Women with a history of gestational diabetes (GDM) have an increased risk of developing type 2 diabetes later in life. We evaluated the long-term feasibility and effectiveness of a regionally implemented GDM recall register to stimulate postpartum screening and assess (pre)diabetes prevalence up to 10 years postpartum. We evaluated the “Sweet Pregnancy” GDM recall register, implemented in the northern part of Belgium, from 2009 to 2025. Women with a history of GDM received annual reminders for screening with a fasting plasma glucose in primary care. Response rates, self-reported screening uptake, and cumulative incidence of (pre)diabetes were analyzed. 27,173 women were registered with a mean follow-up of 4.4 years. The yearly response rates (among both responders and non-responders combined) varied from 48.4

Background Globally, the number of people aged 65 years and older is expected to double by 2050. With increasing age, the risk of frailty and the need for palliative care also rise. A shared understanding of how to assess frailty and determine the need for palliative care could support interprofessional collaboration in clinical practice. The transition from a frail condition to palliative care is a dynamic and individualized process. Although frailty and palliative care are distinct concepts, they may overlap. The present study aimed to examine the components of frailty and palliative care in community-dwelling older people. Early recognition by healthcare professionals of the components that contribute to severe frailty can enable the timely initiation of palliative care. Our second aim was to gain insight into whether an individual should be classified as frail or in need of palliative care according to healthcare professionals. Methods We presented fifteen case studies to respondents who were selected based on their specific expertise in the Netherlands and Belgium. Each respondent was asked to identify, for each case study, the components that indicated frailty, palliative care needs, or both. Additionally, they were asked to rate their level of certainty regarding each indication. Wilcoxon tests were employed to assess differences, and regression analyses were conducted to identify the components most strongly associated with frailty and in need of palliative care. Results In most cases, differences were observed between the identification of frailty and palliative care needs, with par-ticipants indicating that a patient could exhibit components of frailty without necessarily having palliative care needs (p-value < 0.05). In no case were palliative components recognized with greater certainty than components of frailty. The case in our study with the highest certainty score for frailty components showed a significant difference compared to the corresponding certainty score for palliative care needs. Conversely, the case with the highest certainty score for palliative care needs did not differ significantly from the certainty score for frailty components. Conclusions Our study showed that healthcare professionals use different components to classify individuals as frail or in need of palliative care. In addition, these professionals were more certain in identifying frailty than in identifying palliative care needs, and may be less likely to recognize palliative care needs in their patients, who may already be quite frail. Improved understanding of the progression from frailty to the need for palliative care may support patient-centered care and increase enhance the quality of life for individuals requiring support.

Background: Interprofessional education (IPE) in developing countries remains challenging. The University of Medicine and Pharmacy, Hue University, developed an IPE module for chronic disease management in Vietnam, incorporating classroom-based interactive learning, simulation with standardised patients, clinical practice, and home visits. This study explores lecturers’ experiences to identify facilitators, barriers, and solutions in the development and implementation of the module. Methods: An exploratory qualitative method with focus group interviews was conducted with 25 lecturers from 11 disciplines involved in this IPE module. Data were thematically analysed using NVivo 1.7.2 software. Results: Four main themes emerged, including ‘motivation’, ‘advantages’, ‘challenges’, and ‘suggestions’. Facilitators of successful implementation included strong institutional support, high lecturer motivation, expert-led faculty development, and robust collaboration between the university and primary healthcare facilities. Major barriers involved challenges in delivering feedback on interprofessional care plans, logistical complexities related to patient and standardised patient preparation, resource and time constraints, and the intensive demands of new assessment tools. To overcome these challenges, strategic solutions were employed, such as recruiting volunteer patients, training standardised patients, designing complex case scenarios around chronic disease and multimorbidity, increasing module offerings per semester, training faculty in assessment methods, hosting IPE conferences to recruit additional lecturers, and integrating the module into the formal academic curriculum. Conclusion: Successful IPE implementation requires recognising context-specific facilitators and barriers and tailored solutions. A structured seven-step process is recommended, offering a scalable and adaptable model for other institutions in Vietnam and similar settings globally.

Background: This study investigates the impact of Type 2 diabetes mellitus (T2DM) and depressive symptoms on the health-related quality of life (HRQoL) among patients at the Agricultural General Hospital in Hanoi, Vietnam. The research explores the interconnections between chronic physical conditions and mental health within a resource-constrained healthcare environment. Methods: A cross-sectional survey was conducted with 516 T2DM patients using the SF-36 to assess HRQoL and the PHQ-9 to measure depressive symptoms. The study examined the prevalence of depressive symptoms and their correlation with various HRQoL components. Results: Among the participants, 45.2% exhibited depressive symptoms from mild to severe levels. Significant disparities in HRQoL scores were observed, particularly in physical composite and overall quality of life scores between T2DM with and without depressive symptoms. Statistical analysis highlighted that depressive symptoms significantly diminish HRQoL, with the PHQ-9 scores serving as a robust predictor. Conclusion: The findings underscore the critical need for integrated care approaches that include mental health support for T2DM patients. Routine screening for depressive symptoms should be a component of diabetes management protocols to improve overall patient outcomes. Further longitudinal research is needed to confirm these findings and develop effective interventions.

OBJECTIVES:Chronic diseases pose significant challenges to primary care, requiring patient-centred strategies to improve chronic care delivery. As telehealth emerges as a promising tool, this study aims to examine patient experiences with chronic care and their preferences for self-management support (SMS) through telehealth services in primary care settings. DESIGN:A multicentre, cross-sectional survey was conducted (June-August 2022) using the Patient Assessment of Chronic Illness Care (PACIC), the Patient Assessment of Self-Management Tasks (PAST) and a telehealth preferences questionnaire. Linear regression assessed the association between PACIC and PAST scores. Multivariate logistic regression identified factors associated with telehealth preferences, with variables selected according to Andersen's model of healthcare utilisation. SETTINGS:Five diverse primary care settings in Central Vietnam, operating under Family Medicine principles. PARTICIPANTS:290 individuals with hypertension and/or diabetes managed at primary care for at least 6 months. RESULTS:The average PACIC score was 2.52 (SD 0.7); 25.5% rated their care as high quality (PACIC score ≥3). Among PACIC domains, goal-setting and follow-up/coordination domains received the lowest ratings. Participants perceived lifestyle changes as their priority self-management tasks, followed by medical management, communication with providers and coping with disease consequences. Higher PACIC scores were significantly associated with greater engagement across most PAST domains. Live video conferencing and mobile health were the most preferred formats for SMS. Participants strongly preferred remote patient monitoring for medical management (OR 8.8, 95% CI 2.0 to 38.1). Rural residents were more likely to prefer other telehealth modalities (ORs 3.8-4.6), particularly for coping with disease consequences (OR 4.1, 95% CI 1.8 to 9.4) and lifestyle changes (OR 5.8, 95% CI 1.1 to 28.9). Telehealth preferences were associated with factors across Andersen's domains, including education (predisposing), resident area and digital access (enabling), and pill count, disease control, and perceived care quality (need-related). CONCLUSIONS:Most elements of the chronic care model remained unmet. Patients' care experiences and self-management priorities aligned with their telehealth preferences, underscoring the need for personalised telehealth strategies to enhance SMS in primary care. Given the cross-sectional design and absence of patient and public involvement, further studies should incorporate these stakeholders and confirm associations in more diverse and underserved populations.

The varicella-zoster virus (VZV) infects >95% of the population. VZV reactivation causes herpes zoster (HZ), known as shingles, primarily affecting the elderly and individuals who are immunocompromised. However, HZ can occur in otherwise healthy individuals. We analyzed the immune signature and risk profile in patients with HZ using a genome-wide association study across different UK Biobank HZ cohorts. Additionally, we conducted one of the largest HZ human leukocyte antigen association studies to date, coupled with transcriptomic analysis of pathways underlying HZ susceptibility. Our findings highlight the significance of the major histocompatibility complex locus for HZ development, identifying 5 protective and 4 risk human leukocyte antigen alleles. This demonstrates that HZ susceptibility is largely governed by variations in the major histocompatibility complex. Furthermore, functional analyses revealed the upregulation of type I interferon and adaptive immune responses. These findings provide fresh molecular insights into the pathophysiology and activation of innate and adaptive immune responses triggered by symptomatic VZV reactivation.

The role of T cell receptor (TCR) diversity in infectious disease susceptibility is not well understood. We use a systems immunology approach on three cohorts of herpes zoster (HZ) patients and controls to investigate whether TCR diversity against varicella-zoster virus (VZV) influences the risk of HZ. We show that CD4+ T cell TCR diversity against VZV glycoprotein E (gE) and immediate early 63 protein (IE63) after 1-week culture is more restricted in HZ patients. Single-cell RNA and TCR sequencing of VZV-specific T cells shows that T cell activation pathways are significantly decreased after stimulation with VZV peptides in convalescent HZ patients. TCR clustering indicates that TCRs from HZ patients co-cluster more often together than TCRs from controls. Collectively, our results suggest that not only lower VZV-specific TCR diversity but also reduced functional TCR affinity for VZV-specific proteins in HZ patients leads to lower T cell activation and consequently affects the susceptibility for viral reactivation.

Background Vietnam is undergoing a rapid epidemiological transition with a considerable burden of non-communicable diseases (NCDs), especially hypertension and diabetes (T2DM). Continuity of care (COC) is widely acknowledged as a benchmark for an efficient health system. This study aimed to determine the COC level for hypertension and T2DM within and across care levels and to investigate its associations with health outcomes and disease control. Methods A cross-sectional study was conducted on 602 people with T2DM and/or hypertension managed in primary care settings. We utilized both the Nijmegen continuity of care questionnaire (NCQ) and the Bice - Boxerman continuity of care index (COCI) to comprehensively measure three domains of COC: interpersonal, informational, and management continuity. ANOVA, paired-sample t-test, and bivariate and multivariable logistic regression analysis were performed to examine the predictors of COC. Results Mean values of COC indices were: NCQ: 3.59 and COCI: 0.77. The proportion of people with low NCQ levels was 68.8%, and that with low COCI levels was 47.3%. Primary care offered higher informational continuity than specialists ( p < 0.01); management continuity was higher within the primary care team than between primary and specialist care ( p < 0.001). Gender, living areas, hospital admission and emergency department encounters, frequency of health visits, disease duration, blood pressure and blood glucose levels, and disease control were demonstrated to be statistically associated with higher levels of COC. Conclusions Continuity of primary care is not sufficiently achieved for hypertension and diabetes mellitus in Vietnam. Strengthening robust primary care services, improving the collaboration between healthcare providers through multidisciplinary team-based care and integrated care approach, and promoting patient education programs and shared decision-making interventions are priorities to improve COC for chronic care.

INTRODUCTION:The literature puts forward a range of challenges of interprofessional education (IPE) related to its planning, initiation, implementation, and especially to IPE assessment. The present study aims to map changes in students' readiness and interprofessional collaboration competence (IPCC) in implementing an innovative IPE module. Potential differences in impact related to the health education programs and IPCC scores resulting from self-, peer-, and tutor assessments will also be analysed. METHODS:A pre-post design was adopted. The student's readiness for interprofessional learning was assessed using the Readiness for Interprofessional Learning Scale, and the student's IPCC score was calculated based on self-, peer-, and tutor assessments with the interprofessional collaborator assessment rubric. RESULTS:Students' mean post-test readiness scores and mean post-test IPCC scores were significantly higher than the total and subscales/domain pre-test scores (p<0.01). No significant within-subject differences were observed in students' readiness total or subscale scores when comparing health educational programs. However, significant differences were observed in students' mean total IPCC scores between programs (p<0.01). Significant differences in students' average IPCC scores were found when comparing self-, peer- and tutor assessment scores in six domains (p<0.01). Also, significant correlations between peer and tutor assessment scores were observed (p<0.01). CONCLUSION:The IPE module, designed and implemented to focus on patient-centred practice within a primary care context, positively impacted students' readiness and IPCC development. These results offer insights to expand the implementation of the IPE module to all health educational programs.

BackgroundScreening for gestational diabetes mellitus (GDM) is important to improve pregnancy outcomes and to prevent type 2 diabetes after pregnancy. Due to a lack of evidence, the 2019 Flemish consensus did not recommend screening for GDM in early pregnancy. Recently, a large randomized controlled trial (TOBOGM) demonstrated that screening for GDM before 20 weeks reduces the risk of neonatal complications in women with risk factors when using higher cut-offs to define GDM compared to the criteria used later in pregnancy.MethodsBased on this new evidence, members of the Diabetes Liga, the Flemish associations of general physicians (Domus Medica), obstetricians (VVOG), midwives (VBOV), diabetes nurse educators (BVVDV), dieticians (VBVD) and clinical chemists (RBSLM) have adapted the Flemish consensus on screening for GDM.BackgroundRecommendations: As in 2019, this new consensus recommends universal screening for overt diabetes in early pregnancy preferably by measuring fasting plasma glucose by using the same diagnostic criteria as in the non-pregnant state. Based on the new evidence, women with fasting plasma glucose 95-125 mg/dL (5.3-6.9 mmol/L) before 20 weeks gestation should be diagnosed as early GDM. In addition, in women with obesity and/or a history of GDM, it is advised to perform already a 75 g oral glucose tolerance test (OGTT) between 6 and 20 weeks gestation using higher cut-offs to diagnose early GDM [fasting >= 95 mg/dL (5.3 mmol/L), 1 hour >= 19 mg/dL (10.6 mmol/L) and/or 2 hour >= 162 mg/dL (9.0 mmol/L))]. The recommendation concerning screening for GDM between 24 and 28 weeks remains unchanged with a diagnosis of GDM based on the 75 g OGTT and IADPSG criteria [fasting >= 92 mg/dL (5.1 mmol/L), 1 hour >= 180 mg/dL (10.0 mmol/L) and/or 2 hour >= 153 mg/dL (8.5 mmol/L)].

PurposeThis study explored students' perspectives on designing and implementing the new clinical interprofessional education (IPE) module for chronic disease management at the primary care level in the Vietnamese context.Design/methodology/approachStudents from seven different university-level healthcare programmes participated in a cross-sectional survey Course Experience Questionnaire-based study. Additionally, two open-ended questions were presented to gather qualitative data, mapping student perspectives. Statistical analyses and thematic analyses were performed.FindingsThe results show that students agree with quality statements about IPE design features, such as good teaching, clear goals and standards, appropriate workload, appropriate assessment and a blended learning approach. Answers to the open-ended comments pointed out the strengths of the IPE module in providing opportunities for interprofessional learning, improving interprofessional collaboration competencies, real-life interprofessional collaboration practice and continuous feedback from tutors. Students also reported weaknesses in the IPE module, including a lack of feedback on the care plan and logistics of the IPE module.Originality/valueStudents positively recognise key design features of the IPE module, combining classroom activities with standardised patient simulations, clinical practice and home visits. Chronic disease management at the primary care level is a suitable context for training students to work interprofessionally. The strengths and weaknesses identified by students could help in the redesign and future implementation of the IPE module in the Vietnamese context. They could inspire practices in Southeast Asian medical education and beyond.

In Vietnam, each primary care community health center (CHC) consists of a multi-professional team with six disciplines, including a physician, assistant physician, nurse, pharmacist, midwife, and Vietnamese traditional physician, who are able to meet the majority of patient's needs at the primary care level. How they collaborate, especially in chronic disease management (CDM), is still limited described in the literature. This study aims to gain insight into the perceptions and the experiences of primary health care providers (PHCPs) toward interprofessional collaboration (IPC) in CDM in CHCs in (Hue) Vietnam. A qualitative study of descriptive phenomenology was performed using two focus groups and 15 semi-structured interviews with PHCPs from six professions relevant to CDM in CHCs. The data were analyzed using NVivo 12.0 with a thematic analysis method by a multiprofessional research team. From the analysis, the data were classified into three main themes: "lack of collaborative practice," "knowledge," and "facilitators and barriers to IPC." This study provided evidence of the awareness that actual collaboration in daily care is fragmentarily organized and that PHCPs try to finish their tasks within their profession. PHCPs work multiprofessionally and lack shared decision-making in patient-centered care. There is a need to develop an interprofessional education program and training to address these deficiencies in the Vietnamese context to improve interprofessional collaboration in health care.

Objectives: Our study aimed to identify the complex interplay between self-efficacy, self-care practice, and glycaemic control among people with type 2 diabetes mellitus (PWDs) to inform the design of more targeted and effective behavioural interventions in primary care. Methods: A cross-sectional descriptive study was performed with 294 PWDs managed in primary care. The Diabetes Management Self-Efficacy Scale (DMSES) and Summary of Diabetes Self-Care Activities (SDSCA) questionnaire measured patients’ self-efficacy and self-care practice. Multivariate logistic regression models were developed to explore how SDSCA, DMSES, and their combined effect relate to glycaemic control, adjusting for patient characteristics. Network analysis in R software examined relationships between self-efficacy and self-care dimensions across glycaemic control subgroups using a Gaussian graphical model with the extended Bayesian information criterion. Results: Half the PWDs (50.7%) had suboptimal glycaemic control. Better glycaemic control was consistently associated with higher self-efficacy (odds ratio (OR) = 0.76, 95% confidence (CI) (0.60, 0.97), p = 0.03), shorter duration of diabetes (OR = 1.89, 95% CI (1.08, 3.31), p = 0.03), normal waist circumference (OR = 1.76, 95% CI (1.02, 3.05), p = 0.04), absence of diabetes complications (OR = 2.09, 95% CI (1.10, 3.98), p = 0.02), and treatment with oral hypoglycaemic agents (OR = 3.05, 95% CI (1.53, 6.09), p < 0.01). Network analysis among people with well-controlled HbA1c revealed that diet adherence and self-efficacy had the most robust connection, with diet self-efficacy strongly associated with most self-efficacy dimensions. Self-efficacy in exercise, blood glucose monitoring, and foot care are the most central factors in the network structures for PWDs with suboptimal glycaemic control. Conclusions: Our study highlights the critical role of self-efficacy in diabetes primary care. For people with optimal glycaemic control, prioritising self-efficacy in diet adherence is crucial for sustaining glycaemic outcomes and supporting other self-care behaviours. Among those with suboptimal glycaemic control, enhancing self-efficacy in exercise, blood glucose monitoring, and foot care is essential. Targeted education programs, personalised counselling, and E-health tools can further empower patients to manage their diabetes more effectively.

Background: The Finnish Diabetes Risk Score (FINDRISC) tool is used to identify undetected cases of diabetes and risk scores. The FINDRISC tool outlines questions to ask, including anthropometric parameters to measure, during screening and detection of diabetes cases. This study assessed the feasibility for the introduction of FINDRISC tool for use in South Africa. The aim is to determine the overall competence of home-based carers (HBCs) in utilising this tool.Method: A quantitative approach and cross-sectional feasibility study was conducted involving 52 HBCs who were sampled using homogeneous purposive sampling. The study was conducted in clinics of Ga-Dikgale Village in Polokwane. A FINDRISC questionnaire was used to assess competence of HBCs. Data were analysed using SPSS, with both descriptive and inferential statistical analysis.Results: None (0%) of the participants were fully competent, 6% were incompetent and 94% were moderately competent on use of the FINDRISC tool.Conclusion: Most HBCs were moderately competent in the use of this tool, while none were competent. It is feasible that the FINDRISC tool can be adapted and utilised by HBCs in South Africa. However, a proper training should be offered to HBCs on the use of the FINDRISC tool. It is also recommended to assess components of requiring professionals considering the scope of work and qualification.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Background. Diabetes and psychiatric disorders often co-occur. The prevalence of depression in a person with diabetes is two times higher than that of the general population. During the last decade, the prevalence of diabetes in Vietnam has nearly doubled. However, there is little data regarding depressive symptoms among people with diabetes. Therefore, this study aims to explore the level of depressive symptoms and its associated factors among patients with type 2 diabetes mellitus in Hanoi, Vietnam. Methodology. A cross-sectional study was conducted among 519 patients diagnosed with type 2 diabetes at the Agricultural General Hospital, one of the largest primary care hospitals for diabetes in Hanoi, Vietnam. Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive symptoms. Multivariate Tobit and logistic regression models were applied to examine factors associated with the severity of depressive symptoms and medication adherence Results. Approximately 45.2% of participants were identified as having depressive symptoms at different levels. The proportion of patients with mild, moderate, moderately severe, and severe depressive symptoms is 36.0%, 7.6%, 1.4%, and 0.2% respectively. Regarding the treatment process, patients being treated for their diabetes for a longer time were more likely to have depressive symptoms. Depression was positively linked to currently drinking alcohol (Coef = 1.04; 95% CI = 0.30-1.78), having comorbidities (Coef = 1.08; 95% CI = 0.15; 2.01) and having irregular physical activities (Coef = -1.28; 95% CI = -2.18; -0.38). Patients with severe depressive symptoms (higher PHQ-9 score) were more likely to be non-adherent to their medications in the last month (AOR = 1.30; 95% CI = 1.17; 1.46). Conclusion. Our study shows that a high percentage of patients with diabetes have depressive symptoms. There is a strong association between having depressive symptoms and non-adherence to medications in the last month. To reduce the risk of developing depressive symptoms, depression should be screened at the initial treatment process and patients should be advised to avoid alcohol and to engage in physical activities regularly.

BACKGROUND:Women with advanced uterine cervical cancer suffer from a combination of moderate to severe physical, psychological, social, and spiritual distress due to their disease and are in need of palliative care to improve their quality of life. Approximately 85% of the women live in the low- and middle-income countries. Whether these women and their families access palliative care is not known.OBJECTIVES:To understand the geographic accessibility, availability, financial accessibility, and acceptability of palliative care by patients with advanced cervical cancer and their families.METHODS:We conducted a Systematic review following PRISMA guidelines in CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE, PsychINFO, PubMed and Scopus for the core concepts: palliative care, access, advanced uterine cervical cancer. Eligible articles were published in English, contained original data on experiences of patients and/or caregivers including symptoms management, and discussed available resources, communication, satisfaction, and healthcare utilization.RESULTS:Overall there was limited access to palliative care with the few available facilities located in cities, far from the rural areas where most women lived. Pervasive poverty was common with poor affordability of healthcare, travelling, accommodation, and subsistence expenses. Misconceptions and poor knowledge of the disease, cultural beliefs and attitudes, and other health system insufficiencies also presented challenges for access.CONCLUSION:Concerted effort should be made to improve availability of palliative care facilities. Health education to address misconceptions and other cognitive barriers that limit access among cervical cancer patients and their families should be urgently undertaken in the LMICs.

BACKGROUND:Interprofessional education (IPE) is expected to help prepare undergraduate health profession students to collaborate with other healthcare professionals in realising quality of care. Studies stress the necessity of students' readiness for interprofessional learning (IPL) in view of designing IPE programs. The present study aims to determine students' IPL-readiness and looks at related differences in students enrolled in different programs and at different phases in their educational program.METHODS:A cross-sectional survey study was set up among 1139 students from six health programs at HueUMP, using the Readiness for Interprofessional Learning Scale (RIPLS). Statistical analysis was performed using Kruskal-Wallis H and Mann-Whitney U tests.RESULTS:The overall mean RIPLS score was 68.89. RIPLS scores significantly differed between programs and between phases in the educational programs. Medical students presented a lower readiness level for IPL than students from other programs. In contrast to a significant increase in RIPLS scores of students in the clinical phase in Vietnamese traditional medicine, medicine, and pharmacy, a decrease in RIPLS scores was observed in students in the clinical phase in odonto-stomatology.CONCLUSIONS:The differences could be related to differences in educational programs and the study phases in a particular program. These results offer insights to direct the design and implementation of IPE in health education curricula and especially underscore the need to provide IPE throughout the curriculum.

Data for "Lack of functional TCR-epitope interaction is associated with herpes zoster through reduced downstream T cell activation" Data directories bulk-1week Contains processed bulk TCR sequencing data from cohort 1. longitudinal Contains processed bulk TCR sequencing data from cohort 2. Note that this is the same dataset as reported in the following reference (it is included again in this repository for completeness): B. Ogunjimi, J. Van den Bergh, P. Meysman, S. Heynderickx, K. Bergs, H. Jansens, E. Leuridan, A. Vorsters, H. Goossens, K. Laukens, N. Cools, V. Van Tendeloo, N. Hens, P. Van Damme, E. Smits, P. Beutels, Multidisciplinary study of the secondary immune response in grandparents re-exposed to chickenpox. Sci Rep 7, 1077 (2017). single-cell Contains processed single cell data from cohort 1 Script directories src Contains various scripts used to generate the results and figures in the manuscript. Result directories results Contains the inbetween files for many of the analyses. Contains the Seurat object for the single cell analysis reported in the paper. Also used as output directory for the scripts listed in src. tcrex_results Full results from using the aforementioned data sets with the TCRex tool: https://tcrex.biodatamining.be/

Background: The COVID-19 pandemic has profoundly affected assessment practice in higher education including a complex planning of supervision. To organise safely and reliably a remote prociency-test for admission to the Advanced Master of General Practice (AMGP), we developed a supervisor app tracking and tracing candidates’ behaviour. Methods: A cross-sectional design was adopted with candidates applying for admission to the AMGP. The supervisor app operated on three levels to register events: recording actions, analysing behaviour, and live supervision. Each suspicious event was given a score. The outcome measures were the number of suspicious events and the exam outcome compared to the past year. To get more insight into candidates’ perceptions about the app, a post-test questionnaire was administered. An exploratory factor analysis was performed to explore quantitative data, while qualitative data were thematically analysed. Results: In total, 472 (79%) candidates used the app in an off campus setting and 121 (20%) were on campus with live supervision. Test results of both groups were comparable. The app detected 22 candidates with a suspicious level >1, mainly due to background noise. All events occurred without fraud purpose. Out of 472 candidates, 304 �lled in the post-test questionnaire. Two factors were extracted from the analysis and identi�ed as candidates’ appreciation of the app and as emotional distress because of the app. Four themes were identi�ed in the thematic analysis providing more insight on candidates’ emotional well-being. Conclusions: A supervisor app registering and recording behaviour to prevent fraud during off-campus exams is e�cient without in�uencing the exam outcome. Although candidates’ perceptions were mixed, increased anxiety was due to the lack of clear guidelines about the app. Future research should compare in a controlled design the cost-benet balance between the supervisor app and candidates’ awareness of being monitored combined with a safe exam browsing plug in.