Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder that occurs in women of reproductive age and is linked to pregnancy, metabolic, and psychological complications. Although it is very prevalent, a significant percentage of the cases are not diagnosed, because of poor awareness and access to diagnostic services. Identifying non-clinical symptom patterns associated with PCOS may support the development of symptom-based risk assessment approaches and facilitate earlier clinical evaluation of women at increased risk of the condition. The objective of the study was to examine differences in non-clinical, self-reported, and observable symptom profiles between women with and without PCOS in Bangladesh. Methods A cross-sectional study was carried out on 546 women between the ages of 15 and 30 years in Bangladesh, 273 with physician-diagnosed PCOS and 273 controls. chi 2 tests were conducted on bivariate analyses and multivariate logistic regression was conducted to determine the possible symptoms of PCOS with age and body mass index as confounding variables. Results There were a number of symptoms that were significantly different in the two groups. The strongest associations with PCOS in multivariate analysis were irregular menstrual cycles (odds ratio (OR) = 4.93), unexpected weight gain (OR = 4.32), and hair growth in the jawline (OR = 4.25). The condition was also significantly related to self-reported sleep difficulty (OR = 2.62) and waist circumference greater than hips (OR = 2.47). Conversely, the symptoms that were frequently reported, including acne, oily skin, loss of hair, anxiety or stress, hair growth in upper lip, thigh, and upper arm, and family history of PCOS were not statistically significant after adjustments. Conclusions Several observable and self-reported symptoms were associated with PCOS among Bangladeshi women. These findings provide a basis for future research aimed at developing and validating symptom-based risk assessment approaches for PCOS.
Background Neonatal malaria remains underrecognised despite persistent high neonatal mortality in endemic regions. Evidence to guide diagnosis, classification, and treatment during the first 28 days of life is scarce, and neonatal-specific recommendations are largely absent. We conducted an international survey to describe current practices in neonatal malaria management and identify gaps in care. Methods We performed an anonymous online survey of healthcare professionals involved in neonatal malaria care between April 2024 and July 2025. The questionnaire, available in English, French, Portuguese, and Spanish, was distributed through professional networks and targeted invitations, assessing screening practices, diagnostic approaches, disease definitions, treatment strategies, dosing approaches, and perceived challenges. Data were analysed descriptively. Results A total of 173 respondents from malaria-endemic and non-endemic settings were included; most (91%) were based in sub-Saharan Africa. Most (61%) reported diagnosing neonatal malaria at least once yearly and 39% at least once a month. Most respondents (72%) did not distinguish between asymptomatic and symptomatic neonatal parasitaemia, and half (49%) did not differentiate between uncomplicated or severe malaria in neonates. The most used drugs were intravenous artesunate and artemether-lumefantrine for oral treatment. Among those using oral therapy, 71% reported using paediatric formulations, while 38% crushed tablets prior to administration. Crushed tablets were mostly mixed with water (90%), followed by expressed breast milk (23%) and infant formula (20%). In a case vignette of neonatal malaria, 87% of respondents recommended inpatient management with initial intravenous artesunate (92%) followed by oral artemisinin-based combination therapy (66%) with treatment duration ranging from 1 to 10 days and follow-up within 28 days (33%). Conclusions This survey demonstrates consensus in antimalarial drug selection alongside significant practice variation in disease classification and dosing, highlighting the need for evidence-based guidelines and improved access to age-appropriate formulations for neonatal malaria management.
Background Digital-device debates in schools often focus on students’ own use or nominal phone bans. We examined whether school-level peer digital distraction, conceptualised as a shared classroom exposure, was associated with mathematics performance, creative thinking, and life satisfaction across PISA 2022 systems. Methods In this cross-sectional observational study, we used public PISA 2022 student, school, and creative-thinking data. The analytic file included 613,744 students from 21,629 schools in 80 countries/economies, representing approximately 28.3 million 15-year-old students. Full adjusted complete-case samples included 77,216 students for mathematics, 65,222 for creative thinking, and 67,748 for life satisfaction. The exposure was a weighted leave-one-out school-level peer digital-distraction measure. Models used country/economy fixed effects, PISA final student weights, 80 Fay balanced repeated replication weights, and plausible-value pooling. Results We found that higher school-level peer digital distraction was associated with lower mathematics performance (β = −34.28; standard error (SE) = 3.95; 95% confidence interval (CI) = −42.02, −26.54, P < 0.001) and lower creative-thinking performance (β = −3.81; SE = 0.53; 95% CI = −4.85, −2.76, P < 0.001). Per within-country standard deviation of the exposure, the adjusted associations were −11.31 points for mathematics and −1.19 points for creative thinking. Phone-ban interactions were not statistically significant. School-level peer digital distraction was not significantly associated with life satisfaction. Conclusions Across a large global PISA 2022 file, school-level peer digital distraction was consistently associated with lower mathematics and creative-thinking performance in complete-case adjusted models. Findings are cross-sectional associations and should not be interpreted as causal evidence of educational harm or policy effectiveness.
Background Colorectal cancer (CRC) represents a major global public health challenge, yet age- and sex-specific patterns in mortality burden and risk factor contributions remain incompletely characterised. We aimed to analyse global age- and sex-specific mortality patterns of CRC from 1990 to 2021, project trends to 2050, and assess the mortality burden attributable to risk factors. Methods We extracted CRC mortality data from 204 countries and territories between 1990 and 2021 from Global Burden of Disease 2021. We stratified the population into very early-onset CRC (VEOCRC) (aged 15-34 years), early-onset CRC (EOCRC) (aged 35-49 years), and late-onset CRC (LOCRC) (aged 50-95 years). Age-specific mortality rates (MRs) characterised mortality burden, and estimated annual percentage changes quantified temporal trends. We applied population attributable fractions (PAFs) to estimate the mortality burden attributable to risk factors and used Bayesian age-period-cohort models to project global mortality trends from 2022 to 2050. Results From 1990 to 2021, LOCRC accounted for the greatest global mortality burden, followed by EOCRC and VEOCRC. The VEOCRC and EOCRC MRs were highest in East Asia, while LOCRC rates were highest among females in Australasia and males in Western Europe. All three subtypes had the highest MRs in the high-middle sociodemographic index region. Males consistently had higher MRs than females across all three subtypes. Generally, MRs declined from 1990 to 2021 across all three CRC subtypes, although some low- and middle-income regions, particularly East Asia, Latin America, and Africa, showed increasing trends. The PAFs of risk factors increased with age, particularly for behavioural, metabolic, and dietary factors. Projections suggested declining global CRC age-standardised MRs by 2050, while LOCRC would remain the major contributor, with rates of 57.47 per 100,000 in males and 31.40 in females. Conclusions We found substantial age, sex, and regional disparities in global CRC mortality. Despite projected declines by 2050, LOCRC will remain the dominant contributor, while younger-onset CRC warrants greater attention.
Background Despite extensive evidence that early childhood parenting interventions improve children's development, whether these effects are sustained in the longer term remains uncertain. We measured the medium-term effects of a parenting and cash transfer programme compared to a cash transfer alone on child, parenting, and maternal outcomes. Methods In the original trial, we recruited twenty clusters in Rangpur City Corporation of Bangladesh and randomised them equally to intervention (parenting and unconditional cash, 299 participants) or control groups (unconditional cash transfer only, 300 participants). Participants were mothers of children aged 6-16 months on enrolment. Here, we followed up mother/child dyads five years after the intervention when children were aged 6.2 to 8.4 years. The parenting intervention involved fortnightly home visits by trained facilitators for one year. Funds for the cash transfer were provided by the Government of Bangladesh. The primary child outcome was IQ, while secondary ones included reading and mathematics skills. Parenting outcomes included quality of home stimulation and mothers' childcare knowledge. Maternal outcomes included depressive symptoms, empowerment, violence exposure and quality of life. Results Out of the 599 participants enrolled in the initial trial, 555 (92.7%) mother/child dyads participated in this five-year follow-up. We observed no benefits of the combined intervention compared with cash alone for the primary outcome of child IQ (effect size = 0.11; 95% confidence interval = -0.04, 0.27); for the secondary outcomes, we observed benefits for reading, but not for mathematics skills. We also found benefits for home stimulation, mothers' childcare knowledge, depressive symptoms, and empowerment, but none for mothers' violence exposure and quality of life. Conclusions Although we found no benefit for the primary outcome of child IQ, a combined parenting and cash transfer intervention showed medium-term benefits compared to cash transfer alone for children's reading skills, home stimulation, mothers' childcare knowledge, depressive symptoms, and empowerment. However, as these findings are related to secondary outcomes of interest for our study, they should be considered as hypothesis-generating only. Registration clinicaltrials.gov: NCT03753646 (original cluster randomised controlled trial), NCT07432971 (follow-up).
