Background: Environmental surface contamination in early childhood education settings has been recognized as a potential source of exposure to microorganisms. However, the available evidence on bacterial contamination in these environments remains limited, methodologically heterogeneous, and difficult to interpret from an epidemiological perspective. Methods: A scoping review was conducted following Joanna Briggs Institute methodology and reported according to the PRISMA-ScR guidelines. Searches were performed in PubMed/MEDLINE, Embase, Scopus, Web of Science, CINAHL, LILACS, and gray literature sources. Studies reporting bacterial contamination of environmental surfaces and fomites in early childhood education settings were included. Data were extracted and synthesized using descriptive and thematic approaches. Results: Nine studies met the inclusion criteria. Most employed cross-sectional designs and showed substantial variability in sampling strategies, microbiological methods, and outcome definitions. Frequently identified microorganisms included Staphylococcus aureus (including methicillin-resistant strains [MRSA]), Bacillus spp., Pseudomonas spp., Klebsiella spp., Enterococcus spp., and Escherichia coli. Bacterial contamination was consistently reported on high-touch surfaces such as toys, tables, doorknobs, and shared objects. However, most studies did not distinguish between microbial detection, viability, and transmission potential, limiting epidemiological interpretation. Evidence regarding antimicrobial resistance was restricted to a small number of studies and remained fragmented. Conclusions: Evidence on the bacterial contamination of surfaces and fomites in early childhood education settings is scarce, heterogeneous, and predominantly descriptive. Current knowledge is largely limited to documenting the presence of microorganisms, with insufficient evidence to determine their viability or role in transmission processes. Future studies should adopt standardized methodologies and integrate environmental, microbiological, and epidemiological measures to strengthen the understanding of contamination patterns and their public health relevance.
Background: People living with HIV in sub-Saharan Africa face a growing burden of cancer, yet evidence on treatment outcomes and barriers to care is dispersed across cancer types and settings. This review examined treatment approaches, outcomes, challenges, and strategies for improving care. Methods: We conducted a scoping review of primary studies identified through searches of MEDLINE via PubMed, CINAHL, EBSCO, Google Scholar, and African Journals Online, with ClinicalTrials.gov searched for relevant interventional studies. Data on cancer treatment, outcomes, HIV care, barriers, and service strategies were charted and synthesised descriptively. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) tools to inform interpretation. Results: Thus, 51 reports from ten countries were included: 13 on Kaposi sarcoma, 13 on cervical cancer, 11 on lymphoma, 8 on breast cancer, and 6 on other cancers or mixed-cancer populations. Selected treatment cohorts reported tumour responses and survival after chemotherapy, radiotherapy, surgery, or combined treatment. Across the care pathway, however, delayed diagnosis, limited treatment capacity, travel and financial costs, toxicity, interrupted treatment, and loss to follow-up constrained outcomes. Associations between HIV status and survival varied by cancer and setting. HIV-specific outcomes were reported inconsistently, and pooled outcomes from studies combining participants with and without HIV could not be attributed to people with HIV alone. Care coordination and patient support were frequently proposed, but few strategies were evaluated comparatively. Conclusions: Improving outcomes requires timely access to complete cancer treatment, coordinated HIV and oncology care, and support for patients throughout treatment. Studies beginning at diagnosis and comparative evaluations of service interventions are needed to establish which approaches improve treatment completion and survival. The study protocol was registered prospectively on the Open Science Framework: 10.17605/OSF.IO/8642R.
Background: Regional HIV data can support surveillance only when the meaning, timing, and completeness of core variables are explicit. We audited a regional HIV registry extract from Bihor County, Northwestern Romania, and described recorded diagnoses during 2013–2023. Methods: The supplied extract contained 192 individual records. Completeness analyses used all records. Annual-count analyses used 154 records with a diagnosis year between 2013 and 2023; 22 records diagnosed before 2013 and 16 with unknown diagnosis year were excluded from temporal analyses. A prespecified recorded advanced-category proxy was defined as CDC stage C and/or immunologic category 3 among records with interpretable A1–C3 staging. Drug indicators were recoded as non-mutually exclusive antiretroviral classes. A Poisson model quantified change in annual recorded counts; it was not interpreted as incidence because population denominators were unavailable. Results: Diagnosis year was available in 176/192 records (91.7%), residence in 149/192 (77.6%), interpretable CDC staging in 119/192 (62.0%), and at least one ART entry in 112/192 (58.3%). Exact diagnosis date, CD4 count, viral load, ART initiation date, retention in care, viral suppression, and transmission route were not represented as dedicated variables in the supplied extract. Annual recorded diagnoses ranged from 6 to 21. There was no evidence of a linear change in annual counts (incidence-rate ratio per year 0.972, 95% CI 0.925–1.022; p = 0.274). Among 119 staged records, 48 (40.3%) met the recorded advanced-category proxy; the timing of staging relative to diagnosis was unknown. NRTI exposure was the most frequently documented ART class, but treatment sequence and current-regimen status could not be reconstructed. Conclusions: The extract supports a data-quality and descriptive audit, not estimates of HIV incidence, confirmed late diagnosis, treatment effectiveness, or the HIV care continuum. Standardized capture of diagnosis date, CD4 count, viral load, staging date, ART initiation and current regimen, transmission route, and follow-up status is required for stronger regional surveillance.
Background: Macrolides are classified in the Watch group of the World Health Organization Access, Watch, and Reserve (AWaRe) classification and are prescribed for both acute infections and chronic respiratory diseases. Aggregate antimicrobial use indicators do not distinguish short- from extended-duration prescribing. This study characterized outpatient macrolide prescription-duration patterns using community pharmacy dispensing data. Methods: A retrospective observational study comprising repeated cross-sectional analyses at the drug prescription-record level and a secondary patient-level longitudinal analysis was conducted using anonymized dispensing data from participating community pharmacies in Tokyo, Japan, collected between April 2023 and March 2025. Prescription durations were classified as 1–14, 15–28, 29–89, and ≥90 days. The primary outcome was a prescription duration of ≥29 days, corresponding to the Japanese dispensing-fee classification during the study period. Modified Poisson regression was used to estimate associations with extended-duration prescription records. Results: The analysis included 200,632 systemic macrolide drug prescription records from 139,293 pharmacy-specific patient keys. Overall, 13,555 records (6.8%) had durations of ≥29 days. The proportion increased from 1.6% among patients aged 0–14 years to 25.4% among those aged ≥75 years. Compared with patients aged 15–39 years, the adjusted prevalence ratios were 2.11 (95% CI, 1.73–2.57) for those aged 40–64 years, 4.30 (95% CI, 3.18–5.82) for those aged 65–74 years, and 5.45 (95% CI, 3.98–7.47) for those aged ≥75 years. Marked differences were observed among macrolide agents and formulations. Sensitivity analyses excluding exact duplicates, restricting the analysis to continuously contributing pharmacies, and using an alternative clustering specification supported the principal adult/older-age and agent-specific findings. Conclusions: Extended-duration macrolide dispensing records were more frequently observed in older age groups and specific erythromycin formulations among participating pharmacies. Prescription-duration and repeated-prescribing measures may complement conventional antimicrobial utilization indicators by identifying strata for subsequent indication-linked review; they should not be interpreted as stand-alone measures of prescribing appropriateness.
Background: People living with HIV (PLWH) have increased cardiovascular disease risk, and dyslipidemia remains a major modifiable factor. Achieving recommended low-density lipoprotein cholesterol (LDL-C) targets can be challenging. Objective: To evaluate the real-world effectiveness and safety of fixed-dose low-dose rosuvastatin/ezetimibe in virologically stable PLWH and to describe lipid-lowering kinetics in comparison with an HIV-negative control cohort. Methods: This retrospective single-center study included 32 PLWH and 43 HIV-negative outpatients receiving rosuvastatin 5 mg plus ezetimibe 10 mg daily. Lipid parameters, cardiovascular risk scores, and safety markers were assessed at baseline, 3 months, and 6 months. Results: In PLWH, LDL-C decreased from 170.7 ± 35.1 to 87.8 ± 24.6 mg/dL at 6 months, corresponding to a mean reduction of 46.7% (p < 0.001). Total cholesterol and non-HDL cholesterol also decreased significantly (p < 0.001 for both), while triglycerides decreased significantly at month 6 (p = 0.016). Overall, 53.1% of PLWH reached guideline-recommended LDL-C targets. Both the 5-year and 10-year D:A:D scores decreased significantly during follow-up (p < 0.001 for both). The exploratory comparison suggested a more rapid early lipid response among HIV-negative controls, with most of the reduction occurring by month 3. No treatment-limiting adverse events or viro-immunological deterioration occurred. Conclusions: Low-dose rosuvastatin combined with ezetimibe was associated with substantial improvement in atherogenic lipid parameters in virologically stable PLWH, while the exploratory finding of an earlier response among HIV-negative controls may support further investigation of treatment-response kinetics.
