ABSTRACT Background and Aim Human Immuno‐deficiency Virus (HIV) testing serves as the essential entry point to prevention, treatment, and care. Despite progress, uptake remains low among adolescent girls and young women (AGYW) in sub‐Saharan Africa (SSA), specifically The Gambia. Identifying sociodemographic and behavioural determinants of HIV testing can guide targeted interventions. Methods This cross‐sectional study analysed 1,083 AGYW from the 2019/20 Gambia Demographic and Health Survey, a nationally representative population‐based survey. We assessed the prevalence of ever having tested for HIV and examined its associations with sociodemographic, reproductive, and behavioural factors, among AGYW aged 15 to 24 years. Bivariate and multivariable logistic regression models were applied to identify independent predictors of HIV testing, with analyses adjusted for unequal probability selection using survey weights. Results Of 1,083 AGYW analysed, 45.33% (95%CI: 41.20–49.60) had tested for HIV, lower among adolescent girls aged 15–19 years at 34.92% (95%CI: 28.60–41.80) compared to 49.39% (95%CI: 44.37–54.41) for young women aged 20–24 years. In adjusted analyses, higher education (aOR 2.97, 95%CI: 1.15–7.72), being married/in union (aOR 2.82, 95%CI: 1.43–5.58), comprehensive HIV knowledge (aOR 2.82, 95%CI: 1.73–4.60), having ever been pregnant (aOR 7.11, 95%CI: 4.14–12.20), and being in the poorer (aOR 2.09, 95%CI: 1.18–3.70) or middle (aOR 1.93, 95%CI: 1.00–3.71) quintiles, were significantly associated with HIV testing. However, age category, residence, employment status, and behavioural risk factors were not significantly associated with HIV testing. Conclusion We observed less than half of AGYW in The Gambia ever had an HIV test, highlighting the need for targeted, youth friendly, and equitable HIV testing strategies.
ABSTRACT Background and Aims Intentional poisoning is a major public health challenge requiring rapid emergency intervention. This study aimed to identify demographic, psychiatric, and toxicological factors associated with intentional poisoning among patients presenting to a hospital emergency department. Methods We conducted a retrospective cross‐sectional analysis of 658 poisoning cases recorded in a hospital emergency department poisoning registry in Ilam, Iran (March 2022–March 2023), with linked medical‐record data reviewed after the index encounter. The primary outcome was a final binary classification of intentional versus unintentional poisoning. Categorical associations were examined using Pearson chi‐square tests or Fisher exact tests as appropriate. A multivariable logistic regression model included five prespecified clinical/psychiatric variables and estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Analyses used Stata version 11.0 (α = 0.05, two‐sided). Results Of 658 patients, 367 (55.8%) were classified as intentional poisoning and 291 (44.2%) as unintentional. Intentional poisoning was more frequent among women than men (194/279, 69.5% vs. 173/379, 45.6%; p < 0.001) and among urban than rural residents (295/476, 62.0% vs. 72/182, 39.6%; p < 0.001). In the multivariable clinical model, previous suicide attempt showed the strongest association with intentional poisoning (aOR 4.69, 95% CI 2.55–8.61, p < 0.001), and psychiatric disorder history remained associated (aOR 1.78, 95% CI 1.02–3.12, p = 0.043); current psychiatric disorder did not remain independently associated after mutual adjustment (aOR 0.91, 95% CI 0.59–1.40, p = 0.669). Among specific agents, high intentional‐use proportions were observed for aluminum phosphide (17/18, 94.4%), antibiotics (13/15, 86.7%), and acetaminophen (35/43, 81.4%). Conclusions Intentional poisoning was associated with distinct demographic patterns and psychiatric vulnerability, particularly a history of previous suicide attempts. These findings support systematic mental health assessment in emergency poisoning care and prevention strategies focused on patients with established self‐harm history and access to highly lethal agents.
ABSTRACT Background and Aim Patients recovering from lumbar spine surgery frequently report persistent pain, functional limitation, and limited understanding of postoperative self‐care. This study examined whether participation in a standardized perioperative care program was associated with differences in pain, functional disability, and patient knowledge at 2 months, compared with routine hospital care, among adults undergoing elective lumbar spine surgery in Erbil, Iraq. Method This was a non‐randomized (quasi‐experimental) controlled study with two parallel groups and pre–post assessment, conducted between September 29, 2024 and April 25, 2025 in the Neurosurgery Unit of Hawler Teaching Hospital. Participants were recruited by purposive sampling and allocated non‐randomly by admission cohort; groups were matched on surgery type and key sociodemographic characteristics. Reporting follows the TREND statement for non‐randomized evaluations and the TIDieR checklist for intervention description. Outcomes were pain (Universal Pain Assessment Tool, 0–10), functional disability (Oswestry Disability Index, reported throughout on the 0%–100% scale), and knowledge (36‐item researcher‐developed questionnaire, scaled 0–100). The primary analysis was the between‐group difference in change from baseline, estimated by analysis of covariance adjusted for the baseline outcome value and pre‐specified covariates and confirmed by a linear mixed model. Responder, hierarchical‐regression, and mediation analyses were pre‐specified as exploratory and non‐causal. Results Seventy patients (35 per group) completed the study with no loss to follow‐up. Groups were comparable at baseline (all p > 0.05). At 2 months, the intervention group reported lower pain (median 0 [IQR 0–2] vs. 5 [3–7]; p < 0.001), lower disability (ODI 4% [2–6] vs. 46% [30–68]; p < 0.001), and higher knowledge (69 [67–70] vs. 41 [40–46]; p < 0.001). The between‐group differences in mean change from baseline favored the program for pain (− 3.58 points), disability (− 44.2 percentage points), and knowledge (+ 25.3 points). In exploratory hierarchical regression, program participation showed the largest standardized coefficient for treatment response (β = 0.58, p < 0.01), with the full model accounting for 69% of the variance; these estimates are associative and are not adjusted for unmeasured confounding. Conclusions Participation in an intensive, structured perioperative care program was associated with substantially better self‐reported pain, disability, and knowledge at 2 months in this selected single‐center cohort. Because allocation was not randomized and the program involved considerably greater professional contact than routine care, these findings describe an association rather than a causal effect, and require confirmation in randomized, multicentre trials with longer follow‐up. Trial Registration ClinicalTrials.gov (NCT07459985), registered 04/03/2026 (retrospectively registered; see Section 2.13).
ABSTRACT Background and Aims Ovarian reserve markers are reported to differ across ethnic groups, though the sources of this variation are unclear. We aimed to document this variation and examine the environmental, nutritional, and sociocultural factors that may explain it. Methods Observational studies were included if they enrolled women aged 18–45 and reported ovarian reserve markers (AMH, AFC, or FSH) stratified by an explicitly defined ethnicity classification. Four databases were searched. Risk of bias was assessed with the Joanna Briggs Institute checklist. A random‐effects meta‐analysis estimated standardized mean differences (SMD) with 95% confidence intervals (CI) and prediction intervals; heterogeneity was assessed with τ2 and I2. The two‐study FSH comparison was treated as exploratory. Results Ten studies (10,349 women, nine countries) were included in the narrative synthesis; six contributed to the AMH meta‐analysis and two to the exploratory FSH analysis. Most studies (7/10) had a low risk of bias. Individually, most studies reported higher ovarian reserve markers in White European women than in women of Middle Eastern, South Asian, or some Latin American or African descent. The pooled estimates for Asian versus European women were not statistically significant and were accompanied by extreme heterogeneity: AMH (6 studies: SMD –0.68, 95% CI –1.84 to 0.48; p = 0.19; I2 = 99.1%) and FSH (2 studies: SMD –1.36, 95% CI –15.25 to 12.54; p = 0.43; I2 = 89.8%). The wide FSH interval reflects the fragility of pooling only two studies. Conclusion The consistent, clinically relevant finding here is qualitative: individual studies repeatedly report lower ovarian reserve markers outside White European populations, most plausibly reflecting environmental, nutritional, and socioeconomic exposures rather than fixed biology. The pooled estimates are exploratory given the small number of studies and near‐total heterogeneity, and should not be over‐interpreted. Population‐specific AMH reference ranges, informed by studies that rigorously adjust for these confounders, are needed for equitable clinical decision‐making. Trial Registration PROSPERO Registration: CRD420251026342.
ABSTRACT Background and Aims Sleep characteristics have been increasingly recognized as important determinants of obesity and metabolic health. This study aimed to investigate the association between sleep characteristics and obesity indices among adults participating in the Prospective Epidemiological Research Studies in Iran (PERSIAN) Guilan Cohort Study (PGCS). Methods This cross‐sectional analytical study included 10,520 adults aged 35–70. Demographic, lifestyle, anthropometric, and sleep‐related data were collected using standardized questionnaires. Obesity indices included body mass index (BMI), waist‐to‐hip ratio (WHR), and waist‐to‐height ratio (WHtR). Associations between sleep characteristics and obesity indices were evaluated using chi‐square tests and logistic regression analyses. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated after controlling for potential confounders. Results The mean age of participants was 51.52 ± 8.90 years, and 53.5% were women. Overall, 32.7% of participants were obese based on BMI, with significantly higher prevalence among women than men (47.0% vs. 16.1%, p < 0.001). Short sleep duration (< 7 h) was reported by 43.7% of participants. In men, sleeping 7–9 h and > 9 h was associated with lower odds of BMI‐defined obesity compared with sleeping < 7 h (aOR = 0.75, 95% CI: 0.64–0.88 and aOR= 0.54, 95% CI: 0.38–0.78, respectively). Longer sleep duration was also associated with lower odds of WHR‐ and WHtR‐defined obesity in men (p < 0.05). Conversely, daytime sleeping and daytime napping were associated with higher odds of central obesity among men (p < 0.05). In women, later bedtime was independently associated with higher odds of obesity, while waking between 06:00 and 09:00 was associated with lower odds of central obesity (p < 0.05). Conclusion Sleep characteristics were significantly associated with general and central obesity, with notable sex‐specific differences. These findings support the integration of sleep assessment into obesity prevention and management strategies.
ABSTRACT Background and Aims Chronic cardiovascular diseases (CVDs) remain a primary contributor to global mortality. Despite their prevalence, the comprehensive care needs of affected patients are not fully elucidated. This integrative review sought to synthesize current evidence on the multifaceted care requirements of individuals with chronic CVDs. Methods A comprehensive literature search was performed using PubMed, Scopus, and Web of Science, targeting studies published between 2010 and February 2025. The Whittemore and Knafl framework guided the methodology, incorporating both quantitative and qualitative research. Thematic analysis was utilized to distill key care‐related themes. Results The analysis of 14 studies revealed 5 predominant themes central to the care needs of patients with chronic CVDs. Health Education encompassed the dissemination of medical information, lifestyle education, guidance on using medical instruments, promotion of healthy behaviors, and counseling on diet and nutrition. Self‐Care Management focused on self‐care practices, medication adherence, symptom monitoring, risk factor control, and strategies to prevent complications. Holistic Support included mental health resources, emotional reassurance, support groups, assistance with daily activities, engagement of family and community, caregiver support, cost management, and socioeconomic aid. Care Coordination highlighted the importance of primary contact persons, telehealth and digital health solutions, and accessibility to healthcare services. Lastly, End‐of‐Life Care addressed decision‐making processes, palliative care consultations, and attention to spiritual and existential needs. Conclusion This review underscores the complex and diverse care needs of patients with chronic CVDs, advocating for the adoption of comprehensive, patient‐centered care models. These insights provide a foundation for designing targeted interventions and directing future research to enhance patient outcomes and quality of life.
ABSTRACT Background and Aim Exclusive breastfeeding (EBF) reduces infant mortality and HIV vertical transmission (VT). The 2016 World Health Organisation (WHO) guidelines recommend 6 months of EBF for mothers living with HIV (MLWH) on antiretroviral therapy, yet uptake in sub‐Saharan Africa (SSA) remains low, and evidence on predictors is fragmented. This scoping review synthesised quantitative evidence on predictors of EBF among MLWH in SSA since the 2016 WHO guidelines, identifying geographic gaps and methodological trends to guide research and policy. Methods Following Joanna Briggs Institute methodology and PRISMA‐ScR reporting, five databases, PubMed, EMBASE, Web of Science, Scopus, and Global Health, were searched for studies conducted from 2016 onwards that quantitatively assessed predictors of EBF among MLWH in SSA. Included studies were descriptively synthesised and mapped by geography, frequency, association, and analysis type. Quality appraisal used the Mixed Methods Appraisal Tool 2018. Results 19 studies met inclusion criteria. Positive predictors included healthcare engagement, knowledge, favourable attitudes, and HIV‐status disclosure. Negative/mixed predictors included employment, education, and pregnancy complications. Studies were geographically skewed (42% from Ethiopia), largely cross‐sectional (74%), and facility‐based. Psychosocial, socioeconomic, and biological/clinical barriers remain underexplored. Conclusions Evidence on EBF predictors among MLWH in SSA remains limited, geographically uneven, and methodologically restricted. Future research should adopt longitudinal, intervention‐focused, and contextually diverse designs to inform scalable, culturally responsive strategies for improving EBF and preventing HIV VT.
Background and Aims:Major Depressive Disorder (MDD) is a highly common neuropsychiatric disorder globally. A variety of factors contribute to the neuropathology of MDD. Microbiome research in neuropsychiatric disorders such as MDD has recently attracted attention. Indeed, the gut-brain axis could influence the course of MDD through metabolites such as Gamma-Aminobutyric Acid (GABA), Quinolinate, and other factors. Such metabolites may modulate the balance of excitatory and inhibitory signals. Moreover, MDD features abundant hyperinflammatory bacteria, whereas anti-inflammatory butyrate-synthesizing genera are decreased. Methods:Despite mounting evidence on the implications for the microbiome in MDD, it is unclear whether a bidirectional or causal relationship is in effect. To overcome this challenge, researchers have utilized AI tools to investigate the complex association between the microbiome and MDD. Results:Additionally, there is no solid biomarker recognized for diagnosis and prognosis of MDD, while further application of AI using ML protocols, such as random forest, NNs, SVM, and DL models, could offer a rather solid and reliable comprehension of the complicated nature of microbiome-MDD interplay. Conclusions:The present article reviews microbiome alterations as well as inflammatory and metabolic pathways in MDD with a focus on AI technology including support vector machines (SVM), random forests (RF), deep neural networks (DNNs), and autoencoders, which are used to identify microbial biomarkers, predict treatment results, and support personalized medicine.
ABSTRACT Background Nurses are central to palliative and end‐of‐life care, yet organizational, family‐related, and professional barriers may restrict person‐centered support. Evidence from Palestinian governmental hospitals remains limited. Aim To assess nurses' perceived barriers to palliative care delivery and examine associated demographic and professional factors. Methods A multicentre cross‐sectional study was conducted in four hospitals in Hebron Governorate, Palestine, from January to March 2026. A convenience sample of 200 nurses completed a demographic questionnaire and a 15‐item Perceived Barriers to Palliative Care Scale. Data were analyzed using descriptive statistics, Mann–Whitney U tests, Kruskal–Wallis tests with Dunn–Bonferroni post hoc comparisons, and multiple linear regression. Results The mean perceived‐barriers score was 2.05 (SD = 0.24), with a median of 2.07 and an interquartile range of 1.93–2.20. The highest‐rated barriers were uncertainty regarding patients' wishes, family non‐acceptance of poor prognosis, liberal visiting hours, family absence at death, inadequate consideration of nurses' opinions, and limited resources. Barrier scores differed across age groups, H(3) = 10.70, p = 0.013, although no pairwise comparison remained significant after Bonferroni adjustment. Nurses aged 50 years or older had higher barrier scores than those aged 20–29 years (B = 0.147, p = 0.026). However, the model was not significant, F(9, 189) = 1.87, p = 0.059, and explained 8.2% of the variance. Conclusion Nurses perceived multidimensional barriers involving patient preferences, family communication, resources, privacy, and participation in decision‐making. Organizational, educational, and policy interventions are needed to strengthen palliative care delivery.
ABSTRACT Background and Aims Measuring difficulties in Emotion regulation is crucial from the perspective of clinical assessment and intervention. Difficulties in Emotion Regulation Scale‐Short Form (DERS‐SF) is the most commonly used tool to assess emotional dysregulation. Nevertheless, this essential tool has not been validated, and its psychometric properties have not been explored in the Bangladeshi culture. Consequently, the study aimed to assess the psychometric properties of the Bangla Version of the DERS‐SF in a sample of university students in the Bangladeshi culture. Method The study included 328 university students (58% Male and 42% female) as a sample aged 19 to 26 (M = 23.19, SD = 1.62) from the University of Rajshahi, Bangladesh. The study employed a purposive sampling strategy. A confirmatory factor analysis (CFA) was employed to confirm the factor structure of the DERS‐SF. Results The results of the study revealed that the original six‐factor model of the DERS‐SF had a good fit [χ2/df = 2.495, GFI = 0.911, TLI = 0.901, and CFI = 0.925, RMSEA = 0.068] in the present sample, which justifies factorial validity of the Bangla DERS‐SF. The high reliability of the Bangla DERS‐SF was justified by the value of Cronbach's α (total Score = 0.88, Strategies = 0.64, Non‐acceptance = 0.68, Impulse = 0.84, Awareness = 0.55 and Clarity factor =0.69). The concurrent validity of the DERS‐SF was determined by the correlation with the psychological distress and positive mental health in the expected direction. Conclusion The findings of the study indicate that DERS‐SF is a valid and reliable measure for assessing emotion dysregulation among the student population in Bangladesh. This study will benefit mental health practitioners and researchers in many ways.
ABSTRACT Background and Aims Type 2 Diabetes Mellitus (T2DM) is a growing health burden globally, and its concurrence with Congestive Heart Failure (CHF) significantly increases morbidity and mortality. However, long‐term mortality trends remain underexplored. This study aims to assess temporal trends in mortality from comorbid T2DM and CHF in the United States (U.S.) from 1999 to 2020, with emphasis on demographic and geographical disparities. Methods We analysed U.S. mortality data from 1999 to 2020 for adults aged ≥ 25 years with coexisting T2DM and CHF using the CDC WONDER Multiple Cause of Death database. Cases were identified using the ICD‐10 codes E11 and I50.0 for T2DM and CHF, respectively. Temporal trends in crude mortality rates (CMRs) and age‐adjusted mortality rates (AAMRs) per 100,000 population were stratified by demographic and geographic characteristics and were used to estimate the annual percent change (APC) and average annual percent change (AAPC) using Jointpoint regression. Results Between 1999 and 2020, 292,452 deaths related to T2DM, and CHF were recorded among U.S. adults, with most deaths occurring in medical facilities. The overall AAMR increased from 4.33 in 1999 to 8.98 in 2020, with a significant rise after 2014. (APC: 7.31) AAMRs varied substantially by age, sex, race, and urbanization level. AAMRs were 27.96 among adults aged ≥ 65 years versus 0.93 among those aged 25–64 years and 7.47 among males versus 5.24 among females. Across racial groups, AAMRs were highest among American Indian/Alaska Native populations at 11.53, followed by Hispanic/Latino populations at 6.76, Black/African American populations at 6.53, non‐Hispanic White populations at 6.06, and Asian/Pacific Islander populations at 4.07. AAMRs were also higher in non‐metropolitan regions at 8.58 compared with 5.62 in metropolitan regions. Geographically, the highest mortality rate was observed in West Virginia at 11.27, with the Western region also exhibiting the highest regional mortality. Conclusions T2DM and CHF‐related mortality have increased substantially over the past two decades, with marked increases after 2014. Increased susceptibility among certain demographic and geographical groups highlight the need for integrated strategies to combine personalized care, treatment adherence, and population‐level risk factor management to reduce mortality.
ABSTRACT Background and Aims Exercise dependence is a potentially maladaptive pattern in which regular training becomes compulsive, poorly controlled, and associated with functional impairment. Given uncertainty about whether dependence‐related symptoms are more closely associated with affective distress, impulsivity, or exercise exposure, the present study examined multidimensional impulsivity, depressive symptom severity, sociodemographic characteristics, and weekly exercise duration in relation to the 21‐item Exercise Dependence Scale (EDS‐21) risk classification among regular exercisers. Methods In the present cross‐sectional study, 850 adults aged ≥18 years who regularly exercised at municipal centers, sports facilities, and healthy‐living complexes in Türkiye completed the EDS‐21, Short UPPS‐P Impulsive Behavior Scale, Short Beck Depression Inventory, and questions on weekly exercise duration, sociodemographic information, and health‐related variables. Analyses included descriptive statistics, Spearman correlations, Kruskal‐Wallis tests, Firth‐penalized binary logistic regression, and an exploratory multinomial logistic regression retaining all three EDS‐21 categories. Results Thirty‐two participants met the EDS‐21 dependence‐risk classification (3.8%), while 443 were symptomatic (52.1%) and 375 were asymptomatic (44.1%). EDS‐21 total score correlated with sensation seeking (r = 0.28, p < 0.001), total impulsivity (r = 0.23, p < 0.001), and depression symptom severity (r = 0.09, p = 0.01). In the Firth model, being single (OR = 5.77, 95% CI [1.23, 33.03], p = 0.02), higher total impulsivity (OR = 1.71 per 10‐point increase, 95% CI [1.07, 2.75], p = 0.02), and longer weekly exercise duration (OR = 1.23 per additional 60 min/week, 95% CI [1.14, 1.33], p < 0.001) were associated with the dependence‐risk classification. Depression symptom severity was not (p = 0.25). Conclusion EDS‐21 dependence‐risk classification was associated with impulsivity, single marital status, and weekly exercise duration in the present sample. The null depression finding should be interpreted cautiously because scores were low and showed limited between‐group variability. These cross‐sectional findings identify correlates rather than temporal or causal predictors.
ABSTRACT Background and Aims Retinoblastoma is the most common intraocular rare disease in children arising in the retinal cells. This study aimed to evaluate the consistency of the findings of factors associated with mortality in retinoblastoma children between the Cox Proportional Hazards Regression Model (Cox PHR) and the Multiple Logistic Regression Model (MLR). Methods A retrospective cohort study was conducted from January 2004 to April 2023 on 402 children diagnosed with retinoblastoma who were admitted to hospitals with paediatric ophthalmology services in Malaysia. The statistical analyses used to model the factors associated with mortality were Cox PHR and the MLR. The five key elements evaluated for parameter estimates encompass direction, estimation, precision, significance, and magnitude of risk. The performance of the models was assessed using the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). Results Among 402 children, 22 (5.5%) died, 27 (6.7%) were lost to follow‐up, and 353 (87.8%) remained alive. Prolonged delay in diagnosis and non‐compliance with follow‐up were significant factors associated with mortality in both models. In the Cox PHR model, prolonged delay in diagnosis (AHR: 4.45, 95% CI: 1.86–10.62, p = 0.001) and non‐compliance with follow‐up (AHR: 5.21, 95% CI: 2.24–12.10, p < 0.001) increased mortality risk. Similar findings were observed in the MLR model, with prolonged delay in diagnosis (AOR: 4.73, 95% CI: 1.84–12.15, p = 0.001) and non‐compliance with follow‐up (AOR: 9.51, 95% CI: 3.75–24.11, p < 0.001) significantly increasing the odds of mortality. Both regression models showed consistent direction, and significant results. Conclusion Both Cox PHR and MLR models consistently identified prolonged delay in diagnosis and non‐compliance with follow‐up as factors associated with mortality among children with retinoblastoma.
ABSTRACT Background and Aims Iron deficiency is the most widespread nutritional deficiency worldwide. Although iron deficiency can affect women throughout their reproductive years, late adolescence (16–18 years) represents a particularly vulnerable period because of rapid growth, increased iron requirements, establishment of menstrual cycles, and dietary transitions. Identifying iron deficiency during this critical developmental stage may facilitate early intervention before entry into adulthood and the broader reproductive period. Since there is no confirmed information on the prevalence of iron deficiency in this high‐risk age group in South Khorasan Province, this study aimed to assess the prevalence of IDA among female high school students in Birjand. Methods This study was conducted on blood samples from participants to analyze serum ferritin, total iron‐binding capacity (TIBC), iron as well as complete blood count (CBC). Written consent was obtained before sample collection. The samples were then sent to a medical diagnostic facility for analysis. IDA was diagnosed based on the criteria established by the World Health Organization (WHO). Results The study included 148 participants, with an average age of 17.47 ± 1.209 years (range: 16–18). Among the 143 participants, 15.5% were diagnosed with anemia, while 7.4% were classified as iron deficiency anemia. The mean levels of ferritin, TIBC, and serum iron were 44.199 ng/mL, 327.79 µg/dL, and 97.31 µg/dL, respectively. Out of all, 8.8% of individuals were assigned to the first phase of progress to IDA, whereas 2.7% were assigned to the second phase. Conclusion Findings of the present study showed that iron deficiency is an increasing concern in this population and needs to be addressed.
ABSTRACT Background and Aims Knee osteoarthritis (KOA) is a leading cause of functional impairment and decreased quality of life. Exercise is the recommended approach; however, adjunct interventions such as kinesio taping (KT) have gained attention for potential to reduce pain, improve proprioception, and enhance functional performance. Despite its growing clinical use, research on the effectiveness of combining KT with neuromuscular control exercises (NCE) in KOA remains limited. Therefore, this study aimed to assess the effectiveness of KT combined with NCE in reducing pain and improving functional outcomes in KOA. Methods This randomized controlled trial is recruiting 80 participants with KOA. Participants are randomly allocated (1:1) to either an experimental group receiving KT combined with NCE or a control group receiving sham KT with NCE. Both groups are undergoing supervised intervention sessions three times per week for 8 weeks. Primary outcomes include pain intensity (Visual Analog Scale, VAS), pressure pain threshold (PPT—digital pressure algometer), and functional status (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC). Secondary outcomes include lower limb muscle strength (modified sphygmomanometer), knee range of motion (goniometer), and functional mobility (Timed Up and Go test, TUG). Outcomes are planned to be assessed at baseline, post‐intervention (8 weeks), and follow‐up (6 months). Repeated‐measures ANOVA will assess group, time, and group × time interaction effects, with between‐group differences and 95% CIs reported according to the intention‐to‐treat principle. Results The trial is expected to generate evidence on whether adding KT to NCE yields greater improvements in pain modulation, physical function, and mobility in KOA. Conclusions This study will address a crucial evidence gap in multimodal, non‐pharmacological rehabilitation for KOA. Findings could support evidence‐based clinical decisions and provide a cost‐effective addition to exercise therapy, especially in resource‐limited settings like Bangladesh. Results might also guide future multicenter trials and standardized rehabilitation protocols for KOA. Trial Registration CTRI/2025/08/093317 [Registered on: 20/08/2025]; trial registered prospectively.
ABSTRACT Background and Methods This study examined the association between completion of a general nutrition course (GNC) and nutrition knowledge among university students in the United Arab Emirates (UAE). A cross‐sectional online survey was conducted at the University of Sharjah. Nutrition knowledge was compared between students who completed the GNC (GNC group, n = 249) and those who did not (non‐GNC group, n = 561). The elective course comprised three modules covering macronutrients and micronutrients, selected nutrition topics, and common nutrition‐related diseases. At the end of the academic semester, participants completed the validated 88‐item General Nutrition Knowledge Questionnaire‐Revised (GNKQ‐R), which assesses dietary recommendations, food groups and nutrient sources, healthy food choices, and diet‐related diseases and weight management. Each correct response was awarded 1 point, for a maximum score of 88. Results Overall, 16.4% of participants demonstrated good nutrition knowledge (≥ 64/88). This proportion was higher in the GNC group than in the non‐GNC group (26.5% vs. 11.9%, p < 0.001). The GNC group also had a higher mean total knowledge score (55.19 ± 12.50 vs. 52.55 ± 9.75, p = 0.001; Cohen's d = 0.25), with differences observed in three of the four GNKQ‐R sections. In the full multivariable model, GNC completion, high Body Mass Index (BMI), enrollment in medical or health‐related majors, and more positive self‐rated health were associated with higher total scores. Conclusions Completion of a general nutrition course was associated with higher nutrition knowledge among university students; however, the magnitude of the difference was modest and overall knowledge levels remained low. Longitudinal and intervention‐based studies are needed to assess knowledge retention and whether knowledge differences translate into lifelong dietary behavior change.
ABSTRACT Background and Aims Thalassemia is an inherited hemoglobin disorder characterized by ineffective erythropoiesis, chronic anemia, and progressive multisystem complications that require lifelong management. Current treatment relies on regular red blood cell transfusions, iron chelation therapy, and supportive multidisciplinary care, while hematopoietic stem cell transplantation offers a curative option for selected patients. Although gene‐based therapies and novel pharmacological agents have expanded therapeutic options, their widespread implementation is limited by cost, accessibility, and long‐term safety considerations. This article summarizes contemporary management strategies for α and β thalassemia, with particular emphasis on the recent emergence of the FDA‐approved oral pyruvate kinase activator, mitapivat. Methods A structured literature review was conducted using PubMed and PubMed Central. Searches included the terms “thalassemia,” “mitapivat,” “pyruvate kinase activator,” “gene therapy,” “hydroxyurea,” and “luspatercept.” Priority was given to recent systematic reviews, clinical practice guidelines, pivotal phase II and III clinical trials, regulatory publications, and peer‐reviewed studies relevant to current therapeutic practice. Results Conventional therapies remain essential but are associated with significant limitations, including transfusion dependence, iron overload, and treatment‐related complications. Curative strategies such as hematopoietic stem cell transplantation and gene therapy are effective in selected patients but remain constrained by donor availability, toxicity, cost, and limited accessibility. Emerging pharmacological therapies target ineffective erythropoiesis and iron dysregulation. Phase III ENERGIZE and ENERGIZE‐T trials demonstrated that mitapivat significantly improved hemoglobin response in non‐transfusion‐dependent disease and reduced transfusion burden in transfusion‐dependent disease, with an acceptable safety profile, leading to FDA approval as the first oral therapy for adults with α or β thalassemia. Conclusion Mitapivat represents a significant advance in thalassemia management by targeting erythrocyte metabolism and providing the first FDA‐approved oral treatment for anemia in adults with α or β thalassemia. Multi‐year follow‐up and real‐world studies are needed to further define its durability, safety, and role within evolving treatment strategies.
ABSTRACT Background and Aim Social media has evolved into a major source of health and medical information. This study investigated exposure to medication‐related content on social media among adults in Jordan and examined factors influencing trust, confidence in distinguishing accurate from inaccurate information, and health‐related decision‐making. Methods A cross‐sectional online survey was conducted in February 2026 among adults aged ≥ 18 years using convenience and snowball sampling. The questionnaire assessed demographics, social media use, exposure to medication‐related content, trust, verification behaviors, and digital health literacy (eHEALS). Data were analyzed using descriptive statistics and binary logistic regression, with significance set at p < 0.05. Results A total of 501 participants were included (median age 26, 309 females, 61.7%). Instagram (n = 416, 83%), Facebook (n = 383, 76.4%) and YouTube (n = 376, 75%) were the most common social platforms used. Respondents had frequent encounters with medication information (n = 199, 39.7% more than once a day). Content consisted mostly of herbal remedies (n = 404, 80.6%), advice from healthcare professionals (n = 330, 65.9%) and influencers (n = 329, 65.7%). Trust levels were neutral (n = 244, 48.7%) to low (n = 200, 39.9%). Trust was affected by the nature of the content source (n = 426, 85%), nature of the information source (n = 426, 85%) and social media platform used (n = 309, 61.7%). Most participants (n = 309, 61.7%) had encountered false information including false health claims/benefits (n = 263, 52.5%) and misleading ads/promotion (n = 243, 48.5%). Verification behavior was low to moderate (n = 209, 41.7%), with more respondents (n = 194, 38.7%) taking action on content seen. Higher education predicted high trust (AOR = 3.05, p = 0.009) and low confidence to differentiate reliable information from misinformation predicted high trust (AOR = 3.64, p = 0.001). Higher digital health literacy predicted more confidence to differentiate reliable from unreliable information (AOR = 1.082, p < 0.001) and low risk to act upon social media advice (AOR = 0.956, p = 0.007). Conclusion Social media is widely used for medication information, yet trust and digital health literacy remain limited. Exposure to misinformation is common and affects decision‐making. Enhancing digital health literacy, encouraging verification, and promoting credible health communication are critical.
ABSTRACT Background Malaria remains a leading cause of morbidity and mortality in sub‐Saharan Africa, disproportionately affecting children under five. In Tanzania, where malaria accounts for a significant share of pediatric deaths, the use of insecticide‐treated nets (ITNs) is a cornerstone of prevention. However, despite widespread ITN distribution, usage remains suboptimal due to socioeconomic and behavioral factors. This study applied machine learning (ML) methods to predict ITN usage among under‐five children in Tanzania using nationally representative survey data. Methods We utilized data from the 2022 Tanzania Demographic and Health Survey (TDHS), comprising 8,319 women with complete information relevant to ITN use. Six supervised ML models—Random Forest, Bagging, Support Vector Machine (SVM), Gradient Boosting Machine (GBM), Naïve Bayes, and Logistic Regression—were developed to predict ITN usage. The dataset was split into training (70%) and testing (30%) sets. Class imbalance was addressed using Synthetic Minority Over‐sampling Technique, and model performance was evaluated using AUC, accuracy, sensitivity, specificity, PPV, and NPV. Feature importance was assessed using the Mean Decrease in Gini index. Results The Random Forest model achieved the highest performance (AUC = 0.90, accuracy = 87%, sensitivity = 90%, specificity = 75%), followed closely by Bagging and SVM models. Key predictors of ITN use included wealth index, education level, region, and mosquito net ownership. Socioeconomic and geographic disparities were the strongest contributors to variations in ITN utilization, while pregnancy status and household size were less influential. Conclusion Machine learning offers a powerful approach for identifying determinants of ITN use and targeting high‐risk populations. This study demonstrates the potential of predictive modeling to enhance malaria prevention strategies in Tanzania and similar endemic settings. Future work should integrate geospatial and longitudinal data and explore operationalization through digital decision‐support systems.
