People experiencing homelessness (PEH) face significant barriers to accessing cancer prevention services. The CANCERLESS project co-developed and implemented the Health Navigator Model (HNM) – a person-centred approach using trained health navigators to provide tailored support, promote cancer awareness, and facilitate access to preventive services – in Austria, Greece, Spain, and the UK. This study examined the HNM’s impact on healthcare empowerment, health-related quality of life (HRQoL), and self-rated health among PEH. This non-randomised, single-arm study included 652 PEH from 16 pilot sites in four European countries between June 2022 and December 2023. Healthcare empowerment, HRQoL, and self-rated health were assessed using the healthcare empowerment questionnaire and the EQ-5D-5L (including the EQ Visual Analogue Scale) when participants entered and completed the intervention. A per-protocol analysis with repeated measures ANOVA revealed changes over time and between countries. Participants were predominantly male (64.1

Cancer-related mortality among People Experiencing Homelessness (PEH) is twice as high as in the housed population, with one-third of deaths in this community linked to conditions preventable through timely healthcare. The Health Navigator Model (HNM) is a person-centred approach to improve healthcare access for PEH. This study assessed the feasibility of implementing the HNM across four European countries. A non-randomised, single-arm pilot study was conducted from June 2022 to December 2023 in Austria, Spain, Greece, and the UK. Trained Health Navigators supported adult PEH-excluding those with cancer diagnoses or cognitive impairments-through tailored guidance, education, and referrals. Feasibility indicators (demographics, recruitment, retention, engagement) were collected at baseline and follow-up points. Health Navigators' experiences were explored via qualitative interviews. Out of 1981 individuals approached, 652 PEH participated. The average age was 47.4 years; 64.1% were male, 41.6% relied on state benefits and 62.4% had experienced homelessness for over a year. Nineteen Health Navigators (mean age 34.95 years) were involved. Engagement included cancer education (N = 494), health consultations (N = 286), specialist referrals (N = 212), and screening tests (N = 169). Follow-up rates were 69% at the first time point and 42.5% at the second. Low cancer awareness, prioritisation of subsistence needs over health, and system-level barriers were identified as challenges, while building trust with individuals and stakeholders emerged as facilitators. Health Navigators reported increased empathy, awareness of PEH's needs, and confidence in empowering them as key benefits of their role. Training skilled Health Navigators, building trust and fostering strong inter-organisational collaborations are key to successfully implementing the HNM among PEH.

Necrophilia is a paraphilia in which the primary source of pleasure comes from having sex with, or sexually abusing the dead. The etiology is unknown and includes multiple social, environmental and contextual factors. Its prevalence is probably underestimated, and, especially in low-income settings, the reporting is limited. We report on a 17-year-old female cadaver characterized by generalized coldness, fixed lividity in the posterior plane, cadaveric relaxation phase, presence of a green abdominal stain in the right iliac fossa and chromatic phase of putrefaction; exhumed and sexually violated after burial. We also provide a review of the existing literature.

Background:People experiencing homelessness (PEH) face major barriers to accessing healthcare, including cancer preventive services, which results in increased cancer morbidity and mortality. However, tailored integrated care interventions addressing these disparities are scarce. Methods:Using a qualitative, participatory approach, seven focus group discussions were conducted with 15 PEH and 41 health and social care professionals in Austria, Greece, Spain, and the UK. Data were thematically analysed using a framework based on ten core components of navigation interventions. Results:Collaborative discussions led to a consensus on the Health Navigator Model (HNM), designed to improve cancer prevention for PEH. This model introduces "health navigators" from health and social care backgrounds to identify health needs, raise cancer awareness, coordinate healthcare access, and provide practical support. Thematic analysis ensured consistency across countries, shaping a person-centred approach. Comprehensive training and supervision were identified as critical for the effectiveness of the HNM. Conclusion:The co-design approach allowed PEH and professionals to actively shape the intervention, addressing gaps in cancer prevention. The HNM offers a structured, internationally consistent model that could bridge access gaps in cancer care for PEH. Further research using implementation science frameworks is needed to evaluate its effectiveness in real-world settings.

Background: The burden of stroke is on the rise in low-income countries (LICs). Organized stroke care (OSC) is crucial for improving outcomes in LICs and is the very first step to reducing delays in diagnosis and treatment. We aim to evaluate delay times (DT) in accessing OSC at the national reference hospital of Mozambique, a LIC from southern Africa. Methods: An observational study based on consecutive case series of 59 stroke patients confirmed by computed tomography (CT) scans over a period of 3 months (May–July 2023). The total DT (from stroke onset to inward hospitalization) was the main outcome. Other specific DTs were analyzed including initial symptoms to arrival and admission (DT0), arrival to CT scans (DT1), arrival of laboratory results (DT2), and arrival to inward hospitalization (DT3). Results: The mean age was 61.9 (min 30–max 90) and 45.8% were female. The median total DT was 20 h. The median time DT0 was 10.6 h (interquartile range (IQR): 16.48). The median DT1 and DT2 were 4 h (IQR: 3.5) and 5 h (IQR: 2.6), respectively. The median DT3 was 10 h (IQR: 4). None of the patients were treated under a stroke code. Conclusions: This study reveals an unacceptable prehospital and in-hospital DT. Waiting for the CT scan contributed to a large proportion of the total DT, which among other factors can be explained by the absence of a stroke code and limited imaging capacity. These findings mirror disparities in stroke care seen in other LICs, where late presentation, scarce imaging, and limited specialized protocols are common. The urgent implementation of organized prehospital and in-hospital stroke pathways is needed in Maputo to improve outcomes.

BackgroundCoherence across sites in multicenter datasets is one substantial data quality dimension for reliable health data reuse, as unexpected heterogeneity in data can lead to biases in data analyses and suboptimal generalization of results. ObjectiveThis work aims to characterize and label the data coherence across sites in the first European multicenter dataset for cancer prevention in people and early detection among the homeless population in Europe: coadapting and implementing the health navigator model. This dataset emerged to enable research to address disparities in health challenges and health care access due to barriers such as unstable housing, limited resources, and social stigma in people experiencing homelessness. MethodsThe dataset comprises 652 cases: 142 from Austria, 158 from Greece, 197 from Spain, and 155 from the United Kingdom. All participants fit classifications from the European Typology of Homelessness and Housing Exclusion. This longitudinal study collected questionnaires at baseline, after 4 weeks, and at the end of the intervention. The 180-question survey covered sociodemographic data, overall health, mental health, empowerment, and interpersonal communication. Data variability was assessed using information theory and geometric methods to analyze discrepancies in distributions and completeness across the dataset. ResultsSubstantial variability was observed among the 4 pilot countries, both in the overall analysis and within specific domains. In particular, measures of health care empowerment, quality of life, and interpersonal communication demonstrated the greatest discrepancies among pilot sites, with the exception of the health domain. Notably, Spain exhibited the most pronounced differences, characterized by a high number of missing values related to interpersonal communication and the use of health care services. ConclusionsHealth data may be comparable across the 4 countries; however, substantial differences were observed in the other questionnaires, requiring independent, country-specific analyses. This study underscores the heterogeneity among people experiencing homelessness and the critical need for data quality assessments to inform future research and policymaking in this field.

Background: People experiencing homelessness (PEH) face significant health disparities and systemic barriers to healthcare, elevating their risk for cancer and other chronic diseases. To tackle PEHs' challenges in accessing cancer preventive care, the CANCERLESS project implemented the Health Navigator Model (HNM)-a person-centered intervention that utilizes trained Health Navigators to provide tailored support and facilitate service access. Recognizing housing as a key determinant of health, this analysis assessed changes in housing status associated with participation in the HNM among CANCERLESS participants in Austria, Greece, Spain, and the UK. Methods: This was a secondary analysis of cross-national data collected during a single-arm interventional study. Of 652 enrolled PEH, 277 (42.5%) completed the HNM intervention follow-up and were included in the analysis. Changes in housing status from baseline to follow-up were categorized using the European Typology of Homelessness and Housing Exclusion (ETHOS) and treated as an ordered outcome. Descriptive statistics were complemented by a cumulative link mixed model with a participant random intercept to estimate the association between time (follow-up vs. baseline) and housing transitions among completers, adjusting for age, residence/legal status, and daily smoking. Results: Participants had a mean age of 47.4 (SD 13.8), primarily identified as male (64.1%), reported upper secondary education (33.9%), and were from Western European countries (39.7%), with varying housing situations. Among intervention completers, time (follow-up vs. baseline) was associated with higher odds of being in a higher ETHOS category (OR = 1.49, 95% CI = 1.02-2.20, p = 0.042), consistent with a modest improvement in housing status. Larger estimates were observed among migrants without legal documents (OR = 24.13, 95% CI = 6.41-90.89, p < 0.001), while daily smoking was associated with lower odds (OR = 0.33, 95% CI = 0.11-0.96, p = 0.041); other residence status categories were not statistically significant. Conclusions: Suggesting that tailored, navigation-based models, such as the HNM, may be linked to improved housing stability for PEH, these findings can inform piloting and context-aligned integration of the HNM within public health strategies as an alternative approach to address the complex, interconnected health and social needs of PEH. However, the lack of a comparison group and high attrition limit the results' conclusiveness, and future evaluations should aim to include assessments of housing-associated contextual factors.

Hyper-IgE syndrome (HIES) is a rare and sporadic primary immunodeficiency usually characterized by atopic dermatitis, recurrent skin staphylococcal infections, recurrent pulmonary infections, and elevated IgE levels. Due to the rarity of the syndrome and its nonspecific and wide presentation, the diagnosis is difficult and arises with other diagnoses including other types of primitive chronic granulomatous disease or acquired immunodeficiency, severe atopic dermatitis, or cystic fibrosis or chronic respiratory infection as tuberculosis. To date, there is no gold standard management and treatments aim to relieve symptoms and avoid complications. We report on a 30-year-old female with a long-time misdiagnosed HIES.

OBJECTIVE:Suicide is a leading cause of death among adolescents, and despite the need to distinguish between suicidal consideration and suicide attempts, research focused on suicide attempts remains insufficient. Therefore, this study aims to investigate the influence of self-perceived weight on suicide attempts. METHODS:This study utilized data from the Korea Youth Risk Behavior Web-based Survey for its analysis from 2005 to 2023, including a total of 1,156,728 participants. This study utilized various analytical methods to examine the influence of self-perceived weight on suicide attempts. We estimated weighted prevalence and used linear regression to assess temporal trend β coefficients and their differences (βdiff) with 95% confidence intervals (CIs), and survey-weighted logistic regression to estimate weighted odds ratios (wORs) and 95% CIs for the association between self-perceived weight and suicide attempts. RESULTS:A comparison of suicide attempts based on self-perceived weight suggested that individuals who perceived themselves as overweight (weighted prevalence, 3.97% [95% CI, 3.89 to 4.04]) had the highest rate of suicide attempts, followed by those who perceived themselves as underweight (3.36% [95% CI, 3.28 to 3.44]), while those who perceived themselves as having a normal weight (3.20% [95% CI, 3.14 to 3.27]) had the lowest rate. Additionally, females (underweight: 4.47% [95% CI, 4.32 to 4.62]; normal weight: 3.91% [95% CI, 3.81 to 4.01]; overweight: 5.23% [5.11 to 5.35]) experienced more suicide attempts than males (underweight: 2.73% [95% CI, 2.65 to 2.82]; normal weight: 2.43% [95% CI, 2.35 to 2.51]; overweight: 2.60% [95% CI, 2.52 to 2.69]). CONCLUSION:Findings from the present study suggest that self-perceived weight was associated with suicide attempts and interaction analyses indicated a potential sex-based difference in the impact of body image distortion. Therefore, this study suggests the introduction of programs and campaigns aimed at correcting distorted self-perceived weight.

ABSTRACTCarcinoid tumours are slow‐growing neuroendocrine neoplasms mainly affecting the gastrointestinal tract, the respiratory tree, ovaries and kidneys. Approximately 20% of patients with carcinoid tumour are affected by carcinoid syndrome, characterised by chronic diarrhoea and/or flushing in the presence of systemically elevated levels of specific markers as serotonin or 5‐hydroxyindolacetic acid. Skin manifestations include flushing of the face, neck and anterior surface of the chest but after repeated and prolonged relapses, the skin lesions become fixed, acquiring a bluish‐red tint with telangiectasias. Patients may also develop pellagra skin symptoms including erythema, xerosis, scaling, hyperkeratosis and pigmentation, caused by a deficiency of tryptophan, due to its high consumption for serotonin synthesis.

Meigs syndrome is a rare condition characterized by the presence of a benign fibroma of the ovary, ascites, and pleural effusion. It is very uncommon and the diagnosis is made with difficulty based on symptoms that usually mimic disseminated malignancy or tuberculosis. Although it is a benign and treatable condition, extreme presentations of late-stage diseases occur with high mortality and morbidity rates. We report on a case of a 13-year-old female presenting with misdiagnosed late-stage Meigs Syndrome in a low-resource setting.

BACKGROUND AND OBJECTIVE:People experiencing homelessness (PEH) face higher cancer risk due to social exclusion, housing and limited access to healthcare. This study proposes a microsimulation model using machine learning (ML) to predict the effect of quality of life, healthcare utilisation and empowerment at the end of the intervention under the Health Navigator Model, enabling cost-effective resource allocation and identifying high-risk subgroups. MATERIALS & METHODS:We used data from 652 PEH recruited in four European countries (June 2022 - November 2023); 255 completed an 18-month Health Navigator Model programme. Standardised questionnaires were administered at baseline, four weeks and post-intervention. A modular ML microsimulation was built that (1) creates a constraint-based synthetic cohort, (2) estimates outcome changes by matching each simulated case to real program completers, and (3) sums those differences to gauge the intervention's impact. Multiple ML techniques were tested to keep the synthetic sample true to the original and to improve effect-size predictions. RESULTS:CTGAN generated the most realistic synthetic baseline (propensity score = 0.152; 95 % CI 0.148-0.162), markedly outperforming univariant, multivariant and SMOTE approaches (> 0.21). Regression models reproduced most numerical outcomes with good fidelity (e.g., EQ-5D-5L MAE = 0.10 on a 0-1 scale; Health-Rating MAE = 10 on a 0-100 scale), while categorical outcomes were predicted within roughly one category. Binary classifiers yielded F1-scores of 0.58 for smoking status and 0.64 for programme adherence. An online demonstrator (https://epione.upv.es) visualises the process. CONCLUSION:The proposed ML-based microsimulation generates realistic PEH profiles and projects intervention outcomes, providing a flexible, evidence-driven tool to optimise cancer-prevention strategies for PEH supporting evidence-based decision-making and optimise resource allocation, enhancing intervention outcomes by predicting the intervention before implementation.

Schistosomiasis is a parasitic disease mainly prevalent in tropical and subtropical areas, especially in poor settings without adequate sanitation and access to clean water. It is caused by trematode parasites living within the veins of their human host, where they mate and produce fertilized eggs. The eggs are either shed into the environment through feces or urine, or are retained in host tissues where they induce inflammation and then die. The genital form is caused by Schistosoma haematobium and affects both the urinary and genital tracts in up to 75% of infected individuals, both male and female. Female genital schistosomiasis is a challenging and potentially lethal condition and may affect the whole genital tract leading to a wide range of urinary, sexual, and reproductive health problems. The main reasons leading women to health services are infertility and genital nonspecific symptoms including vaginal discharge, pruritus, pelvic pain, dyspareunia, and haematuria. Other severe complications caused by schistosomiasis include increased risk of HIV and HPV infection, genital ulcers, miscarriage, and ectopic pregnancy. We report in the present case study a 23-year-old female with schistosomiasis and ruptured ectopic tubal pregnancy successfully managed in a low-income setting.

Malnutrition is a major public health issue that has been associated with high susceptibility for impaired brain development and mental functioning. However, to date studies on this topic have not been collated and appraised. This systematic review and meta‐analysis investigated the association between malnutrition and cognitive development.

Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19–0.97; I2 = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43–0.65; I2 = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI −0.00; 1.15; I2 = 96.52), while the pooled SMD in hospitalization days was −1.35 (95% CI −1.87; −0.82; I2 = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential.

Malnutrition is a major public health issue that has been associated with high susceptibility for impaired brain development and mental functioning. However, to date studies on this topic have not been collated and appraised. This systematic review and meta-analysis investigated the association between malnutrition and cognitive development. We searched the MEDLINE, Scopus, CINAHL, Embase PsycINFO and Cochrane Library databases in English up to 8 December 2020. All studies reporting an association between nutritional status and cognitive development were included. p values of less than 0.05 were considered statistically significant and the results are reported as standardised mean differences (SMD), 95% confidence intervals (95%) and I 2 statistics. We included 12 studies comprising 7,607 participants aged 1 to 12 years. Children with malnutrition had worse scores than controls for the Wechsler Intelligence Scale (SMD −0.40; 95% CI −0.60 to −0.20; p  < 0.0001; I 2 77.1%), the Raven's Coloured Progressive Matrices (SMD −3.75; 95% CI −5.68 to −1.83; p  < 0.0001; I 2 99.2%), visual processing (SMD −0.85; 95% CI −1.23 to −0.46; p 0.009; I 2 11.0%) and short memory (SMD 0.85; 95% CI −1.21 to −0.49; p  < 0.0001; I 2 0%) tests. Normal cognitive development requires access to good and safe nutrition.