronic database using the following key terms: “prostate cancer and suppositories”, “prostate cancer”. To monitor and analyze international scientific research, with the help of visualization tools and modern SciVal citation metrics using the online platform, bibliometric analysis can be performed. Using the VOSviewer functional program, bibliometric networks were constructed and visualized. Results. A map of the relationships between the most used keywords on the topics of “prostate cancer” and “prostate cancer and suppositories”, grouped into clusters for the period from 1986 to 2024, was built. The clustering of the most used keywords on the subject of “prostate cancer” for the specified period is summarized. According to the bibliographic analysis, interest in the above topic was highest in 2014 and 2021. Conclusions. According to the bibliographic analysis, the interest in the subject of the patients’ treatment with prostate cancer disease continues to grow from 1998 up to the present. The analysis of publication activity using the visualization tool of bibliometric networks VOSviewer for the period from 2014 to 2024 for the key words “prostate cancer” has shown the presence of 14 clusters. The largest cluster is devoted to modern methods of prostate cancer treatment, studies of gene rearrangement, target therapy, carcinogenesis.

Comparative Study of the Nutritive and Elemental Composition of Smoked and Raw Clarias gariepinus from Three Selected Fish Farms in Ado Ekiti, Ekiti State, Nigeria

Clarias gariepinus is of economic importance in aquaculture due to its rapid growth, omnivorous diet, and potential as food source. It has been widely cultured and dispensed both in raw and smoked forms in various regions to meet the demand for fish protein This study assessed and compared the nutritional quality and elemental composition of smoked and raw samples of Clarias gariepinus. A total of twelve fish samples were analysed, six raw samples and six smoked samples with two fishes sampled from each farm tagged A, B and C. The Proximate and elemental analysis were done using standard procedures. The result of the study showed that moisture content measured in the raw Clarias gariepinus which ranged between (73.074 ± 1.59) % and (71.52 ± 1.83) %. was higher than that of the smoked fish ranging from (26.69±0.03) % to (32.21± 0.02) %. The protein content of smoked fish ranged (43.2±0.02) % to (46.78±0.01) while that of raw fish was between (20.52 ± 1.12) % and (22.15 ± 0.43) %. Similarly, the crude fat, ash, carbohydrate, and fibre content were higher in the smoked fish than raw catfish samples. The elemental composition of both smoked and raw catfish were within the permissible limit of World Health Organization. Arsenic was not detected in the muscle of the raw fish, while cadmium, chromium, lead and magnesium were present in values within WHO permissible limit and similar results was observed for the smoked fish samples. The result of this study presents the possibility of smoked catfish being more nutritious than the raw samples aside from the fact that it has more shelf life than raw fish. Also, both smoked and raw samples of the fish are safe as the values of heavy metal observed were all within the permissible limit of WHO.

Routine HPV vaccination: Reflection on delivery strategies based on countries’ experiences

Despite the introduction of the human papillomavirus (HPV) vaccine in many low- and middle-income countries (LMICs), countries are still struggling to maintain HPV vaccination coverage and manage sustainable delivery strategies. This article explores the challenges and effective strategies for HPV vaccine delivery in LMICs, with a focus on reflecting upon current HPV vaccine delivery strategies in the World Health Organization (WHO) HPV vaccine introduction guidelines to align with practical implementation experiences. The article utilizes presentations and discussions from Coalition to Strengthen the HPV Immunization Community (CHIC) symposia, field experiences of program implementers who participated in the meeting and immunization expert opinions, to inform its findings. Several countries are spotlighted for their delivery strategies. These include routinized campaign mode vaccinations at schools in The Gambia, Zambia, and Ethiopia; routine health facility services in Tanzania, Kenya, and Maldives; and outreach strategies targeting out-of-school girls. By evaluating these diverse strategies, the article suggests a need to delve deeper and build an understanding of the routinized campaign mode of HPV vaccine delivery, and advocates for expanding the scope of delivery strategies and consequently updating the WHO HPV vaccine delivery guidelines in line with the evolving landscape of HPV vaccination delivery to ensure comprehensive, cost-effective, and sustainable programs in LMICs.

Nutritional Status of Children Attending Basic Schools Providing Mid-Day Meal A Comparative Study

World Health Organization has stated malnutrition as a condition where there is deficiencies, excesses, or imbalances in an individual's energy and/or nutrient consumption. In Nepal, the government school is mandatory to provide MDM to students up to basic school level. Education system consists of one year of pre-primary to grade 8 known as basic schools. This study aimed to find out the nutritional status of schoolchildren attending basic schools in rural and urban municipalities providing and comparing between those children having midday meal in school with those who are not having. .A cross - sectional, analytical study was designed, multistage sampling techniques were used , where the lottery method was used for the selection of municipalities and schools and simple random sampling technique for the selection of students by using a table of random numbers. A total 276 students were selected of both genders. Data collecting included of anthropometric measurement and structured questionnaire of dietary habit. Among 276 students mean age was 7.76  3.229. MUAC of aged 3-8 years was 14.84  1.35 and BMI of aged above 8 years old was 14.98  2.50. Among them 50.4% were male. 4.3% among 3-5 years group presented with SAM. Age and sex was significantly associated with nutritional status p-value 0.007 and 0.008 respectively. Both parents’ education was associated with Nutritional status of child (p-value 0.001). Children not having MDM in school are more vulnerable of malnutrition (p-value 0.015). MDM is more significant for malnutrition (AOR: 0.364 CI: 0.139- 0.953, p-value 0.41). Nutritional status of those not having MDM in schools are likely to have malnutrition by 1.913times than those having MDM provided by schools (CI: 0.867-4.22, p-value 0.002). The prevalence of malnutrition is significantly associated with parents’ education, consumption of EDNP, and MDM provided by schools.

Evidence for an HPV one-dose schedule

The World Health Organization has recently updated their dosing schedule recommendations for the human papillomavirus (HPV) vaccine to include a single-dose schedule. We review the biologic plausibility of a single dose, the evidence from clinical trials, post-licensure observational studies, and mathematical modeling for a single-dose schedule. We also discuss the implications of countries switching to a single-dose program from a two or three-dose schedule. Finally, we review the countries that have currently switched to or introduced the vaccine with a single-dose schedule.

Threats from the Candida parapsilosis complex: the surge of multidrug resistance and a hotbed for new emerging pathogens.

SUMMARYCandida parapsilosis is a common agent of candidiasis that has gained increased attention in recent years, culminating with its recent consideration as a high-priority fungal pathogen by the World Health Organization. Reasons for this classification are the recent surge in incidence and the alarmingly growing rates of drug and multidrug resistance. In addition, several closely related species such as Candida metapsilosis and Candida orthopsilosis may represent recently emerged opportunistic pathogens originated from environmental niches through interspecies hybridization. Here, I review recent research focused on the potential origin and spread of drug resistance and of emerging species in this complex. I will also discuss open questions regarding the possible implications of human activities in these two epidemiological phenomena.

Ependymal Tumors: Overview of the Recent World Health Organization Histopathologic and Genetic Updates with an Imaging Characteristic.

The 2021 World Health Organization Classification of Tumors of the Central Nervous System (CNS5), introduced significant changes, impacting tumors ranging from glial to ependymal neoplasms. Ependymal tumors were previously classified and graded based on histopathology, which had limited clinical and prognostic utility. The updated CNS5 classification now divides ependymomas into 10 subgroups based on anatomic location (supratentorial, posterior fossa, and spinal compartment) and genomic markers. Supratentorial tumors are defined by zinc finger translocation associated (ZFTA) (formerly v-rel avian reticuloendotheliosis viral oncogene [RELA]), or yes-associated protein 1 (YAP1) fusion; posterior fossa tumors are classified into groups A (PFA) and B (PFB), spinal ependymomas are defined by MYCN amplification. Subependymomas are present across all these anatomic compartments. The new classification kept an open category of "not elsewhere classified" or "not otherwise specified" if no pathogenic gene fusion is identified or if the molecular diagnosis is not feasible. Although there is significant overlap in the imaging findings of these tumors, a neuroradiologist needs to be familiar with updated CNS5 classification to understand tumor behavior, for example, the higher tendency for tumor recurrence along the dural flap for ZFTA fusion-positive ependymomas. On imaging, supratentorial ZFTA-fused ependymomas are preferentially located in the cerebral cortex, carrying predominant cystic components. YAP1-MAMLD1-fused ependymomas are intra- or periventricular with prominent multinodular solid components and have significantly better prognosis than ZFTA-fused counterparts. PFA ependymomas are aggressive paramedian masses with frequent calcification, seen in young children, originating from the lateral part of the fourth ventricular roof. PFB ependymomas are usually midline, noncalcified solid-cystic masses seen in adolescents and young adults arising from the fourth ventricular floor. PFA has a poorer prognosis, higher recurrence, and higher metastatic rate than PFB. Myxopapillary spinal ependymomas are now considered grade II due to high recurrence rates. Spinal-MYCN ependymomas are aggressive tumors with frequent leptomeningeal spread, relapse, and poor prognosis. Subependymomas are noninvasive, intraventricular, slow-growing benign tumors with an excellent prognosis. Currently, the molecular classification does not enhance the clinicopathologic understanding of subependymoma and myxopapillary categories. However, given the molecular advancements, this will likely change in the future. This review provides an updated molecular classification of ependymoma, discusses the individual imaging characteristics, and briefly outlines the latest targeted molecular therapies.

Progress Toward Global Dracunculiasis (Guinea Worm Disease) Eradication, January 2023-June 2024.

The effort to eradicate Dracunculus medinensis, the etiologic agent of dracunculiasis, or Guinea worm disease, began at CDC in 1980. In 1986, with an estimated 3.5 million global cases in 20 African and Asian countries, the World Health Assembly called for dracunculiasis elimination. The Guinea Worm Eradication Program (GWEP) was established to help countries with endemic dracunculiasis reach this goal. GWEP is led by The Carter Center and supported by partners, including the countries with endemic disease, CDC, UNICEF, and the World Health Organization. Since 2012, infections in dogs, cats, and baboons have posed a new challenge for GWEP, as have ongoing civil unrest and insecurity in some areas. As of June 2024, dracunculiasis remained endemic in five countries (Angola, Chad, Ethiopia, Mali, and South Sudan). Fourteen human cases and 886 animal infections occurred, including 407 dogs in Chad and 248 dogs in Cameroon, reported in 2023, and three human cases and 297 animal infections reported during January-June 2024. Animal infections, primarily in dogs in Cameroon and Chad, and impeded access due to civil unrest and insecurity in Mali, threaten the near-term possibility of global eradication. Nevertheless, countries appear poised to reach zero cases.

Post-disappearance scenarios: policy implications following the potential disappearance of B/Yamagata lineage influenza viruses.

The COVID-19 pandemic and related preventive measures reduced influenza virus circulation, notably causing the disappearance of the B/Yamagata lineage of influenza viruses. In this Perspective, we discuss the implications that this development may have for global influenza epidemiology, and the adjustments that may need to be implemented concerning surveillance strategies and practices, laboratory safety protocols, and influenza vaccine formulations. The disappearance of the B/Yamagata lineage might indeed alter the dynamics of the influenza disease burden (although in a way that is difficult to predict at the moment), and associated diagnostic practices, and may also necessitate updated biosafety levels and revised influenza surveillance strategies. Furthermore, the World Health Organization (WHO) recommended in September 2023 the exclusion of B/Yamagata antigens from future vaccines, with a shift towards trivalent vaccines or modified quadrivalent vaccines; this new scenario underscores the importance of robust global respiratory virus surveillance, effective communication with healthcare professionals and the population to maintain trust in vaccines, and a collaborative approach among health policymakers and vaccine manufacturers to navigate this epidemiological change.

Pioneering Klebsiella Pneumoniae Antibiotic Resistance Prediction With Artificial Intelligence-Clinical Decision Support System-Enhanced Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry: Retrospective Study.

The rising prevalence and swift spread of multidrug-resistant gram-negative bacteria (MDR-GNB), especially Klebsiella pneumoniae (KP), present a critical global health threat highlighted by the World Health Organization, with mortality rates soaring approximately 50% with inappropriate antimicrobial treatment. This study aims to advance a novel strategy to develop an artificial intelligence-clinical decision support system (AI-CDSS) that combines machine learning (ML) with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), aiming to significantly improve the accuracy and speed of diagnosing antibiotic resistance, directly addressing the grave health risks posed by the widespread dissemination of pan drug-resistant gram-negative bacteria across numerous countries. A comprehensive dataset comprising 165,299 bacterial specimens and 11,996 KP isolates was meticulously analyzed using MALDI-TOF MS technology. Advanced ML algorithms were harnessed to sculpt predictive models that ascertain resistance to quintessential antibiotics, particularly levofloxacin and ciprofloxacin, by using the amassed spectral data. Our ML models revealed remarkable proficiency in forecasting antibiotic resistance, with the random forest classifier emerging as particularly effective in predicting resistance to both levofloxacin and ciprofloxacin, achieving the highest area under the curve of 0.95. Performance metrics across different models, including accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1-score, were detailed, underlining the potential of these algorithms in aiding the development of precision treatment strategies. This investigation highlights the synergy between MALDI-TOF MS and ML as a beacon of hope against the escalating threat of antibiotic resistance. The advent of AI-CDSS heralds a new era in clinical diagnostics, promising a future in which rapid and accurate resistance prediction becomes a cornerstone in combating infectious diseases. Through this innovative approach, we answered the challenge posed by KP and other multidrug-resistant pathogens, marking a significant milestone in our journey toward global health security.

Assessing agricultural practices and insecticides resistance for effective malaria vector control in northwestern Iran

BackgroundAfter three years with no local transmission of malaria, an outbreak occurred in Iran in 2022. Key malaria control methods in Iran are including indoor residual spraying (IRS), long-lasting insecticide-treated nets (LLINs), and prompt diagnosis and treatment of malaria cases. Anopheles sacharovi is one of the main malaria vectors in Iran. This study aimed to determine the insecticides resistance status of An. sacharovi in northwestern Iran, to inform effective vector control programs in this region.MethodsLarval stages of An. sacharovi were collected from various larval habitats located in the villages along the Aras River. Adult susceptibility tests were performed on An. sacharovi using diagnostic doses of insecticides accordance to World Health Organization (WHO) guidelines. The study also evaluated agricultural insecticide and fertilizer usage alongside the presence of natural mosquito predators in breeding sites in the study area.ResultsAlongside various chemicals such as silica, humic acid, superphosphate, sulfur, urea, and solupotasse at different dose levels, organophosphorus and pyrethroid insecticides are commonly used in rice fields and orchards. Anopheles sacharovi displayed diverse reactions to insecticides, demonstrating resistance to DDT but sensitivity to malathion, and showing similar reactions to carbamate and pyrethroid insecticides.ConclusionsThese results provide significant insights into agricultural practices and the presence of mosquito larvae in the study area. The extensive use of a specific herbicide illustrates its popularity among farmers for weed control, while other agricultural products focus on enhancing soil fertility and productivity. The absence of mosquito larvae in habitats with predators indicates the usefulness of these predators in controlling the population of mosquitoes. The resistance of mosquitoes to certain insecticides highlights the need for careful selection and intermittent use of insecticides in vector control programs. These findings can inform the development of targeted strategies to reduce malaria transmission risks. Further research is essential for assessing the effectiveness of these interventions.

Primary healthcare as a strategy for eliminating hepatitis C: the METRIC toolkit.

This paper presents the development of the METRIC toolkit, aimed at enhancing primary healthcare interventions in the context of hepatitis C control, thus contributing to the World Health Organization's global strategy to achieve the elimination of the disease by 2030. At the global level, most people living with hepatitis C are unaware of their condition. As such, the eradication of hepatitis C necessitates comprehensive strategies within primary healthcare settings, as it provides an opportunity to reach the general population, facilitates the identification of potential patients who may be unfamiliar with hepatitis C, and guides them toward adequate care. Herein, we propose the METRIC toolkit as a means to optimize the efficiency and efficacy of healthcare services dedicated to hepatitis C control. The development of the METRIC toolkit was guided by a thorough review of pertinent literature, focusing on primary healthcare interventions in hepatitis C control. Key components were identified, encompassing systematic problem identification, solution formulation, outcome evaluation, and feedback integration. The METRIC toolkit represents a valuable resource for strengthening primary healthcare interventions in hepatitis C control. By fostering a culture of continuous improvement and data-driven decision-making, this framework holds promise in advancing the global agenda towards hepatitis C elimination. However, its successful application requires careful consideration of contextual factors and ongoing adaptation to local needs and circumstances.

Case of delayed diagnosis of combined urogenita and pulmonary tuberculosis in a patient with abnormal uterine bleeding

According to the World Health Organization tuberculosis remains a global health issue for both adult and pediatric populations worldwide. Among women the peak incidence occurs during the active reproductive age, with pregnant women being 1.5–2 times more likely to be affected and experience more severe symptoms than non-pregnant women. In the Altai Region, the epidemiological situation of tuberculosis is characterized by instability, with the incidence rate among women reaching30.5 per 100 000 of the corresponding population in 2022. Delayed diagnosis and treatment can lead to serious complications, including fatal outcomes for both mother and fetus. This article describes a clinical observation of a case of urogenital and pulmonary tuberculosis diagnosed three months after premature abdominal delivery. The course of pregnancy was complicated by acute pleuritis at 13–14 weeks, however, negative results of bacteriological culture of pleural fluid led to the absence of specific tuberculosis treatment and the development of chronic subcompensated placental dysfunction. Three months after delivery, a 34-year-old patient was admitted to the gynecological department of the emergency hospital with abnormal uterine bleeding. The diagnosis was confirmed by histopathology of an endometrial sample revealing tuberculous granulomas without caseous necrosis with epithelioid giant cells of Pirogov – Langhans. Subsequently, generalized tuberculosis was diagnosed in the preterm infant. The negative impact of undiagnosed combined urogenital and pulmonary tuberculosis on the course and outcome of pregnancy is demonstrated, including the development of anemia, placental dysfunction, preterm delivery, puerperal complications, and adverse perinatal outcomes.

Simulation-Based Education of Health Workers in Low- and Middle-Income Countries: A Systematic Review.

Simulation-based education (SBE) is increasingly used to improve clinician competency and patient care and has been identified as a priority by the World Health Organization for low- and middle-income countries (LMICs). The primary aim of this review was to investigate the global distribution and effectiveness of SBE for health workers in LMICs. The secondary aim was to determine the learning focus, simulation modalities, and additional evaluation conducted in included studies. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analysis guidelines, searching Ovid (Medline, Embase, and Emcare) and the Cochrane Library from January 1, 2002, to March 14, 2022. Primary research studies reporting evaluation at Level 4 of The Kirkpatrick model were included. Studies on simulation-based assessment and validation were excluded. Quality and risk-of-bias assessments were conducted using appropriate tools. Narrative synthesis and descriptive statistics were used to present the results. A total of 97 studies were included. Of these, 54 were in sub-Saharan Africa (56%). Forty-seven studies focused on neonatology (48%), 29 on obstetrics (30%), and 16 on acute care (16%). Forty-nine used mannequins (51%), 46 used scenario-based simulation (47%), and 21 used synthetic part-task trainers (22%), with some studies using more than 1 modality. Sixty studies focused on educational programs (62%), while 37 used SBE as an adjunct to broader interventions and quality improvement initiatives (38%). Most studies that assessed for statistical significance demonstrated at least partial improvement in Level 4 outcomes (75%, n=81). SBE has been widely applied to improve outcomes in a variety of contexts across LMICs. Modalities of simulation are typically low-technology versions. However, there is a lack of standardized reporting of educational activities, particularly relating to essential features of SBE. Further research is required to determine which approaches are effective in specific contexts.

Estimated human intake of endogenous and exogenous hormones from beef in the United States.

Endogenous and exogenous hormones may be present in beef. Human consumption of hormones has been linked to adverse health effects. To estimate daily intake of hormonal growth promotants (HGP) from beef consumed by the US population. We combined self-reported beef consumption information from a nationally-representative survey with concentrations of 12 HGP measured in 397 samples of retail beef/fat purchased in California. We defined typical, high, and maximum intake scenarios assuming self-reported consumed beef contained the mean, 95th percentile, and maximum concentrations of each HGP, respectively. We estimated distributions of usual (i.e., long-term) daily intake and short-term daily intake (µg/kg/day). We calculated the hazard quotient (HQ), or ratio of estimated intake to the World Health Organization's acceptable daily intake (ADI) for the HGP. The highest estimated HQs were found for melengestrol acetate (MGA). For usual daily intake under the typical intake scenario, no HQ exceeded 0.02 (0.00047 µg MGA/kg/day). Under the maximum intake scenario, the highest HQ was 0.29 (0.0087 µg MGA/kg/day), corresponding to the 99th percentile of intake among young boys (ages 1-5). The highest short-term intake estimates for MGA under the maximum intake scenario were the 99th percentile of intake among young girls and boys, which equaled (HQ = 1.00) or exceeded (HQ = 1.29) the ADI for MGA, respectively. Hormonal growth promotants (HGP) are used to increase beef production and have been linked to adverse reproductive effects. We estimated daily intake of MGA and several other HGP using US nationally-representative beef consumption data collected between 2015-2018 and HGP concentrations in retail beef. Estimated intake was highest for young children, but estimates were generally very low compared to current health-based intake limits. However, these limits are typically based on studies in adult animals, and further study of potential adverse effects during sensitive developmental periods, such as in early life, may be warranted to ensure recommended intake limits are health-protective.

Assessing the validity of METS-IR for predicting the future onset of diabetes: an analysis using time-dependent receiver operating characteristics

BackgroundThe Metabolic Insulin Resistance Score (METS-IR) is a non-invasive proxy for insulin resistance (IR) that has been newly developed in recent years and has been shown to be associated with diabetes risk. Our aim was to assess the predictive value of METS-IR for the future development of diabetes and its temporal differences in people of different sex, age, and body mass index (BMI).MethodsThe current study included 15,453 baseline non-diabetic subjects in the NAGALA cohort and then grouped according to the World Health Organization’s (WHO) recommended criteria for age and BMI. Multivariate Cox regression and time-dependent receiver operator characteristics (ROC) curves were used to analyze the value of METS-IR in assessing and predicting the risk of diabetes in people of different sexes, ages, and BMIs.Results373 individuals developed diabetes during the observation period. By multivariate COX regression analysis, the development of future diabetes was significantly associated with increased METS-IR, and this positive association was stronger in women than in men and in individuals < 45 years than in individuals ≥ 45 years; while no significant differences were observed between non-obese and overweight/obesity individuals. Using time-dependent ROC analysis we also assessed the predictive value of METS-IR for future diabetes at a total of 11-time points between 2 and 12 years. The results showed that METS-IR had a higher predictive value for the future development of diabetes in women or individuals < 45 years of age compared to men or individuals ≥ 45 years of age for almost the entire follow-up period. Furthermore, across different BMI categories, we also found that in the short term (3–5 years), METS-IR had a higher predictive value for the development of diabetes in individuals with overweight/obesity, while in the medium to long term (6–12 years), METS-IR was more accurate in predicting the development of diabetes in non-obese individuals.ConclusionsOur study showed that METS-IR was independently associated with the development of future diabetes in a non-diabetic population. METS-IR was a good predictor of diabetes, especially for women and individuals < 45 years old for predicting the future risk of developing diabetes at all times.

Understanding the longitudinal trends (2005-2018) and multilevel risk factors of complementary feeding in Guinea.

This study aimed to define complementary feeding trends in Guinea from 2005 to 2018 and complementary feeding risk factors at the individual, household, and community levels. Data from 2005 to 2018 demographic health surveys (DHS) and Multiple Indicator Cluster Surveys were used to describe complementary feeding trends in Guinea. The most recent DHS was used to examine complementary feeding risk factors at the individual, household, and community levels. Complementary feeding indicators including introduction to complementary foods (INTRO), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were calculated based on the 2010 World Health Organisation guidance. Multivariate logistic regressions were used to identify significant risk factors (p < 0.05). Since 2005, there has been a marginal increase in MDD and MAD, but a decrease in INTRO and MMF. The 2018 DHS survey revealed various complementary feeding risk factors. At the individual level, travelling 1-60 min to get water was associated with decreased odds of meeting INTRO, while iron supplementation and maternal education were associated with increased odds of meeting MMF and MDD, respectively. Routine vitamin A supplementation, fever in the past 2 weeks, and low birth weight were associated with increased odds of meeting MAD. At the household level, being in a lower wealth quintile was associated with decreased odds of meeting MDD and MAD. National and subnational programmes and policies designed to improve infant and young child diets may consider tailored approaches that address the specific indicators and risk factors associated with poorer diets in this Guinean context.