The convergence of emerging infectious diseases, accelerating ecological changes, and increasing global mobility makes Vaccine Literacy (VL) a critical component of contemporary travel medicine. Enhanced VL can facilitate more effective provider-traveler communication, ultimately reducing infectious disease transmission risks associated with international travel. This cross-sectional survey aimed to measure VL levels among Italian travelers through an online survey using the 'Vaccine Literacy Brief Tool' (VLBT), a new three-item instrument assessing functional, interactive, and critical dimensions, derived from previously validated measures. Additional study objectives were to explore VL relationships with antecedents, attitudes, and outcomes, as well as to establish the tool's construct and criterion validity within the traveler population. Enrollment was conducted through a QR code displayed at nine vaccination clinics across five Italian regions, linking to an anonymous questionnaire (Google Forms) that visiting travelers could voluntarily access and complete before receiving vaccination for their trip. In addition to VL skills, the psychological antecedents of Vaccine Hesitancy (VH), the "3Cs" (confidence, complacency, convenience) were assessed. Additional measures included demographic and travel-related variables, as well as behavioral, cognitive and intentional vaccination outcomes. A total of 534 questionnaires were collected between January and July 2025. Participants showed a mean VL score of 3.07 ± 0.66 on a four-point Likert scale, significantly lower than the 3.21 ± 0.42 reported in previous general population studies (p < .001). The mean 3Cs score was 1.92 ± 0.60, indicating relatively high VH levels. VL and 3Cs scores showed a significant negative correlation (r = -0.204, P < .001). Participants consisted primarily of highly educated adults aged 18-40 years. VL scores were negatively associated with younger age (ρ = -0.132, p = .002), and positively with higher educational level (ρ = 0196, p < .001), higher income (ρ = 0.145, p < .001), greater number of information sources consulted (r = 0.104, p = .016), and more favorable vaccination outcomes. Conversely, the 3Cs demonstrated inverse significant relationships with the same demographic and behavioral variables. No significant gender differences emerged for either VL or 3Cs measures. Construct validity of the VLBT was supported by the significant negative correlation between VL and 3Cs scores, and with additional confirmation provided through reliability tests and factor analyses. Criterion validity was demonstrated through significant associations between VL scores and vaccination behaviors: number of vaccines received, vaccination recall accuracy, awareness of destination-specific pre-travel vaccination requirements, and influenza vaccination intention. Mediation analysis revealed that the 3Cs partially mediated the relationship between VL and specific vaccination intention outcomes, while demographic characteristics (age, income) and travel-related factors (number of information sources) significantly moderated these associations. The VLBT assessed travelers' VL levels through three simple questions and demonstrated potential clinical utility in travel medicine. By facilitating identification of individuals with limited literacy levels, the new tool can help providers orientate the discussion for a profitable counseling session. Implementation research is needed to confirm its effectiveness in routine travel clinical practice. The high VH revealed in the traveler population warrants future targeted research.
Respiratory diseases remain a leading health burden across Europe, yet national strategies are often fragmented or absent. The International Respiratory Coalition's Lung Facts platform offers a comprehensive, up-to-date resource for epidemiological and economic data for major respiratory conditions across 53 European countries. This viewpoint outlines the platform's development and the types of data available, including disease burden, societal costs and risk factor attribution. It also demonstrates how national coalitions are using it to advocate for respiratory health policies. By providing accessible, country-specific information in visual formats, Lung Facts supports benchmarking, evidence-based advocacy and planning of national respiratory strategies. The platform is a dynamic tool intended to strengthen respiratory health policy and empower stakeholders to act on the growing burden of lung disease.
Abstract Whether clonal hematopoiesis (CH) in follicular lymphoma (FL) patients affects clinical outcome or is merely a bystander phenomenon is unclear. We leveraged the Phase III Fondazione Italiana Linfomi FOLL12 trial, which treated patients with advanced‐stage FL with R‐CHOP or R‐Bendamustine, to evaluate the role of myeloid CH at baseline and after chemoimmunotherapy (CIT). A total of 528 serial blood samples from 242 FL were analyzed by CAPP‐Seq. At baseline, CH occurred in 35.5% patients with DNMT3A (N = 41, 16.9%) and TET2 (N = 29, 12.0%) being the most frequently mutated genes. After a median follow‐up of 8.2 years, CH at baseline did not impact progression‐free survival (PFS), overall survival (OS), or risk of transformation (P = 0.660, P = 0.230, and P = 0.584, respectively), but instead associated with therapy‐related hematological toxicities driven by TET2 mutations. CH dynamics after the genotoxic pressure imposed by CIT was evaluated in 211 patients provided with sequential samples. CIT significantly expanded both prevalence and size of CH, with clones affected by DNA damage response (DDR) gene mutations exhibiting the highest fitness. Distinct selective pressures were observed between R‐CHOP and R‐Bendamustine, with the latter creating a tighter bottleneck that facilitates the emergence of fitter CH clones preferentially carrying TP53 mutations. Patients acquiring fit DDR clones (N = 37) had inferior long‐term outcomes, including independent increased risk of second malignancies (hazard ratio [HR] 2.63, P = 0.035) that developed in 28 patients, and shorter OS (HR 3.28, P = 0.008). CH emerges as a novel and potentially valuable biomarker in FL, capable of predicting long‐term toxicities that are key endpoints in indolent lymphoid malignancies characterized by long‐lasting survival.
Background: Determining biological sex is pivotal for archaeological and forensic studies, providing insights into past societies, burial practices, and population demographics. Traditional methods, such as morphological analysis and DNA-based techniques, face limitations, including inconclusive results for juveniles, contamination, and genetic material degradation. Additionally, these approaches often involve significant destruction of artifacts, raising ethical concerns. Dental proteomics has emerged as a robust alternative, utilizing the stability of enamel-bound proteins, such as amelogenin isoforms (AMELx and AMELy). However, current sampling techniques are invasive, requiring substantial material removal and risking the integrity of culturally significant specimens. Results: This study introduces a novel, minimally invasive technique for enamel protein sampling using a polyvinyl alcohol (PVA)-based highly viscous polymeric dispersion (HVPD). Acting as an elastic gel-like system, HVPD enables in-situ digestion and efficient extraction of proteins without compromising the tooth's structural integrity. The method was successfully applied to contemporary and archaeological samples, demonstrating effective recovery of amelogenin isoforms, reduced contamination risk, and compatibility with degraded specimens. This minimally invasive approach achieves reliable detection of all key amelogenin markers required for sex determination, matching the analytical outcome of conventional destructive protocols while preserving specimen integrity.' Significance: This methodology offers transformative potential for archaeology, anthropology, and forensic science, bridging scientific innovation with ethical stewardship. By preserving the physical and cultural integrity of artifacts, it addresses a critical need for sustainable research practices. Reliable biological sex determination in challenging contexts expands the scope of proteomic applications, providing new insights into past societies while safeguarding irreplaceable heritage for future generations. (c) 2026 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
AIMS:This post hoc analysis of COMBINE 1-3 assessed efficacy and hypoglycaemia outcomes with IcoSema (once-weekly combination therapy of basal insulin icodec and semaglutide [a glucagon-like peptide-1 analogue]) versus comparators in adults with type 2 diabetes (T2D) by kidney and liver function subgroups. MATERIALS AND METHODS:Treatment outcomes were analysed by trial according to kidney (estimated glomerular filtration rate ≥ 90; 60-< 90; 30-< 60; < 30 mL/min/1.73 m2) and liver (total bilirubin ≤ 21 μmol/L or aspartate aminotransferase [AST] ≤ 31/≤ 37 [female/male] U/L; total bilirubin > 21 μmol/L or AST > 31/> 37 [female/male] U/L) function subgroups. RESULTS:In COMBINE 1-3, across kidney and liver function subgroups, there were no statistically significant treatment by subgroup interactions for change in glycated haemoglobin (HbA1c) (baseline to week 52), change in body weight (baseline to week 52) or rates of combined clinically significant or severe hypoglycaemia (not assessed by kidney function for COMBINE 2) (all p > 0.05). There were statistically significant treatment by kidney function subgroup interactions for the achievement of HbA1c < 7.0% without weight gain and without clinically significant or severe hypoglycaemia in COMBINE 3 (p < 0.05) but not COMBINE 1 or 2, and statistically significant treatment by liver function subgroup interactions in COMBINE 1 (p < 0.05) but not COMBINE 2 or 3. For COMBINE 1 and 3, there were statistically significant treatment by kidney function subgroup interactions for mean weekly total insulin dose, but not statistically significant treatment by liver function subgroup interactions. CONCLUSIONS:Efficacy and hypoglycaemia outcomes with IcoSema versus comparators were generally consistent among adults with T2D with mild to moderate kidney impairment or impaired liver function. TRIAL REGISTRATION:The COMBINE 1-3 trials were sponsored by Novo Nordisk and are registered with ClinicalTrials.gov (NCT05352815; NCT05259033; NCT05013229).
